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Cited by 286Cardiac and Coronary Surgery TechniquesMechanical Circulatory Support DevicesCardiac, Anesthesia and Surgical Outcomes

Predictors of low cardiac output syndrome after coronary artery bypass

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Rao, Vivek, Ivanov, Joan, Weisel, Richard D., Ikonomidis, John S., Christakis, George T., David, Tirone E.·1996·The Journal of Thoracic and Cardiovascular Surgery
DOI 10.1016/s0022-5223(96)70176-9
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Abstract

The purpose of this study was to identify patients at risk for the development of low cardiac output syndrome after coronary artery bypass. Low cardiac output syndrome was defined as the need for postoperative intraaortic balloon pump or inotropic support for longer than 30 minutes in the intensive care unit to maintain the systolic blood pressure greater than 90 mm Hg and the cardiac index greater than 2.2 L/min per square meter. The preoperative patient characteristics that were independent predictors of low cardiac output syndrome were identified among 4558 consecutive patients who underwent isolated coronary artery bypass at The Toronto Hospital between July 1, 1990, and December 31, 1993. The overall prevalence of low cardiac output syndrome was 9.1% (n = 412). The operative mortality rate was higher in patients in whom low cardiac output syndrome developed than in those in whom it did not develop (16.9% versus 0.9%, p < 0.001). Stepwise logistic regression analyses identified nine independent predictors of low output syndrome (percent frequency in parentheses) and calculated the factor-adjusted odds ratios associated with each predictor: (1) left ventricular ejection fraction less than 20% (27%, odds ratio 5.7); (2) repeat operation (25%, odds ratio 4.4); (3) emergency operation (27%, odds ratio 3.7); (4) female gender (16%, odds ratio 2.5); (5) diabetes (13%, odds ratio 1.6); (6) age older than 70 years (13%, odds ratio 1.5); (7) left main coronary artery stenosis (12%, odds ratio 1.4); (8) recent myocardial infarction (16%, odds ratio 1.4); and (9) triple-vessel disease (10%, odds ratio 1.3). Low cardiac output syndrome is a clinical outcome that may result from inadequate myocardial protection or perioperative ischemic injury. Patients at high risk for the development of low cardiac output syndrome should be the focus of trials of new techniques of myocardial protection to resuscitate the ischemic myocardium.

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  • Low cardiac output syndrome, caused by inadequate cardiac pump function, is a serious complication after cardiac surgery with high morbidity and mortality.

    “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).”

    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 [4]

    The Results section reports longer ICU and hospital stays, more ventilatory support, and substantially higher mortality among patients with low cardiac output syndrome. The Study outcomes and Diagnosis sections connect the syndrome to hemodynamic compromise and inadequate postoperative cardiac performance. The study covers coronary artery bypass patients, however, not cardiac surgery generally; page numbers are unavailable in our copy. (LLM, conf=0.84)

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  • The reported incidence of LCOS varies from 2 to 27% in the adult population.

    “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 [4]

    The Results (page unavailable) report LCOS in 9.1% of coronary-bypass patients, and the Predictors section reports 27% in certain high-risk subgroups. The paper does not report a 2% LCOS incidence or establish a 2–27% range for the adult population generally. (LLM, conf=0.85)

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Research works printed but not linked: 4

  1. The Warm Heart Investigators. Normothermic versus hypo- thermic cardiac surgery: a randomized trial in 1732 coronary bypass patients. Lancet 1994;343:559-63.
  2. Menasch6 P, Jamieson WRE, Flameng W, Davies MK. Acadesine: a new drug that improves myocardial protection in coronary artery bypass graft surgery: results of the first multicenter study. J Thorac Cardiovasc Surg 1995;110:1096- 106.
  3. Weisel RD, Hoy FBY, Baird RJ, et al. Improved myocardial protection during a prolonged crossclamp period. Ann Tho- rac Surg 1983;36:664-74.
  4. Dixon WJ, ed. BMDP statistical software manual, part 2. Berkeley: University of California Press, 1992.

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Authors
Rao, V., Ivanov, J., Weisel, R. D., Ikonomidis, J. S., Christakis, G. T., & David, T. E.
Affiliations
University of Toronto (CA)
ORCID
Venue
The Journal of Thoracic and Cardiovascular Surgery
Publisher
Elsevier BV
Published
1996-07
Volume
112
Issue
1
Pages
38-51
ISSN
0022-5223 (ISSN-L)
DOI
10.1016/s0022-5223(96)70176-9
OpenAlex
W2072841444
Cited by
286
References
32
Citations by year
2026: 4 · 2025: 7 · 2024: 6 · 2023: 14 · 2022: 6 · 2021: 9 · 2020: 15 · 2019: 7 · 2018: 11 · 2017: 9 · 2016: 10 · 2015: 7 · 2014: 12 · 2013: 9 · 2012: 17
FWCI
5.41
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Heart and Stroke Foundation of Canada
  • Medical Research Council Canada
  • Medical Research Council
Topics
  • Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
  • Physical Sciences › Engineering › Biomedical Engineering › Mechanical Circulatory Support Devices
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
Keywords
low cardiac output syndrome, coronary artery bypass grafting, risk factors, left ventricular ejection fraction, reoperation, emergency surgery, female sex, diabetes mellitus, old age, left main coronary artery stenosis, recent myocardial infarction, three-vessel coronary artery disease, postoperative mortality, cardioprotection, perioperative myocardial ischemia, intra-aortic balloon pump, inotropic support
MeSH terms
Aged, Coronary Artery Bypass, Cardiac Output, Low, Female, Humans, Male, Middle Aged, Postoperative Complications, Prognosis, Prospective Studies, Sex Factors, Syndrome, Survival Rate, Odds Ratio, Ventricular Dysfunction, Left, Diabetes Complications

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