Division of Cardiovascular Surgery, Peter Munk Cardiac Center, Toronto General Hospital and Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
J Thorac Cardiovasc Surg. 2010 Oct;140(4):790-6. doi: 10.1016/j.jtcvs.2009.11.022. Epub 2010 Feb 11.
Low cardiac output syndrome is defined as the need for a postoperative intra-aortic balloon pump or inotropic support for longer than 30 minutes in the intensive care unit. Mitral valve surgery is increasingly being performed in high-risk patients who might require mechanical circulatory support for low cardiac output syndrome. Therefore the aim of this study was to identify the preoperative predictors of low cardiac output syndrome after mitral valve surgery.
We conducted a retrospective review of data prospectively entered into an institutional database. Between 1990 and February 2008, 3039 patients underwent isolated mitral valve surgery with or without coronary bypass surgery. The independent predictors of low cardiac output syndrome and operative mortality were determined by means of stepwise logistic regression analysis.
The overall prevalence of low cardiac output syndrome was 7%. The independent predictors of low cardiac output syndrome were urgency of the operation (odds ratio, 2.9), earlier year of operation (odds ratio, 2.4), left ventricular ejection fraction of less than 40% (odds ratio, 2.1), New York Heart Association class IV (odds ratio, 2), body surface area of 1.7 m(2) or less (odds ratio, 1.6), ischemic mitral valve pathology (odds ratio, 1.6), and cardiopulmonary bypass time (odds ratio, 1.02). The operative mortality was higher in patients with low cardiac output syndrome (30% vs 1.3%, P < .001). Overall operative mortality was 3.4%. The independent predictors of mortality were urgency of the operation (odds ratio, 7.1), renal failure (odds ratio, 4.3), nonuse of polytetrafluoroethylene sutures (Gore-Tex; W. L. Gore & Associates, Inc, Austin, Tex; odds ratio, 2.1), any reoperative surgical intervention (odds ratio, 1.8), increasing age (odds ratio, 1.03), and cardiopulmonary bypass time (odds ratio, 1.02).
Low cardiac output syndrome is associated with significantly increased morbidity and mortality. Novel strategies to preserve renal function, optimization of pre-existing heart failure symptoms, and use of artificial polytetrafluoroethylene sutures might reduce the incidence of low cardiac output syndrome and lead to improved results after mitral valve surgery.
低心输出综合征的定义为在重症监护病房中需要术后主动脉内球囊泵或正性肌力支持超过 30 分钟。二尖瓣手术越来越多地应用于高危患者，这些患者可能需要机械循环支持来治疗低心输出综合征。因此，本研究的目的是确定二尖瓣手术后低心输出综合征的术前预测因素。
我们对前瞻性纳入机构数据库的数据进行了回顾性分析。1990 年至 2008 年 2 月，3039 例行单纯二尖瓣手术或同时行冠状动脉旁路移植术的患者。通过逐步逻辑回归分析确定低心输出综合征和手术死亡率的独立预测因素。
低心输出综合征的总发生率为 7%。低心输出综合征的独立预测因素为手术的紧急程度（比值比，2.9）、手术年份较早（比值比，2.4）、左心室射血分数<40%（比值比，2.1）、纽约心脏协会心功能分级Ⅳ级（比值比，2）、体表面积<1.7 m²（比值比，1.6）、缺血性二尖瓣病变（比值比，1.6）和体外循环时间（比值比，1.02）。低心输出综合征患者的手术死亡率较高（30%比 1.3%，P<0.001）。总的手术死亡率为 3.4%。死亡的独立预测因素为手术的紧急程度（比值比，7.1）、肾衰竭（比值比，4.3）、不使用聚四氟乙烯缝线（戈尔公司，戈尔有限公司，奥斯汀，德克萨斯州；比值比，2.1）、任何再次手术干预（比值比，1.8）、年龄增加（比值比，1.03）和体外循环时间（比值比，1.02）。
低心输出综合征与发病率和死亡率显著增加相关。保护肾功能、优化现有心力衰竭症状、使用人工聚四氟乙烯缝线等新策略可能会降低低心输出综合征的发生率，并改善二尖瓣手术后的结果。
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