Hemodynamic Effects of Protamine Infusion in Dogs with Myxomatous Mitral Valve Disease Undergoing Mitral Valvuloplasty

Tomohiko Yoshida; Katsuhiro Matsuura; Ahmed S Mandour; Yuki Aboshi; Shusaku Yamada; Hideki Yotsuida; Mizuki Hasegawa; Chieh-Jen Cheng; Youta Yaginuma; Momoko Watanabe; Shou Fukuzumi

doi:10.3390/vetsci9040178

Hemodynamic Effects of Protamine Infusion in Dogs with Myxomatous Mitral Valve Disease Undergoing Mitral Valvuloplasty

Vet Sci. 2022 Apr 8;9(4):178. doi: 10.3390/vetsci9040178.

Authors

Tomohiko Yoshida^{1

2}, Katsuhiro Matsuura^{1

2}, Ahmed S Mandour^{2

3}, Yuki Aboshi¹, Shusaku Yamada¹, Hideki Yotsuida⁴, Mizuki Hasegawa¹, Chieh-Jen Cheng^{1

2}, Youta Yaginuma¹, Momoko Watanabe², Shou Fukuzumi^{1

2}

Affiliations

¹ VCA Japan Shiraishi Animal Hospital, 4-33-2 Sayamadai, Sayama, Saitama 350-1304, Japan.
² Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu 183-0054, Tokyo, Japan.
³ Department of Animal Medicine, Faculty of Veterinary Medicine, Suez Canal University, Ismailia 41522, Egypt.
⁴ Department of Clinical Engineering, National Cerebral and Cardiovascular Center, Osaka 564-8565, Japan.

Abstract

Protamine, an antagonizing agent to heparin, is indispensable for dogs undergoing cardiopulmonary bypass. Protamine-induced hypotension (PIH) during cardiac anesthesia has been reported in humans. The purpose of this study was to describe the hemodynamic effect of protamine administration in dogs during cardiac surgery in clinical cases. Study design: Retrospective, clinical, cohort study. A total of 14 client-owned dogs who suffered heart failure due to medically uncontrolled myxomatous mitral valve disease (MMVD) were included in this study. The severity of MMVD was classified according to American College of Veterinary Internal Medicine staging (ACVIM: stage B2, C, D) and dogs undergoing mitral valve surgery. Records with clinical data for dogs treated between July 2019 to August 2020 were examined for age, sex, breed, body weight, concurrent diseases, hospitalization, anesthetic record, and mortality within 3 months after the operation. PIH was defined as mean arterial pressure (MAP) lowered by 20% of that before protamine infusion. To evaluate the effect of protamine on hemodynamic variables, each of the other values was compared with values at the beginning of protamine infusion. MAP decreased by 41.0 and 45.7% in two dogs (14.3%) compared with pressure before protamine infusion. Others did not show obvious alteration in hemodynamic variables. Epinephrine treatment alleviated hypotension in one dog. Another dog with systemic hypotension concomitant with elevated central venous pressure did not respond to epinephrine treatment and a reboot of extracorporeal circulation was required. Reheparinization and reinstitution of cardiopulmonary bypass successfully resuscitate the second dog. In conclusion, clinicians should alert the incidence of severe hypotension even with slow protamine infusion following canine cardiac surgery. This study also provides two effective treatments for catastrophic hypotension during protamine infusion.

Keywords: cardiac surgery; cardiopulmonary bypass; hypotension; norepinephrine; protamine.