Low output syndrome following aortic valve replacement. Predictors and prognosis
Journal Title: Archives of Medical Science - Year 2007, Vol 3, Issue 2
Abstract
Introduction: Low output syndrome (LOS) is a dangerous postoperative complication, which significantly worsens the prognosis; it is an essential risk factor of postoperative death. The aim of the study was to analyze the predictors of postoperative low cardiac output syndrome in patients subjected to aortic valve replacement due to aortic stenosis or regurgitation. Material and methods: Three hundred (300) patients with significant isolated aortic valve defect due to either aortic stenosis (n=150) or regurgitation (n=150), who underwent isolated aortic valve replacement were included in the study. Low cardiac output syndrome (LOS) was defined as the need for high dosages of inotropic medication, and/or intra-aortic balloon pumping to sustain adequate hemodynamic status. Results: Postoperative low cardiac output syndrome was developed in 86 patients (28.6%), including 39 patients with aortic stenosis (26.0%) and 47 patients with aortic regurgitation (31.3%). We selected the following independent predictors of postoperative LOS (odds ratio in parentheses): (1) aortic stenosis group – advanced age (4.7), end-systolic (5.5) and end-diastolic intraventricular septum thickness (4.2) before the surgery, LVEF Ł50% (5.4) and insignificant mitral regurgitation (4.1) in the early postoperative period; (2) aortic regurgitation group – obesity (4.8), left ventricular end-systolic (4.5) and end-diastolic diameters (6.4) in the preoperative period and left ventricular end-systolic (4.7) and end-diastolic diameters (6.1), and left ventricular ejection fraction Ł50% (7.2) in the early postoperative period. Conclusions: The 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 effectively resuscitate the ischemic myocardium and optimization of preexisting heart failure symptoms.
Authors and Affiliations
Maciej Banach, Aleksander Goch, Małgorzata Misztal, Jacek Rysz, Marcin Barylski, Ryszard Jaszewski, Jan Goch
Why does intensive insulin therapy implemented at the onset of type 1 diabetes not decrease prevalence of diabetic microangiopathy?
A positive correlation of serum homocysteine with leptin in maintenance hemodialysis patients
Introduction: Serum leptin is cleared principally by the kidneys and serum leptin concentrations are increased in patients with chronic renal failure and those undergoing a maintenance dialysis. Mild-to-moderate elevatio...
Advantage of adjunct metformin and insulin therapy in the management of glycemia in critically ill patients. Evidence for nonoccurrence of lactic acidosis and needing to parenteral metformin
Comparison of left ventricular ejection fraction by single photon computed tomographic myocardial perfusion imaging versus coronary computed tomography angiography
Glucose metabolism in conventionally treated patients with b-thalassaemia major assessed with oral glucose tolerance test