Predictors of low cardiac output syndrome after isolated mitral valve surgery
Predictors of low cardiac output syndrome after isolated mitral valve surgery
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DOI：
10.1016/j.jtcvs.2009.11.022
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发表时间：
2010-10-01
影响因子：
6
通讯作者：
Rao, Vivek
中科院分区：
文献类型：
--
作者：
Maganti, Manjula;Badiwala, Mitesh;Rao, Vivek
背景资料：低心输出量综合征定义为在重症监护室需要术后主动脉内球囊反搏或强心剂支持超过30分钟。二尖瓣外科手术越来越多地在高风险患者中进行，这些患者可能需要机械循环支持以治疗低心排血量综合征。因此，本研究的目的是确定二尖瓣手术后低心输出量综合征的术前预测因素。方法：我们对前瞻性地进入机构数据库的数据进行了回顾性分析。在1990年至2008年2月期间，3039例患者接受了单独的二尖瓣手术，伴或不伴冠状动脉搭桥手术。结果：低心排综合征的总患病率为7%，低心排综合征的总患病率为7%。低心排综合征的独立预测因素是手术的紧迫性（比值比，2.9），运营前一年（比值比，2.4），左心室射血分数小于40%（比值比，2.1），纽约心脏协会IV级（比值比，2）、体表面积1.7 m（2）或更小（比值比，1.6）、缺血性二尖瓣病变（比值比，1.6）和心肺转流时间（比值比，1.02）。低心排综合征患者的手术死亡率较高（30%比1.3%，P <0.001）。总手术死亡率为3.4%。死亡率的独立预测因素是手术的紧急程度（比值比，7.1）、肾功能衰竭（比值比，4.3）、不使用聚四氟乙烯缝线（Gore-Tex; W. L.戈尔联合公司，奥斯汀，得克萨斯州;比值比，2.1），任何再手术的外科干预（比值比，1.8），增加年龄（比值比，1.03），和心肺转流时间（比值比，1.02）。保护肾功能、优化既存心力衰竭症状和使用人工聚四氟乙烯缝线的新策略可能会降低低心排血量综合征的发生率，并改善二尖瓣手术后的结果。（《胸血管外科杂志》2010;140：790-6）
Background: Low cardiac output syndrome is defined as the need for a postoperative intra-aortic balloon pump or inotropic support for longer than 30 minutes in the intensive care unit. Mitral valve surgery is increasingly being performed in high-risk patients who might require mechanical circulatory support for low cardiac output syndrome. Therefore the aim of this study was to identify the preoperative predictors of low cardiac output syndrome after mitral valve surgery.Methods: We conducted a retrospective review of data prospectively entered into an institutional database. Between 1990 and February 2008, 3039 patients underwent isolated mitral valve surgery with or without coronary bypass surgery. The independent predictors of low cardiac output syndrome and operative mortality were determined by means of stepwise logistic regression analysis.Results: The overall prevalence of low cardiac output syndrome was 7%. The independent predictors of low cardiac output syndrome were urgency of the operation (odds ratio, 2.9), earlier year of operation (odds ratio, 2.4), left ventricular ejection fraction of less than 40% (odds ratio, 2.1), New York Heart Association class IV (odds ratio, 2), body surface area of 1.7 m(2) or less (odds ratio, 1.6), ischemic mitral valve pathology (odds ratio, 1.6), and cardiopulmonary bypass time (odds ratio, 1.02). The operative mortality was higher in patients with low cardiac output syndrome (30% vs 1.3%, P < .001). Overall operative mortality was 3.4%. The independent predictors of mortality were urgency of the operation (odds ratio, 7.1), renal failure (odds ratio, 4.3), nonuse of polytetrafluoroethylene sutures (Gore-Tex; W. L. Gore & Associates, Inc, Austin, Tex; odds ratio, 2.1), any reoperative surgical intervention (odds ratio, 1.8), increasing age (odds ratio, 1.03), and cardiopulmonary bypass time (odds ratio, 1.02).Conclusions: Low cardiac output syndrome is associated with significantly increased morbidity and mortality. Novel strategies to preserve renal function, optimization of pre-existing heart failure symptoms, and use of artificial polytetrafluoroethylene sutures might reduce the incidence of low cardiac output syndrome and lead to improved results after mitral valve surgery. (J Thorac Cardiovasc Surg 2010;140:790-6)