Proposal predictive model of low cardiac output syndrome in cardiac valvular surgery
Keywords:
low cardiac output syndrome, ventricular failure, heart surgery, extracorporeal circulationAbstract
Introduction: the incidence of postoperative low cardiac output syndrome is variable in the different published series, from 4% to 15%, with a mortality that approaches 20%. Although in patients over 70 years of age the syndrome may be present in up to 63%, despite the development of better cardioprotection techniques and postoperative care, the incidence of this syndrome in high-risk populations has not changed in a significant proportion.Objective: build a predictive model of postoperative low cardiac output syndrome through risk factors.
Methods: an analytical study of cases and controls was carried out in patients with postoperative low cardiac output syndrome treated at the Cardiology and Cardiovascular Surgery Center of the “Saturnino Lora” Provincial Teaching Hospital of Santiago de Cuba, in a period of three years; Logistic regression with adjustments was used to obtain the model.
Results: the most valuable predictive risk factors are: age >65 years, decreased right ventricular systolic function, aortic cross-clamping time and postoperative bleeding, which were those shown by the logistic regression model. Its internal validation was carried out by data division.
Conclusions: the predictive model developed from logistic regression was composed of the predictors: age >65 years, decreased right ventricular systolic function, aortic clamping time >90 minutes and prolonged postoperative bleeding; It presented good fit and discriminating power, especially positive predictive value.
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1.Rao V, Ivanov J, Weisel RD, Ikonomidis JS, Christakis GT, David TE. Predictors of low cardiac output syndrome after coronary artery bypass. J Thorac Cardiovasc Surg [Internet]. 1996 [citado 15/08/2023];112(1):38–51. Disponible en: https://doi.org/10.1016/s0022-5223(96)70176-9
2.Uhlig K, Efremov L, Tongers J, Frantz S, Mikolajczyk R, Sedding D, et al. Inotropic agents and vasodilator strategies for the treatment of cardiogenic shock or low cardiac output syndrome. Cochrane Database Syst Rev [Internet]. 2020 [citado 15/08/2023];(11):CD009669. Disponible en: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009669.pub4/full. https://doi.org/10.1002/14651858.CD009669.pub4
3.Duncan AE, Kartashov A, Robinson SB, Randall D, Zhang K, Luber J, et al. Risk factors, resource use, and cost of postoperative low cardiac output syndrome. J Thorac Cardiovasc Surg [Internet]. 2022 [citado 15/08/2023];163(5):1890–1898.e10. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32800368/. https://doi.org/10.1016/j.jtcvs.2020.06.125
4.Hong L, Xu H, Ge C, Tao H, Shen X, Song X, et al. Prediction of low cardiac output syndrome in patients following cardiac surgery using machine learning. Front Med (Lausanne) [Internet]. 2022 [citado 15/08/2023];9:973147. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9448978/. https://doi.org/10.3389/fmed.2022.973147
5.Ad N, Luc JGY, Nguyen TC, COVID-19 North American Cardiac Surgery Survey Working Group. Cardiac surgery in North America and coronavirus disease 2019 (COVID-19): Regional variability in burden and impact. J Thorac Cardiovasc Surg [Internet]. 2021 [citado 15/08/2023];162(3):893–903.e4. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7330597/. https://doi.org/10.1016/j.jtcvs.2020.06.077
6.Cuerpo Caballero G, Carnero Alcázar M, López Menéndez J, Centella Hernández T, Polo López L, García Fuster R, et al. Cirugía cardiovascular en España en el año 2020. Registro de intervenciones de la Sociedad Española de Cirugía Cardiovascular y Endovascular. Cir Cardiovasc (Barc) [Internet]. 2022 [citado 15/08/2023];29(4):207–220. Disponible en: https://www.elsevier.es/es-revista-cirugia-cardiovascular-358-articulo-cirugia-cardiovascular-espana-el-ano-S1134009622000869. https://doi.org/10.1016/j.circv.2022.03.023
7.Vera Rivero DA, Chirino Sánchez L, Yanes García R. Orígenes y desarrollo histórico de la cirugía cardiovascular en Cuba durante el siglo XX. Acta Méd Centro [Internet]. 2020 [citado 15/08/2023];14(1):133-141. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S2709-79272020000100133&lng=es
8.Ministerio de Salud Pública. Dirección de Registros Médicos y Estadísticas de Salud. Anuario Estadístico de Salud 2021 [Internet]. La Habana: MINSAP; 2022 [citado 15/08/2023]. Disponible en: https://files.sld.cu/bvscuba/files/2023/10/Anuario-Estad%c3%adstico-de-Salud-2021.-Ed-2022_3.pdf
9.Bertini P, Guarracino F. Anticoagulation in extracorporeal membrane oxygenation: still a challenge. Minerva Anestesiol [Internet]. 2020 [citado 15/08/2023];86(1):7-8. https://pubmed.ncbi.nlm.nih.gov/31820880/. https://doi.org/10.23736/S0375-9393.19.14265-4
10.Soto A, Cvetkovich A. Estudios de casos y controles. Rev Fac Med Hum [Internet]. 2020 [citado 31/01/2024];20(1):138-143. Disponible en: http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S2308-05312020000100138&lng=es. http://dx.doi.org/10.25176/rfmh.v20i1.2555
11.Schoonen A, van Klei WA, van Wolfswinkel L, van Loon K. Definitions of low cardiac output syndrome after cardiac surgery and their effect on the incidence of intraoperative LCOS: A literature review and cohort study. Front Cardiovasc Med [Internet]. 2022 [citado 15/08/2023];9:926957. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9558721/. https://doi.org/10.3389/fcvm.2022.926957
12.Kacila M, Tiwari KK, Granov N, Omerbašić E, Štraus S. Assessment of the initial and modified Parsonnet score in mortality prediction of the patients operated in the Sarajevo heart center. Bosn J Basic Med Sci [Internet]. 2010 [citado 15/08/2023];10(2):165-168. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5509404/. https://doi.org/10.17305/bjbms.2010.2717
13.Lorenzo S. Síndrome de bajo gasto cardíaco en el posoperatorio de cirugía cardíaca. Rev Urug Cardiol [Internet]. 2020 [citado 15/08/2023];35(3):292-321. Disponible en: http://www.scielo.edu.uy/scielo.php?script=sci_arttext&pid=S1688-04202020000300292. https://doi.org/10.29277/cardio.35.3.18
14.Pérez Vela JL, Jiménez Rivera JJ, Alcalá Llorente MA, González de Marcos B, Torrado H, García Laborda C, et al. Síndrome de bajo gasto cardiaco en el postoperatorio de cirugía cardiaca. Perfil, diferencias en evolución clínica y pronóstico. Estudio ESBAGA. Med Intensiva [Internet]. 2018 [citado 15/08/2023];42(3):159-67. Disponible en: https://www.medintensiva.org/es-sindrome-bajo-gasto-cardiaco-el-articulo-S0210569117301997. https://doi.org/10.1016/j.medin.2017.05.009
15.Fernández Mesa JE, Padrón García KM, Paredes Cordero ÁM, Díaz Vázquez E, González Greck O, González Trujillo A. Predictores de bajo gasto cardíaco perioperatorio en pacientes operados de cirugía cardíaca valvular. CorSalud [Internet]. 2018 [citado 15/08/2023];10(4):286-293. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S2078-71702018000400286&lng=es
16.Zhao X, Gu B, Li Q, Li J, Zeng W, Li Y, et al. Machine learning approach identified clusters for patients with low cardiac output syndrome and outcomes after cardiac surgery. Front Cardiovasc Med [Internet]. 2022 [citado 15/08/2023];9:962992. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9434347/. https://doi.org/10.3389/fcvm.2022.962992
17.Cubides Núñez RA. Complicaciones en pacientes intervenidos por reemplazo valvular aórtico en el Hospital Universitario Mayor Mederi 2015 – 2018 [tesis]. Bogotá: Universidad del Rosario; 2020 [citado 15/08/2023]. Disponible en: https://repository.urosario.edu.co/handle/10336/25571. https://doi.org/10.48713/10336_25571
18.Gómez-Nuñez K, Hechavarria-Pouymiró S, Perez-López H, Arazoza-Hernández A, Nápoles-Sierra I. Fibrilación auricular post operatoria en cirugía valvular. Rev Cuba Cardiol Cir Cardiovasc [Internet]. 2020 [citado 15/08/2023];26(3):e933 Disponible en: https://revcardiologia.sld.cu/index.php/revcardiologia/article/view/933
19.Sepúlveda FA, Jiménez LM, Castro HD, Castro JA, Cañas EM, Hidalgo JE, et al. Predictores de requerimiento intraoperatorio de soporte inotrópico y/o vasopresor en cirugía de revascularización miocárdica. Rev Chil Anest [Internet]. 2021 [citado 15/08/2023];6(50):851-856. Disponible en: https://revistachilenadeanestesia.cl/revchilanestv5005101106/. https://doi.org/10.25237/revchilanestv5005101106
20.Li Z, Zhang GB, Li TW, Zhang Y, Li MD, Wu Y. Risk factors of low cardiac output syndrome after cardiac valvular surgery in elderly patients with valvular disease complicated with giant left ventricle. Zhonghua Xin Xue Guan Bing Za Zhi [Internet]. 2021 [citado 15/08/2023];49(4):368-373. Disponible en: https://pubmed.ncbi.nlm.nih.gov/33874687/. https://doi.org/10.3760/cma.j.cn112148-20210302-00187
21.Burstein B, Anand V, Ternus B, Tabi M, Anavekar NS, Borlaug BA, et al. Noninvasive echocardiographic cardiac power output predicts mortality in cardiac intensive care unit patients. Am Heart J [Internet]. 2022 Mar [citado 15/08/2023];245:149-159. Disponible en: https://pubmed.ncbi.nlm.nih.gov/34953769/. https://doi.org/10.1016/j.ahj.2021.12.007
22.Torres Quiñones L, Rosabal García Y, Olivares Álvarez DR. Supervivencia de pacientes con síndrome de bajo gasto cardiaco en el periodo posoperatorio. Medisan [Internet]. 2023 [citado 31/01/2024];27(6):e4563. Disponible en: https://www.redalyc.org/articulo.oa?id=368476358012
23.Rosabal-García Y, Pérez-Infante Y, Duconger-Danger M. Predictores de supervivencia al síndrome bajo gasto cardíaco en pacientes sometidos a cirugía valvular cardíaca. Rev Electrón Dr. Zoilo E. Marinello Vidaurreta [Internet]. 2024 [citado 23/02/2024];49:e3621. Disponible en: https://revzoilomarinello.sld.cu/index.php/zmv/article/view/3621
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