PREOPERATIVE THERAPY WITH AMIODARONE AND THE INCIDENCE OF ACUTE ORGANDYSFUNCTION AFTER CARDIAC-SURGERY

We examined the influence of preoperative therapy with amiodarone on t he incidence of acute organ dysfunction after cardiac surgery in a mat ched case-control study. There were 220 case-control pairs matched by day of surgery, source of admission, demographic characteristics, plac ement of intraaortic balloon pump before surgery, repeat operations, e mergency surgery, thoracic aorta surgery and other surgical procedures . History of congestive heart failure was more prevalent in the amioda rone group than in the control group before surgery (60% vs 38%, P < 0 .0001). The incidence of acute organ dysfunction, duration of mechanic al ventilation, and death was similar in both groups after surgery. Th e requirement for inotropes (26% vs 17%, P = 0.03) and vasopressors (6 6% vs 55%, P = 0.02) and the incidence of postoperative nosocomial inf ections (12% vs 6%, P = 0.04) was greater in the amiodarone group. How ever, the difference was not significant after adjustment for congesti ve heart failure (Cochran-Mantel-Haenszel test P = 0.15, P = 0.25, P = 0.16, respectively). Amiodarone did not increase the incidence of acu te organ dysfunction or death after cardiac surgery. The requirement f or inotropes and vasopressors and the incidence of nosocomial infectio ns were related to the severity of the underlying cardiac disease. The practice of discontinuing amiodarone treatment before surgery to redu ce the incidence of postoperative organ dysfunction should be critical ly reevaluated. Implications: Amiodarone is often used for the treatme nt of life-threatening rhythm disorder. Amiodarone has been blamed for causing organ injury after cardiac surgery. In a study of 220 patient s, amiodarone did not increase the risk of organ injury or death after cardiac surgery when compared with control patients. There was no evi dence to support the practice of stopping amiodarone before cardiac su rgery to avoid serious complications.