Preoperative β-blocker use correlates with worse outcomes in patients undergoing aortic valve replacement

Sarah A. Schubert, Robert B. Hawkins, J. Hunter Mehaffey, Clifford E. Fonner, Jeffery B. Rich, Alan M. Speir, Mohammed Quader, Irving L. Kron, Leora T. Yarboro, Gorav Ailawadi

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Objectives: β-Blocker use is associated with fewer cardiac complications in patients undergoing noncardiac surgery and is a quality metric for coronary artery bypass grafting. We sought to determine the influence of preoperative β-blocker administration before aortic valve replacement (AVR). Methods: All patients undergoing isolated AVR from 2002 to 2016 were extracted from a multi-institutional, statewide database composed of Society of Thoracic Surgeons data. Patients were propensity score matched by preoperative and operative variables, and the effects of preoperative β-blockers on outcomes were assessed. Results: Of 7380 eligible patients, 53% received a preoperative β-blocker. After propensity matching, a total of 4592 patients were well matched (1:1) with minimal baseline differences between groups. Within the matched cohort, the operative mortality rate (β-blocker: 2.8% vs no β-blocker: 2.4%; P = .454) and rate of major morbidity (14.4% vs 12.7%; P = .101) were similar between groups. The rates of cardiac arrest (2.1% vs 1.3%; P = .034), renal failure requiring dialysis (1.7% vs 0.9%; P = .007), and postoperative transfusion (38.2% vs 33.8%; P = .002) after AVR were significantly greater in the cohort receiving preoperative β-blockade. Postoperative atrial fibrillation was also more prevalent in patients receiving a preoperative β-blocker (26.9% vs 23.4%; P = .007). Finally, preoperative β-blocker use was associated with longer postoperative intensive care unit stays (45.2 vs 47.0 hours; P = .001), but clinically similar hospital length of stay. Conclusions: Preoperative β-blocker administration is not associated with improved outcomes after AVR but instead is associated with increased postoperative morbidity. Routinely initiating preoperative β-blockade is not supported in patients undergoing AVR.

Original languageEnglish (US)
Pages (from-to)1589-1597.e3
JournalJournal of Thoracic and Cardiovascular Surgery
Volume158
Issue number6
DOIs
StatePublished - Dec 2019
Externally publishedYes

    Fingerprint

Keywords

  • aortic valve replacement
  • beta-blocker
  • perioperative management

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Schubert, S. A., Hawkins, R. B., Mehaffey, J. H., Fonner, C. E., Rich, J. B., Speir, A. M., Quader, M., Kron, I. L., Yarboro, L. T., & Ailawadi, G. (2019). Preoperative β-blocker use correlates with worse outcomes in patients undergoing aortic valve replacement. Journal of Thoracic and Cardiovascular Surgery, 158(6), 1589-1597.e3. https://doi.org/10.1016/j.jtcvs.2018.12.108