Risk Factors of Prolonged Mechanical Ventilation in Patients Undergoing Redo Valve Surgery
DOI:
https://doi.org/10.1532/hsf.4913Keywords:
valve surgery, redo, prolonged mechanical ventilation, EuroSCORE II, vasoactive-inotropic scoreAbstract
Background: Prolonged mechanical ventilation (PMV) after cardiac surgery is associated with high morbidity and mortality. Patients following redo valve surgery possess many attributes that place them at risk for PMV, yet few studies particularly focused on them. The purpose of this study was to identify perioperative variables associated with PMV in redo valve surgery.
Methods: A retrospective study, including 117 patients who underwent redo valve surgery from November 2017 to September 2021, was performed. The potential perioperative risk factors for PMV were collected. PMV was defined as the need for intubation and mechanical ventilation for >24 h, after completion of the operation. The clinical data were analyzed with univariate and multivariate analyses to identify risk factors for PMV following redo valve surgery.
Results: The incidence of PMV was 38.5% (N = 45). Multiple logistic regression analysis showed perioperative risk factors for PMV included advanced age (age>57 years) [odds ratio (OR) 3.043, 95% confidence interval (CI) 1.172-7.905, P = 0.022], low weight (weight ≤58 kg) (OR 2.798, 95% CI: 1.088–7.199, P = 0.033), EuroSCORE II ≥6.8% (OR 3.467, 95% CI: 1.364–8.817, P = 0.009), and VIS at 12 hours post ICU admission (VIS12) >10 (OR 5.613, 95% CI: 2.211–14.249, P < 0.001).
Conclusions: In adult patients undergoing redo valve surgery, advanced age, low weight, high EuroSCORE II and a high VIS at 12 hours post-ICU admission were associated with PMV. Hemodynamic status after operation were more important than preoperative and intraoperative variables in predicting PMV.
References
Ad N, Holmes SD, Patel J, Pritchard G, Shuman DJ, Halpin L. 2016. Comparison of EuroSCORE II, Original EuroSCORE, and The Society of Thoracic Surgeons Risk Score in Cardiac Surgery Patients. Ann Thorac Surg. 102(2):573-579.
Bartz RR, Ferreira RG, Schroder JN, Davies J, Liu WW, Camara A, Welsby IJ. 2015. Prolonged pulmonary support after cardiac surgery: incidence, risk factors and outcomes: a retrospective cohort study. J Crit Care. 30(5):940-944.
Cheng DC. 1998. Fast track cardiac surgery pathways: early extubation, process of care, and cost containment. Anesthesiology. 88(6):1429-1433.
Davidson J, Tong S, Hancock H, Hauck A, da Cruz E, Kaufman J. 2012. Prospective validation of the vasoactive-inotropic score and correlation to short-term outcomes in neonates and infants after cardiothoracic surgery. Intensive Care Med. 38(7):1184-1190.
Fernandez-Zamora MD, Gordillo-Brenes A, Banderas-Bravo E, Arboleda-Sanchez JA, Hinojosa-Perez R, Aguilar-Alonso E, Herruzo-Aviles A, Curiel-Balsera E, Sanchez-Rodriguez A, Rivera-Fernandez R, et al. 2018. Prolonged Mechanical Ventilation as a Predictor of Mortality After Cardiac Surgery. Respir Care. 63(5):550-557.
Filsoufi F, Rahmanian PB, Castillo JG, Chikwe J, Adams DH. 2008. Predictors and early and late outcomes of respiratory failure in contemporary cardiac surgery. Chest. 133(3):713-721.
Furukawa H, Tanemoto K. 2014. Redo valve surgery--current status and future perspectives. Ann Thorac Cardiovasc Surg. 20(4):267-275.
Gaies MG, Gurney JG, Yen AH, Napoli ML, Gajarski RJ, Ohye RG, Charpie JR, Hirsch JC. 2010. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med. 11(2):234-238.
Hsu H, Lai HC, Liu TJ. 2019. Factors causing prolonged mechanical ventilation and peri-operative morbidity after robot-assisted coronary artery bypass graft surgery. Heart Vessels. 34(1):44-51.
Koponen T, Karttunen J, Musialowicz T, Pietilainen L, Uusaro A, Lahtinen P. 2019. Vasoactive-inotropic score and the prediction of morbidity and mortality after cardiac surgery. Br J Anaesth. 122(4):428-436.
Legare JF, Hirsch GM, Buth KJ, MacDougall C, Sullivan JA. 2001. Preoperative prediction of prolonged mechanical ventilation following coronary artery bypass grafting. Eur J Cardiothorac Surg. 20(5):930-936.
Maisat W, Siriratwarangkul S, Charoensri A, Wongkornrat W, Lapmahapaisan S. 2020. Perioperative risk factors for delayed extubation after acute type A aortic dissection surgery. J Thorac Dis. 12(9):4796-4804.
Miyashita F, Kinoshita T, Suzuki T, Asai T. 2021. Respiratory Failure after Open Descending Aortic Aneurysm Repair: Risk Factors and Outcomes. Ann Thorac Cardiovasc Surg. 27(1):41-48.
Murthy SC, Arroliga AC, Walts PA, Feng J, Yared JP, Lytle BW, Blackstone EH. 2007. Ventilatory dependency after cardiovascular surgery. J Thorac Cardiovasc Surg. 134(2):484-490.
Nashef SA, Roques F, Sharples LD, Nilsson J, Smith C, Goldstone AR, Lockowandt U. 2012. EuroSCORE II. Eur J Cardiothorac Surg. 41(4):734-744; discussion 744-735.
Pappalardo F, Franco A, Landoni G, Cardano P, Zangrillo A, Alfieri O. 2004. Long-term outcome and quality of life of patients requiring prolonged mechanical ventilation after cardiac surgery. Eur J Cardiothorac Surg. 25(4):548-552.
Perrotta S, Nilsson F, Brandrup-Wognsen G, Jeppsson A. 2007. Body mass index and outcome after coronary artery bypass surgery. J Cardiovasc Surg (Torino). 48(2):239-245.
Rajakaruna C, Rogers CA, Angelini GD, Ascione R. 2005. Risk factors for and economic implications of prolonged ventilation after cardiac surgery. J Thorac Cardiovasc Surg. 130(5):1270-1277.
Reddy SL, Grayson AD, Griffiths EM, Pullan DM, Rashid A. 2007. Logistic risk model for prolonged ventilation after adult cardiac surgery. Ann Thorac Surg. 84(2):528-536.
Saleh HZ, Shaw M, Al-Rawi O, Yates J, Pullan DM, Chalmers JA, Fabri BM. 2012. Outcomes and predictors of prolonged ventilation in patients undergoing elective coronary surgery. Interact Cardiovasc Thorac Surg. 15(1):51-56.
Sharma V, Rao V, Manlhiot C, Boruvka A, Fremes S, Wasowicz M. 2017. A derived and validated score to predict prolonged mechanical ventilation in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg. 153(1):108-115.
Trouillet JL, Combes A, Vaissier E, Luyt CE, Ouattara A, Pavie A, Chastre J. 2009. Prolonged mechanical ventilation after cardiac surgery: outcome and predictors. J Thorac Cardiovasc Surg. 138(4):948-953.
Varghese J, Kutty S, Abdullah I, Hall S, Shostrom V, Hammel JM. 2016. Preoperative and Intraoperative Predictive Factors of Immediate Extubation After Neonatal Cardiac Surgery. Ann Thorac Surg. 102(5):1588-1595.
