Vol. 26 No. 3 (2022)
ANESTHESIOLOGY & RESUSCITATION

Prediction of the acute heart failure after cardiac valve surgery

PDF (Русский)
  • V.P. Govorushkina,
  • A.V. Kolesnichenko,
  • E.A. Shirshova,
  • S.M. Efremov
V.P. Govorushkina
Saint Petersburg State University
Bio
A.V. Kolesnichenko
Saint Petersburg State University
E.A. Shirshova
Saint Petersburg State University
S.M. Efremov
Saint Petersburg State University
DOI: https://doi.org/10.21688/1681-3472-2022-3-64-72

Published 2022-09-30

Keywords

  • Cardiopulmonary Bypass,
  • Cardiac Surgical Procedures,
  • Intensive Care Units,
  • Length of Stay,
  • Risk Factors

How to Cite

Govorushkina, V., Kolesnichenko, A., Shirshova, E., & Efremov, S. (2022). Prediction of the acute heart failure after cardiac valve surgery. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 26(3), 64–72. https://doi.org/10.21688/1681-3472-2022-3-64-72

Copyright (c) 2022 Govorushkina V.P., Kolesnichenko A.V., Shirshova E.A., Efremov S.M.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Background. Postoperative acute heart failure is a frequent complication in cardiac surgery, prolonging the length of stay in the intensive care unit and the hospital length of stay.
Aim. To develop prognostic risk model of the acute heart failure in the early postoperative period.
Methods. This prospective cohort observation study included 121 adult patients who underwent cardiac valve surgery with cardiopulmonary bypass. The need for vasopressor and inotropic support on the first postoperative day was chosen as the primary endpoint. Univariable and multivariable analysis of logistic regression were used to evaluate the influence of preoperative and intraoperative risk factors.
Results. Univariable analysis showed risk factors of using vasopressor and inotropic support on the first day after surgical intervention: duration of cardiopulmonary bypass (OR 1.02, 95% CI 1.005–1.030, p = 0.005), aortic cross-clamping time (OR 1.02, 95% CI 1.001–1.030, p = 0.006), Logistic EuroSCORE II (OR 1.16, 95% CI 0.90–1.49, p = 0.03) and tricuspid valve surgery (OR 2.59, 95% CI 1.09–6.10, p = 0.03). As a result of multivariable analysis, the final model included aortic cross-clamping time and Logistic EuroSCORE II.
Use of vasopressors and inotropes on the first day after surgical intervention was associated with an increase of the following parameters: duration of mechanical ventilation (p = 0.013), length of stay in the intensive care unit (p = 0.001), hospital length of stay (p = 0.003), and total postoperative blood loss (p = 0.005).
Conclusion. Aortic cross-clamping time and Logistic EuroSCORE II have an independent predictive value for determining the risk of acute heart failure after cardiac surgery.

Received 7 February 2022. Revised 29 March 2022. Accepted 11 April 2022.

Funding. The study had no sponsorship.

Conflict of interest. Authors declare no conflict of interest.

Ethics approval. The local ethics committee of Saint Petersburg State University approved the study (protocol No. 3/2019).

Contribution of the authors. The authors contributed equally to this article.

PDF (Русский)

References

  1. Ломиворотов В.В., Исмоилов С.М., Бобошко В.А., Ландони Дж. Международный опрос о применении кальция при отключении от искусственного кровообращения. Вестник анестезиологии и реаниматологии. 2021;18(3):66-71. https://doi.org/10.21292/2078-5658-2021-18-3-66-71 Lomivorotov V.V., Ismoilov S.M., Boboshko V.A., Landoni G. International survey on calcium use when weaning from cardiopulmonary bypass. Messenger of Anesthesiology and Resuscitation. 2021;18(3):66-71. (In Russ.) https://doi.org/10.21292/2078-5658-2021-18-3-66-71
  2. Baysal P.K., Güzelmeric F., Kahraman E., Gürcü M.E., Erkılınç A., Orki T. Is vasoactive-inotropic score a predictor for mortality and morbidity in patients undergoing coronary artery bypass surgery? Braz J Cardiovasc Surg. 2021;36(6):802-806. PMID: 33577259; PMCID: PMC8641768. https://doi.org/10.21470/1678-9741-2020-0219
  3. Yamazaki Y., Oba K., Matsui Y., Morimoto Y. Vasoactive-inotropic score as a predictor of morbidity and mortality in adults after cardiac surgery with cardiopulmonary bypass. J Anesth. 2018;32(2):167-173. PMID: 29332153. https://doi.org/10.1007/s00540-018-2447-2
  4. Zangrillo A., Alvaro G., Pisano A., Guarracino F., Lobreglio R., Bradic N., Lembo R., Gianni S., Calabrò M.G., Likhvantsev V., Grigoryev E., Buscaglia G., Pala G., Auci E., Amantea B., Monaco F., De Vuono G., Corcione A., Galdieri N., Cariello C., Bove T., Fominskiy E., Auriemma S., Baiocchi M., Bianchi A., Frontini M., Paternoster G., Sangalli F., Wang C.-Y., Zucchetti M.C., Biondi-Zoccai G., Gemma M., Lipinski M.J., Lomivorotov V.V., Landoni G. A randomized controlled trial of levosimendan to reduce mortality in high-risk cardiac surgery patients (CHEETAH): Rationale and design. Am Heart J. 2016;177:66-73. PMID: 27297851. https://doi.org/10.1016/j.ahj.2016.03.021
  5. Monaco F., Di Prima A.L., Kim J.H., Plamondon M.-J., Yavorovskiy A., Likhvantsev V., Lomivorotov V., Hajjar L.A., Landoni G., Riha H., Farag A.M.G.A., Gazivoda G., Silva F.S., Lei C., Bradic N., El-Tahan M.R., Bukamal N.A.R., Sun L., Wang C.Y. Management of challenging cardiopulmonary bypass separation. J Cardiothorac Vasc Anesth. 2020;34(6):1622-1635. PMID: 32276758. https://doi.org/10.1053/j.jvca.2020.02.038
  6. Ad N., Holmes S.D., Patel J., Pritchard G., Shuman D.J., Halpin L. Comparison of EuroSCORE II, original EuroSCORE, and the Society of Thoracic Surgeons risk score in cardiac surgery patients. Ann Thorac Surg. 2016;102(2):573-579. PMID: 27112651. https://doi.org/10.1016/j.athoracsur.2016.01.105
  7. Vittingoff E., McCulloch C.E. Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol. 2007;165(6):710-718. PMID: 17182981. https://doi.org/10.1093/aje/kwk052
  8. Doenst T., Borger M.A., Weisel R.D., Yau T.M., Maganti M., Rao V. Relation between aortic cross-clamp time and mortality — not as straightforward as expected. Eur J Cardiothorac Surg. 2008;33(4):660-665. PMID: 18272383. https://doi.org/10.1016/j.ejcts.2008.01.001
  9. Tunç M., Şahutoğlu C., Karaca N., Kocabaş S., Aşkar F.Z. Risk factors for prolonged intensive care unit stay after open heart surgery in adults. Turk J Anaesthesiol Reanim. 2018;46(4):283-291. PMID: 30140535; PMCID: PMC6101719. https://doi.org/10.5152/TJAR.2018.92244
  10. Al-Sarraf N., Thalib L., Hughes A., Houlihan M., Tolan M., Young V., McGovern E. Cross-clamp time is an independent predictor of mortality and morbidity in low- and high-risk cardiac patients. Int J Surg. 2011;9(1):104-109. PMID: 20965288. https://doi.org/10.1016/j.ijsu.2010.10.007
  11. Tsaousi G.G., Pitsis A.A., Ioannidis G.D., Pourzitaki C.K., Yannacou-Peftoulidou M.N., Vasilakos D.G. Implementation of EuroSCORE II as an adjunct to APACHE II model and SOFA score, for refining the prognostic accuracy in cardiac surgical patients. J Cardiovasc Surg. 2015;56(6):919-927. PMID: 24525523.
  12. Butts R.J., Scheurer M.A., Atz A.M., Zyblewski S.C., Hulsey T.C., Bradley S.M., Graham E.M. Comparison of maximum vasoactive inotropic score and low cardiac output syndrome as markers of early postoperative outcomes after neonatal cardiac surgery. Pediatr Cardiol. 2012;33(4):633-638. PMID: 22349666. PMCID: PMC3989285. https://doi.org/10.1007/s00246-012-0193-z
  13. Koponen T., Karttunen J., Musialowicz T., Pietiläinen L., Uusaro A., Lahtinen P. Vasoactive-inotropic score and the prediction of morbidity and mortality after cardiac surgery. Br J Anaesth. 2019;122(4):428-436. PMID: 30857599; PMCID: PMC6435836. https://doi.org/10.1016/j.bja.2018.12.019