Preoperative Intestinal Preconditioning to Prevent Postoperative Vasoplegia After Tricuspid Valve Surgery

<h2>Abstract</h2><h3>Background</h3> Right ventricular dysfunction may lead to intestinal bacterial translocation secondary to portal venous hypertension, thereby contributing to systemic inflammatory response syndrome and vasoplegia after tricuspid valve surgery. This study aimed to evaluate the impact of preoperative intestinal preconditioning (oral antibiotics and laxatives) on the occurrence of postoperative vasoplegia after tricuspid valve surgery. <h3>Methods</h3> This retrospective single-center analysis included patients who underwent tricuspid valve surgery from 2017 to 2021. The outcomes of patients who received preoperative intestinal preconditioning were compared with the outcomes of patients who did not. Primary outcomes were in-hospital mortality and the occurrence of postoperative vasoplegia. Secondary outcomes were intensive care unit (ICU) and hospital length of stay (LOS). <h3>Results</h3> Among 142 patients, 44 (30.9%) received preoperative preconditioning, whereas 98 (69.0%) did not. Baseline characteristics were similar between the groups. In-hospital mortality rates were comparable (6.8% vs 5.1%, with and without preconditioning, respectively; <i>P</i> = .7). There was no difference in the mean hospital LOS (21 [12] days with preconditioning vs 18 [11] days without; <i>P</i> = .4). Vasoplegia occurred in 0 (0%) patients with intestinal preconditioning vs 9 (9.2%) patients without preconditioning (<i>P</i> = .04). In a subgroup analysis, patients without vasoplegia had significantly lower mortality (3.7% vs 33.3%; <i>P</i> = .001), shorter mean ICU LOSs (3 [6] days vs 12 [20] days; <i>P</i> = .010) and hospital LOS (19 [13] days vs 23 [18] days; <i>P</i> = .134). <h3>Conclusions</h3> Preoperative intestinal preconditioning before tricuspid valve surgery may prevent postoperative vasoplegia. Lower vasoplegia rates are associated with reduced ICU and hospital LOSs and improved in-hospital mortality.