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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 (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]
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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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BackgroundResult2012 ACCF/AATS/SCAI/STS Expert Consensus Document on Transcatheter Aortic Valve Replacement
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Self-citationRisk factors, resource use, and cost of postoperative low cardiac output syndrome
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BackgroundPredictors of Low Cardiac Output Syndrome After Isolated Coronary Artery Bypass Grafting
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BackgroundInfluentialRisk factors for low cardiac output syndrome after coronary artery bypass grafting surgery
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“Notably, hypertension patients were also reported to have higher mortality after the onset of LCOS, because myocardial hypertrophy would exacerbate the deficiency of oxygen supply subsequent to LCOS (31).”
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“The risk factors for PCVD in the current study were similar to those reported for LCOS in previous studies,[3,6,23] and this emphasizes the clinical and pathophysiological continuum between these two entities.”
ResultAmabili, P., Benbouchta, S., Roediger, L., Sénard, M., Hubert, M. B., Donneau, A., Brichant, J.-F., & Hans, G. A. (2017) · Anesthesia & Analgesia · doi:10.1213/ane.0000000000002605 · Cited by 26
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Coronary Insufficiency After Stentless Aortic Root Replacement: Risk Factors and Solutions
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“Moreover, low cardiac output is associated with tissue hypoperfusion and hypoxia in patients after cardiac surgery (2,3).”
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“Among the hemodynamic data predicting post-CPB inotropic support and mortality after cardiac surgery, LV systolic dysfunction is frequently found to be the most important and frequently reported variable.(9,15,21,22,26,30,32,33,66,68,72) LV dysfunction is either defined by a history of congestive heart failure, by a c…”
BackgroundChanging trends in emergency coronary bypass surgery
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“Background The incidence of postcardiotomy cardiogenic shock is approximately 3–9% after cardiac surgical procedures [1, 2].”
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“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)…”
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Defining Characteristics of Decreased Cardiac Output: A Literature Review
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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
“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
“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
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
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
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
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
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
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
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
“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 9
“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
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
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
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
“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
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
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
“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
Zhang, Y., & Mazgalev, T. N. (2009) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2009.04.009 · Cited by 7
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
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
“%) 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
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
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
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
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
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
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
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
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
“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
Weaning from cardiopulmonary bypass
Kim, H. (2013) · Korean Journal of Anesthesiology · doi:10.4097/kjae.2013.64.6.487 · Cited by 4
“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
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
“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
Chowdhury, U. K. (2019) · Open Access Journal of Cardiology · doi:10.23880/oajc-16000140 · Cited by 1
“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
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
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
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
Metadata
- 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 › Cardiology and Cardiovascular 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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