Cited by 115Cardiac Valve Diseases and TreatmentsCardiac and Coronary Surgery TechniquesCardiac, Anesthesia and Surgical Outcomes

Predictors of low cardiac output syndrome after isolated mitral valve surgery

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Maganti, Manjula, Badiwala, Mitesh, Sheikh, Amir, Scully, Hugh, Feindel, Christopher, David, Tirone E., Rao, Vivek·2010·The Journal of Thoracic and Cardiovascular Surgery

Abstract

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.

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Crossref · 10.1016/j.jtcvs.2009.11.022

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  1. Teoh KH, Ivanov J, Weisel RD. The cardiovascular surgeons at the Toronto General Hospital. Determinants of survival and valve failure after mitral valve replacement. Eur J Cardiothorac Surg. 1990;4:425-30.
  2. Sand ME, Naftel DC, Blackstone EH, Kirklin JW, Karp RB. A comparison of repair and replacement for mitral valve incompetence. J Thorac Cardiovasc Surg. 1987;94:208-19.
  3. Chaffin JS, Daggettt WM. Mitral valve replacement: a nine-year follow-up of risks and survivals. Ann Thorac Surg. 1985;39:346-52.

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Authors
Maganti, M., Badiwala, M., Sheikh, A., Scully, H., Feindel, C., David, T. E., & Rao, V.
Affiliations
University of Toronto (CA)
Corresponding author
Rao, Vivek
Venue
The Journal of Thoracic and Cardiovascular Surgery
Publisher
Elsevier BV
Published
2010-10
Volume
140
Issue
4
Pages
790-796
ISSN
0022-5223 (ISSN-L)
OpenAlex
W1992921387
Cited by
115
References
40
Citations by year
2026: 6 · 2025: 8 · 2024: 7 · 2023: 20 · 2022: 6 · 2021: 5 · 2020: 13 · 2019: 10 · 2018: 7 · 2017: 7 · 2016: 8 · 2015: 5 · 2014: 2 · 2013: 4 · 2012: 1
FWCI
2.41
Type
journal article
Language
en
Open access
Locations
  • Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
  • Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
Keywords
low cardiac output syndrome, mitral valve surgery, postoperative mortality, risk factors, left ventricular ejection fraction, NYHA class IV heart failure, body surface area, ischemic mitral valve disease, cardiopulmonary bypass time, renal failure, polytetrafluoroethylene sutures, reoperation, coronary artery bypass grafting
MeSH terms
Aged, Cardiac Output, Low, Female, Cardiac Surgical Procedures, Heart Valve Diseases, Humans, Male, Middle Aged, Mitral Valve, Ontario, Retrospective Studies, Risk Factors, Time Factors, Prevalence, Chi-Square Distribution, Logistic Models, Odds Ratio, Treatment Outcome, Risk Assessment

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