Division of Cardiovascular Surgery, Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
Ann Thorac Surg. 2011 Nov;92(5):1678-84. doi: 10.1016/j.athoracsur.2011.06.017. Epub 2011 Sep 21.
Postoperative low cardiac output syndrome (LCOS) is associated with high morbidity and mortality after coronary artery bypass grafting (CABG). We sought to examine trends in predictors of LCOS after isolated CABG.
A total of 25,176 consecutive patients who underwent isolated CABG between 1990 and 2009 were included. To examine trends over time, we divided patients into four equivalent eras (1990 to -1994, n = 6,489; 1995 to 1999, n = 8,175; 2000 to 2004, n = 6,741; 2005 to 2009, n = 3,797). We used multivariable analysis to identify predictors of LCOS.
The prevalence of LCOS declined from 9.1% (1990 to 1994) to 2.4% (2005 to 2009, p < 0.001). The following were the major independent predictors of LCOS for the entire cohort (odds ratios in parentheses): reoperative CABG (4.1); earlier year of operation (4.1, 2.6, 1.7 for the first, second, and third eras, respectively); left ventricular ejection fraction (LVEF) less than 0.20 (3.5), emergency surgery (2.7), cardiogenic shock (2.3), female gender (2), and LVEF 0.20 to 0.39 (2). Unlike other risk factors, the impact of LVEF less than 0.20 on development of postoperative LCOS increased substantially in the latest era (odds ratio, 7.8) compared with (odds ratios, 3.1, 4.3, and 3.2) the first, second, and third eras, respectively.
The impact of LVEF less than 0.20 on development of postoperative LCOS has increased markedly in the latest era of our study. Prudent preoperative evaluation in patients with severe left ventricular dysfunction is critical. Further innovative research in myocardial protection and circulatory support is warranted in patients with severe left ventricular dysfunction.
术后低心输出量综合征（LCOS）与冠状动脉旁路移植术（CABG）后高发病率和死亡率相关。我们试图研究孤立性 CABG 后 LCOS 的预测因素的趋势。
共纳入 1990 年至 2009 年间接受孤立性 CABG 的 25176 例连续患者。为了研究随时间的趋势，我们将患者分为四个相等的时代（1990 年至 1994 年，n=6489；1995 年至 1999 年，n=8175；2000 年至 2004 年，n=6741；2005 年至 2009 年，n=3797）。我们使用多变量分析来确定 LCOS 的预测因素。
LCOS 的患病率从 9.1%（1990 年至 1994 年）降至 2.4%（2005 年至 2009 年，p<0.001）。整个队列的主要独立 LCOS 预测因素（括号中的比值比）为：再次 CABG（4.1）；手术时间较早（4.1、2.6、1.7 分别为第一、二、三个时代）；左心室射血分数（LVEF）<0.20（3.5）、急诊手术（2.7）、心源性休克（2.3）、女性（2）和 LVEF 0.20 至 0.39（2）。与其他危险因素不同，LVEF<0.20 对术后 LCOS 发展的影响在最新时代（比值比，7.8）与第一、二、三个时代（比值比，3.1、4.3 和 3.2）相比显著增加。
在我们研究的最新时代，LVEF<0.20 对术后 LCOS 发展的影响明显增加。对严重左心室功能障碍患者进行谨慎的术前评估至关重要。需要进一步对严重左心室功能障碍患者的心肌保护和循环支持进行创新性研究。
