LOW CARDIAC OUTPUT SYNDROME AFTER CARDIAC SURGERY: A RETROSPECTIVE ANALYSIS

Authors

DOI:

https://doi.org/10.61751/ijmmr.2413-6077.2023.1.06

Keywords:

cardiopulmonary bypass, risk factors, inotrope, circulatory support, mortality rate

Abstract

Low cardiac output syndrome is a prevalent complication observed after cardiac surgery, related to elevated rates of mortality and morbidity. The study aimed to pinpoint independent risk factors for low cardiac output through the analysis of post-cardiac surgery data. This is a single-centre, two-year retrospective study from January 2021 to December 2022, including all patients admitted to the A1 general intensive care unit for postoperative management of cardiac surgery. Variables from preoperative, intraoperative, and postoperative data were collected and evaluated with the statistical package for the social sciences, with a significance level set at p < 0.05. Overall, the median age was 44 years (22-80), with 60% being female. The prevalence of low cardiac output syndrome after cardiac surgery was 44% (n = 85). Significant risk factors for low cardiac output syndrome were identified: low preoperative left ventricular function (ejection fraction <40%), preoperative atrial fibrillation, impaired preoperative renal function, multiple valve replacement, prolonged extracorporeal circulation, and clamping time. Patients who experienced low cardiac output syndrome had longer hospital stays and a higher incidence of postoperative complications, including atrial fibrillation and kidney injury, as well as a higher mortality rate (7% versus 0%). Identification and treatment of low cardiac output syndrome can improve myocardial recovery and decrease mortality. A better understanding of its physiopathological mechanisms may help develop potential preventive strategies

Received: 16.02.2023 | Revised: 28.04.2023 | Accepted: 30.05.2023

Author Biographies

Ibrahim Bechri, Hassan II University Hospital

Doctor of Medicine, Assistant Professor, 30050, II Hassan Ave., Fes, Morocco

Ali Derkaoui, Hassan II University Hospital

Doctor of Medicine, Professor, 30050, II Hassan Ave., Fes, Morocco

Abdelkarim Shimi, Hassan II University Hospital

Doctor of Medicine, Professor, 30050, II Hassan Ave., Fes, Morocco

Mohammed Khatouf, Hassan II University Hospital

Doctor of Medicine, Professor, 30050, II Hassan Ave., Fes, Morocco

References

Whitson BA. Commentary: Low cardiac output syndrome: A definition or a diagnosis code? J Thorac Cardiovasc Surg. 2022;163(5):1902–3. DOI: 10.1016/j.jtcvs.2020.09.040

Pérez Vela JL, Jiménez Rivera JJ, Alcalá Llorente MÁ, González de Marcos B, Torrado H, García Laborda C, et al. Low cardiac output syndrome in the postoperative period of cardiac surgery. Profile, differences in clinical course and prognosis. The ESBAGA study. Med Intensiva. 2018;42(3):159–67. DOI: 10.1016/j.medin.2017.05.009

Duncan AE, Kartashov A, Robinson SB, Randall D, Zhang K, Luber J, et al. Risk factors, resource use, and cost of postoperative low cardiac output syndrome. J Thorac Cardiovasc Surg. 2022;163(5):1890–98.e10. DOI: 10.1016/j.jtcvs.2020.06.125

Biancari F, Dalén M, Fiore A, Ruggieri VG, Saeed D, Jónsson K, et al. Multicenter study on postcardiotomy venoarterial extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg. 2020;159(5):1844–54.e6. DOI: 10.1016/j.jtcvs.2019.06.039

Qing Q, Wei X, Zhen H, Wen Z, Sun X, Yang J, Chen P. A nomogram to predict the risk of low cardiac output syndrome after heart valve replacement in cardiac valvular disease patients. Version 1. Res Square. [Preprint]. 2021. DOI: 10.21203/rs.3.rs-143778/v1

Posada-Martinez EL, Fritche-Salazar JF, Arias-Godinez JA, Ortiz-Leon XA, Balderas-Muñoz K, Ruiz-Esparza ME, et al. Right ventricular longitudinal strain predicts low-cardiac-output syndrome after surgical aortic valve replacement in patients with preserved and mid-range ejection fraction. J Cardiothorac Vasc Anesth. 2021;35(6):1638–45. DOI: 10.1053/j.jvca.2020.12.008

Mendes MA, Fabre M, Amabili P, Jaquet O, Donneau AF, Bonhomme V, Hans GA. Development and validation of a prediction score for low-cardiac-output syndrome after adult cardiac surgery. J Cardiothorac Vasc Anesth. 2023;37(10):1967–73. DOI: 10.1053/j.jvca.2023.06.025

Zhou S, Diehl R, Sessler DI, Liang C, Mascha EJ, Soltesz EG, Duncan AE. Procedure-specific relationships between postoperative troponin T and a composite of mortality and low cardiac output syndrome: A retrospective cohort analysis. Anesth Analg. 2022;134(6):1260–69. DOI: 10.1213/ANE.0000000000005850

Borde D, Joshi S, Jasapara A, Joshi P, Asegaonkar B, Apsingekar P. Left atrial strain as a single parameter to predict left ventricular diastolic dysfunction and elevated left ventricular filling pressure in patients undergoing off-pump coronary artery bypass grafting. J Cardiothorac Vasc Anesth. 2021;35(6):1618–25. DOI: 10.1053/j.jvca.2020.11.066

Montaigne D, Marechal X, Modine T, Coisne A, Mouton S, Fayad G, et al. Daytime variation of perioperative myocardial injury in cardiac surgery and its prevention by Rev-Erbα 47 antagonism: A single-centre propensity-matched cohort study and a randomised study. Lancet. DOI: 10.1016/S0140-6736(17)32132-3

Hijazi RM, Sessler DI, Liang C, Rodriguez-Patarroyo FA, Soltesz EG, Duncan AE. Association between in-hospital mortality and low cardiac output syndrome with morning versus afternoon cardiac surgery. Anesthesiol. 2021;134(4):552–61. DOI: 10.1097/ALN.0000000000003728

Meani P, Matteucci M, Jiritano F, Fina D, Panzeri F, Raffa GM, et al. Long-term survival and major outcomes in post-cardiotomy extracorporeal membrane oxygenation for adult patients in cardiogenic shock. Ann Cardiothorac Surg. 2019;8(1):116–22. DOI: 10.21037/acs.2018.12.04

The World Medical Association. Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects [Internet]. Available from: https://www.wma.net/what-we-do/medical-ethics/declaration-of-helsinki/

Caraballo C, Desai NR, Mulder H, Alhanti B, Wilson FP, Fiuzat M, et al. Clinical implications of the New York Heart Association Classification. J Am Heart Assoc. 2019;8(23):e014240. DOI: 10.1161/JAHA.119.014240

Schoonen A, van Klei WA, van Wolfswinkel L, van Loon K. Definitions of low cardiac output syndrome after cardiac surgery and their effect on the incidence of intraoperative LCOS: A literature review and cohort study. Front Cardiovasc Med. 2022;9:e926957. DOI: 10.3389/fcvm.2022.926957

Brassart B. Refractory Low Cardiac output syndrome after cardiac surgery with cardiopulmonary bypass at Lille University Hospital: Incidence, Risk factors, hospital mortality, and medium-term outcomese [diploma thesis]. Lille: University of Lille; 2021. 52 p

Luan NT. Study of predictors of low cardiac output syndrome after cardiac valve surgery. Vietnam J Cardiovasc Thorac Surg. 2023;42:5–15. DOI: 10.47972/vjcts.v42i.896

Wang J, Zhang X, Liu X, Pei L, Zhang Y, Yu C, Huang Y. Predictors of low cardiac output after isolated pericardiectomy: An observational study. Perioper Med. 2022;11:e34. DOI: 10.1186/s13741-022-00267-y

Rana KB, Ansari A, Sharma P, Yadav L, Shahbaz A. Frequency of low cardiac output syndrome following on pump coronary artery bypass grafting surgery and it’s association with degree of preoperative left ventricular dysfunction. Kathmandu Univ Med J. 2023; 21(81):79–84.

Amabili P, Benbouchta S, Roediger L, Senard M, Hubert MB, Donneau AF, et al. Low cardiac output syndrome after adult cardiac surgery: Predictive value of peak systolic global longitudinal strain. Anesth Analg. 2018;126(5):1476–83. DOI: 10.1213/ANE.0000000000002605

Ting PC, Wu VC, Liao CC, Chou AH, Tsai FC, Lin PJ et al. Preoperative right ventricular dysfunction indicates high vasoactive support needed after cardiac surgery. J Cardiothorac Vasc Anesth. 2019;33(3):686–93. DOI: 10.1053/j.jvca.2018.07.048

Hong L, Xu H, Ge C, Tao H, Shen X, Song X, et al. Prediction of low cardiac output syndrome in patients following cardiac surgery using machine learning. Front Med. 2022;9:e973147. DOI: 10.3389/fmed.2022.973147

Zhao L, Zhang GB, Li TW, Zhang Y, Li MD, Wu Y. Risk factors of low cardiac output syndrome after cardiac valvular surgery in elderly patients with valvular disease complicated with giant left ventricle. Chin J Cardiol. 2021;(12):368–73. DOI: 10.3760/cma.j.cn112148-20210302-00187

Moon MR, Henn MC, Maniar HS, Pasque MK, Melby SJ, Kachroo P, et al. Impact of Surgical Experience on Operative Mortality After Reoperative Cardiac Surgery. Ann Thorac Surg. 2020;110(6):1909–16. DOI: 10.1016/j.athoracsur.2020.04.077

Downloads

Published

2023-06-19

How to Cite

Bechri, I., Derkaoui, A., Shimi, A., & Khatouf, M. (2023). LOW CARDIAC OUTPUT SYNDROME AFTER CARDIAC SURGERY: A RETROSPECTIVE ANALYSIS. International Journal of Medicine and Medical Research, 9(1), 6–14. https://doi.org/10.61751/ijmmr.2413-6077.2023.1.06