Predictors of low cardiac output syndrome after isolated aortic valve surgery
Open accessAbstract
BACKGROUND: Low cardiac output syndrome (LCOS), defined as the need for postoperative intraaortic balloon pump or inotropic support for >30 minutes in the intensive care unit, remains a relatively common complication of aortic valve (AV) surgery. The aim of this study is to identify the preoperative predictors of LCOS in patients undergoing isolated AV surgery. METHODS AND RESULTS: We conducted a retrospective review of data prospectively entered into an institutional database. Between 1990 and 2003, 2255 patients underwent isolated AV surgery with no other concomitant cardiac surgery. The independent predictors of LCOS and operative mortality (OM) were determined by stepwise logistic regression analysis. The overall prevalence of LCOS was 3.9%. The independent predictors of LCOS were (odds ratio in parentheses) renal failure (5.0), earlier year of operation (4.4), left ventricular ejection fraction <40% (3.6), shock (3.2), female gender (2.8), and increasing age (1.02). Overall OM was 2.9%. The OM was higher in patients who experienced LCOS (38% versus 1.5%; P<0.001). The independent predictors of mortality were (odds ratio in parentheses) preoperative renal failure (8.3), urgency of surgery (3.4), previous stroke (2.9), congestive heart failure (2.6), previous cardiac surgery (2.3), hypertension (1.7), and small AV size (1.3). CONCLUSIONS: Low-output syndrome is associated with significantly increased morbidity and mortality. Novel strategies to preserve renal function, optimization of preexisting heart failure symptoms, and avoidance of prosthesis-patient mismatch may reduce the incidence of LCOS and lead to improved results after AV surgery.
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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 [8]
The Demographics section reports LCOS in 87 patients (3.9%) after isolated aortic valve surgery, providing one incidence estimate within the cited range. It does not establish the 2–27% range or its applicability to the broader adult population. (LLM, conf=0.85)
Experimental — accuracy not yet measuredLow 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).”
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BackgroundHijazi, R. M., Sessler, D. I., Liang, C., Rodriguez-Patarroyo, F. A., Soltesz, E. G., & Duncan, A. E. (2021) · Anesthesiology · doi:10.1097/aln.0000000000003728 · Cited by 16 · see citing works
“013 Aortic valve replacement 1,994 (29) 663 (23) 1,876 (27) 796 (28) Aortic valve replacement + ascending aorta replacement 145 (2) 51 (2) 138 (2) 57 (2) Aortic valve replacement + coronary artery bypass grafting 581 (8) 273 (9) 604 (9) 255 (9) Aortic valve replacement + coronary artery bypass grafting + other 125 (2)…”
Lanning, K. M., Erkinaro, T. M., Ohtonen, P. P., Vakkala, M. A., Liisanantti, J. H., Ylikauma, L. A., & Kaakinen, T. I. (2021) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2021.08.103 · Cited by 16 · see citing works
Zhu, J., Zhang, Y., Chen, L., He, Y., & Qing, X. (2018) · Anaesthesia Critical Care & Pain Medicine · doi:10.1016/j.accpm.2018.08.005 · Cited by 16 · see citing works
Mendes, M. A., Fabre, M., Amabili, P., Jaquet, O., Donneau, A., Bonhomme, V. L., & Hans, G. A. (2023) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2023.06.025 · Cited by 13 · see citing works
Results Differ Between Transaortic and Open Surgical Aortic Valve Replacement in Women
Onorati, F., D’Errigo, P., Barbanti, M., Rosato, S., Covello, R. D., Maraschini, A., Ranucci, M., Grossi, C., Santoro, G., Tamburino, C., et al. (2013) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2013.05.048 · Cited by 12 · see citing works
Kumar, A., Puri, G. D., & Bahl, A. (2017) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2017.04.006 · Cited by 11 · see citing works
Jiang, H., Hultkvist, H., Holm, J., Vánky, F. B., Yang, Y., & Svedjeholm, R. (2018) · PLoS ONE · doi:10.1371/journal.pone.0192503 · Cited by 12 · see citing works
NT-proBNP and postoperative heart failure in surgery for aortic stenosis
Jiang, H., Vánky, F. B., Hultkvist, H., Holm, J., Yang, Y., & Svedjeholm, R. (2019) · Open Heart · doi:10.1136/openhrt-2019-001063 · Cited by 11 · see citing works
“p-CK-MB POD1 >50 μg/L 4 (8) 28 (5) 2 (3) <0.”
Zarragoikoetxea, I., Vicente, R., Pajares, A., Carmona, P. I., Lopez, M., Moreno, I., Argente, P., Hornero, F., Valera, F., & Agüero, J. (2019) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2019.08.019 · Cited by 12 · see citing works
Defining Characteristics of Decreased Cardiac Output: A Literature Review
Brandão, S. M. G., Altino, D. M., Butcher, R. D. C. G. E. S., & Lopes, J. D. L. (2011) · International Journal of Nursing Terminologies and Classifications · doi:10.1111/j.1744-618x.2010.01174.x · Cited by 11 · see citing works
“…Journal of Clinical and Laboratory Investigation 5,001 to 10,000 1 9.1 • European Heart Journal Rössig et al. (2004) Higher than 1,0000 2 9.1 • Circulation Maack et al. (2003); Maganti et al. (2005) International Journal of Nursing Terminologies and Classifications Volume 22, No. 2,…”
BackgroundInfluentialConcepts of Cardiac Dyssynchrony and Dynamic Approach
Catrina, B. I., Batâr, F., Maniţiu, I., Prodan, L., Tanasescu, C. A. H., & Filip, T. (2024) · Diagnostics · doi:10.3390/diagnostics14090937 · Cited by 11 · see citing works
“Stress tests are frequently used to detect mechanical dyssynchrony, which is particularly susceptible to underestimation at rest, particularly in patients with coronary artery disease [45].”
BackgroundJugular bulb desaturation during off-pump coronary artery bypass surgery
Miura, N., Yoshitani, K., Kawaguchi, M., Shinzawa, M., Irie, T., Uchida, O., Ohnishi, Y., & Mackensen, G. B. (2009) · Journal of Anesthesia · doi:10.1007/s00540-009-0794-8 · Cited by 10 · see citing works
“2 l·min·m has been used as a defi nition of low cardiac output syndrome [19–21], we selected SvO2 of 70% and CI of 2.”
MethodXu, J., Yu, J., Xu, X., Shen, B., Wang, Y., Jiang, W., Lv, W., Fang, Y., Luo, Z., Wang, C., et al. (2019) · Journal of Cardiothoracic Surgery · doi:10.1186/s13019-019-0977-9 · Cited by 10 · see citing works
Singh, N., Bhavya, G., Nagaraja, P., Ragavendran, S., Sathish, N., Manjunath, N., Kumar, K., & Nayak, V. B. (2020) · Annals of Cardiac Anaesthesia · doi:10.4103/aca.aca_1_19 · Cited by 10 · see citing works
Senanayake, E. L., Howell, N. J., Ranasinghe, A. M., Drury, N. E., Freemantle, N., Frenneaux, M. P., Oelofse, T., Green, D., Wilson, I. C., Rooney, S. J., et al. (2014) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezu452 · Cited by 10 · see citing works
Xu, J., Jiang, W., Li, Y., Shen, B., Shen, Z., Wang, Y., Hu, J., Fang, Y., Luo, Z., Wang, C., et al. (2020) · Clinical and Experimental Nephrology · doi:10.1007/s10157-020-01908-6 · Cited by 9 · see citing works
The multivariable prognostic models for severe complications after heart valve surgery
Liu, Y., Xiao, J., Duan, X., Lu, X., Gong, X., Chen, J., Xiong, M., Yin, S., Guo, X., & Wu, Z. (2021) · BMC Cardiovascular Disorders · doi:10.1186/s12872-021-02268-z · Cited by 9 · see citing works
Vidlund, M., Tajik, B., Håkanson, E., Friberg, Ö., Holm, J., Vánky, F. B., & Svedjeholm, R. (2015) · BMC Anesthesiology · doi:10.1186/s12871-016-0216-z · Cited by 9 · see citing works
Cheema, H. A., Khan, A. A., Ahmad, A. H., Khan, A. A., Khalid, ., Shahid, A., Hermis, A. H., Syed, A., Bansal, N., Yuki, K., et al. (2023) · American Heart Journal · doi:10.1016/j.ahj.2023.09.006 · Cited by 9 · see citing works
Management of Post-cardiotomy Shock
Hall, E. J., Papolos, A., Miller, P. E., Barnett, C. F., & Kenigsberg, B. B. (2024) · US Cardiology Review · doi:10.15420/usc.2024.16 · Cited by 9 · see citing works
“31,32 The commonly used Society of Thoracic Surgery (STS) and European System for Cardiac Operative Risk Evaluation (EuroSCORE-2) scores do not directly predict the frequency of PCCS. 34 PCCS can develop intraoperatively, resulting in difficulty separating from cardiopulmonary bypass, or…”
MethodCheng, X., Wang, K., Zhang, H.-T., Zhang, H., Jiang, X., Lu, L., Chen, C., Cheng, Y.-Q., Wang, D., & Li, K. (2023) · Journal of Cardiothoracic Surgery · doi:10.1186/s13019-023-02312-3 · Cited by 8 · see citing works
“Background The incidence of cardiogenic shock after cardiac surgery is approximately 3-9% [1, 2].”
BackgroundPedgaonkar, R. A., Singh, N., Dhananjaya, M., Nagaraja, P., Nagesh, K., & Prabhakar, V. (2023) · Annals of Cardiac Anaesthesia · doi:10.4103/aca.aca_9_23 · Cited by 9 · see citing works
Zangrillo, A., Ломиворотов, В. В., Pisano, A., Calabró, M. G., Belletti, A., Brazzi, L., Grigoryev, E. V., Guarracino, F., Monaco, F., Garofalo, E., et al. (2020) · Journal of Critical Care · doi:10.1016/j.jcrc.2020.04.005 · Cited by 8 · see citing works
Belletti, A., Azzolini, M. L., Baldetti, L., Landoni, G., Franco, A., & Zangrillo, A. (2022) · General Reanimatology · doi:10.15360/1813-9779-2022-5-60-77 · Cited by 8 · see citing works
Lanning, K. M., Ylikauma, L. A., Erkinaro, T. M., Ohtonen, P. P., Vakkala, M. A., & Kaakinen, T. I. (2023) · Acta Anaesthesiologica Scandinavica · doi:10.1111/aas.14210 · Cited by 8 · see citing works
“Low cardiac output syndrome is the major cause of adverse outcomes after cardiac surgery.(2,3) Therefore, accurate measurement of CO is critical in the management of cardiac surgical patients.”
BackgroundProlonged cardiovascular pharmacological support and fluid management after cardiac surgery
Kontar, L., Beaubien‐Souligny, W., Couture, É. J., Jacquet‐Lagrèze, M., Lamarche, Y., Levesque, S., Babin, D., & Denault, A. Y. (2023) · PLoS ONE · doi:10.1371/journal.pone.0285526 · Cited by 9 · see citing works
Use of intra-aortic balloon pump in cardiac surgery: analysis of 80 consecutive cases
Júnior, F. P., Tagliari, A. P., Luvizetto, A. B., Pereira, E. M. C., Siliprandi, E. M. O., Nesralla, I. A., dos Santos, R. P., & Kalil, R. A. K. (2012) · Brazilian Journal of Cardiovascular Surgery · doi:10.5935/1678-9741.20120041 · Cited by 8 · see citing works
Predictors of low cardiac output after isolated pericardiectomy: an observational study
Wang, J., Zhang, X., Liu, X., Pei, L., Zhang, Y., Yu, C., & Huang, Y. (2022) · Perioperative Medicine · doi:10.1186/s13741-022-00267-y · Cited by 7 · see citing works
“2 L•min−1•m−2 and no signs of tissue hypoperfusion; or (2) patients required the use of mechanical circulatory support devices, such as an intra-aortic balloon pump (IABP) or extracorporeal membrane oxygenation (ECMO) during or after the surgery (Lomivorotov et al. 2017; Maganti et al. 2005; Ponikowski et al. 2016; Ib…”
MethodPořízka, M., Kunstýř, J., Vaněk, T., Nejedly, M., Bucková, J., Mokrejs, J., & Mošna, F. (2017) · Annals of Thoracic and Cardiovascular Surgery · doi:10.5761/atcs.oa.16-00280 · Cited by 7 · see citing works
Zhang, Y., & Mazgalev, T. N. (2009) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2009.04.009 · Cited by 7 · see citing works
Low output syndrome following aortic valve replacement. Predictors and prognosis
Banach, M., Goch, A., Rysz, J., Barylski, M., Jaszewski, R., & Goch, J. H. (2007) · Cited by 7 · see citing works
Hong, L., Feng, T., Qiu, R., Lin, S., Xue, Y., Huang, K., Chen, C., Wang, J., Xie, R., Song, S., et al. (2023) · Annals of Medicine · doi:10.1080/07853890.2023.2293244 · Cited by 6 · see citing works
“%) were reported independent predictors of lcOs after valve surgery [24,25], which accounted for the largest proportion in our preoperative model. lVeF is a widely used tool to assess left ventricular systolic function, with lower lVeF indicating an increased risk of lcOs [26,27]. increased lVDd,…”
MethodCHEN, D. X., WANG, T. H., Xiong, X., Shi, J. C., & Zhou, L. (2023) · Minerva Anestesiologica · doi:10.23736/s0375-9393.23.17727-3 · Cited by 6 · see citing works
Bari, V., Vaini, E., Pistuddi, V., Fantinato, A., Cairo, B., MARIA, B. D., Ranucci, M., & Porta, A. (2019) · Physiological Measurement · doi:10.1088/1361-6579/ab12f0 · Cited by 5 · see citing works
Anemia as a Risk Factor for Organ Dysfunctions in Patients Operated on Heart Valves
Yudin, G. V., Рыбка, М. М., Khinchagov, D. Y., Дибин, Д. А., & Гончаров, А. А. (2021) · Kardiologiia · doi:10.18087/cardio.2021.4.n1596 · Cited by 6 · see citing works
Levosimendan and Low Cardiac Output After Cardiac Surgery: Analysis of Trial Data
Welker, C. C., Mielke, J. A. R., & Ramakrishna, H. (2023) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2023.03.011 · Cited by 5 · see citing works
Anantasit, N., Boyd, J. H., Russell, J. A., Fjell, C. D., Lichtenstein, S. V., & Walley, K. R. (2014) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2013.11.043 · Cited by 5 · see citing works
Rogers, C. A., Capoun, R., Scott, L. J., Taylor, J., Jain, A. R., Angelini, G. D., Narayan, P., Suleiman, M. S., Sarkar, K., & Ascione, R. (2017) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezx087 · Cited by 5 · see citing works
Lu, F., Wu, B., Li, J., Xu, N., Jiang, H., Shu, X., & Wang, Y. (2023) · The International Journal of Cardiovascular Imaging · doi:10.1007/s10554-023-02959-y · Cited by 4 · see citing works
dos Santos, E. R., Lopes, C. T., Maria, V. L. R., & de Barros, A. L. B. L. (2016) · European Journal of Cardiovascular Nursing · doi:10.1177/1474515116681373 · Cited by 5 · see citing works
Perioperative incidence of ECMO and IABP on 5901 mitral valve surgery procedures
Condello, I., Lorusso, R., Santarpino, G., Bari, N. D., Fiore, F., Moscarelli, M., Calafiore, A. M., Speziale, G., & Nasso, G. (2022) · Journal of Cardiothoracic Surgery · doi:10.1186/s13019-022-01790-1 · Cited by 4 · see citing works
“At present, domestic and foreign studies on the risk factors of LCOS are inconsistent [14].”
BackgroundEvaluation of left ventricular diastolic function in patients operated for aortic stenosis
Hultkvist, H., Nylander, E., Tamás, É., Svedjeholm, R., Engvall, J. E., Holm, J., Maret, E., & Vánky, F. B. (2022) · PLoS ONE · doi:10.1371/journal.pone.0263824 · Cited by 4 · see citing works
Weaning from cardiopulmonary bypass
Kim, H. (2013) · Korean Journal of Anesthesiology · doi:10.4097/kjae.2013.64.6.487 · Cited by 4 · see citing works
“Patients with risk factor of ventricular dysfunction (elderly, chronic beta-blocker treatment, renal failure, pulmonary hypertension) tend to be difficult in weaning from CPB, awareness of these risk factors are important for preparing and planning aggressive cardiosupportive management earlier as prophylactic interve…”
Predictors of cardiogenic shock in cardiac surgery patients receiving intra-aortic balloon pumps
Iyengar, A., Kwon, O. J., Bailey, K. L., Ashfaq, A., Abdelkarim, A., Shemin, R. J., & Benharash, P. (2018) · Surgery · doi:10.1016/j.surg.2017.11.021 · Cited by 3 · see citing works
Tissue Doppler imaging is useful for predicting the need for inotropic support after cardiac surgery
Imai, H., Kurokawa, S., Taneoka, M., & Baba, H. (2011) · Journal of Anesthesia · doi:10.1007/s00540-011-1231-3 · Cited by 3 · see citing works
“after cardiac surgery [4, 5, 7, 8].”
MethodResultEpidemiology of acute kidney injury after cardiac surgery: an update
Regner, K. R. (2007) · Journal of Organ Dysfunction · doi:10.1080/17471060701236935 · Cited by 3 · see citing works
Chowdhury, U. K. (2019) · Open Access Journal of Cardiology · doi:10.23880/oajc-16000140 · Cited by 1 · see citing works
“The management strategies leading to this improvement include aggressive preoperative medical management, advances in cardiac anaesthesia, perioperative critical care, hemodynamic monitoring and chordal preservation strategies during the past 3 decades [1-11].”
BackgroundResultInfluentialPredictors of low cardiac output syndrome after combined mitral and tricuspid valve surgery
Labaste, F., Badie, Y. L., Bouchau, R., Boyère, L., Sanchez-Verlaan, P., Gonzalez, H., Marcheix, B., Botea, R., Bounes, F. V., & Minville, V. (2024) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2024.1452820 · Cited by 2 · see citing works
Qing, Q., Wei, X., Zheng, H., Wen, Z., Sun, X., Yang, J., & Chen, P. (2023) · International Journal of Clinical and Experimental Medicine Research · doi:10.26855/ijcemr.2023.04.029 · Cited by 2 · see citing works
Study of predictors of low cardiac output syndrome after cardiac valve surgery
Luan, N. T. (2023) · Tạp chí Phẫu thuật và Tim mạch và Lồng ngực Việt Nam · doi:10.47972/vjcts.v42i.896 · Cited by 2 · see citing works
Low cardiac output syndrome in cardiac surgery
MEREKIN, D. N., Ломиворотов, В. В., Efremov, S. M., Кirov, М. Y., & Ломиворотов, В. В. (2019) · Almanac of Clinical Medicine · doi:10.18786/2072-0505-2019-47-035 · Cited by 2 · see citing works
- Authors
- Maganti, M. D., Rao, V., Borger, M. A., Ivanov, J., & David, T. E.
- Affiliations
- University of Toronto (CA)
- Venue
- Circulation
- Published
- 2005-08-30
- Volume
- 112
- Issue
- 9_supplement
- Pages
- I448-52
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W1495427827
- Cited by
- 143
- References
- 22
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 4 · 2023: 19 · 2022: 8 · 2021: 5 · 2020: 12 · 2019: 11 · 2018: 3 · 2017: 8 · 2016: 3 · 2015: 7 · 2014: 9 · 2013: 7 · 2012: 9
- FWCI
- 2.05
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Heart and Stroke Foundation of Canada
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Disease and Treatment Approaches
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Keywords
- low cardiac output syndrome, aortic valve surgery, isolated aortic valve replacement, postoperative complications, postoperative mortality, preoperative risk factors, renal failure, left ventricular ejection fraction, shock, prosthesis-patient mismatch, heart failure, intra-aortic balloon pump, inotropic support
- MeSH terms
- Aged, Aortic Valve, Cardiac Output, Low, Cardiotonic Agents, Critical Care, Female, Humans, Intra-Aortic Balloon Pumping, Kidney Failure, Chronic, Length of Stay, Male, Middle Aged, Postoperative Complications, Prospective Studies, Retrospective Studies, Risk Factors, Stroke Volume, Prevalence, Odds Ratio, Databases, Factual, Treatment Outcome
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