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Predictors of low cardiac output syndrome after isolated mitral valve surgery
Open accessAbstract
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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“The reported incidence of LCOS varies from 2 to 27% in the adult population (2–8).”
From Definitions of low cardiac output syndrome after cardiac surgery and their effect on the incidence of intraoperative LCOS: A literature review and cohort study (2022) · cites this paper as [2]
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“Low cardiac output syndrome, caused by an inadequate cardiac pump function, is a serious complication after cardiac surgery with high morbidity and mortality (2–4, 6, 8, 12).”
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Metadata
- 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
- bronze
- doi.org
- Licence
- 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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