Prediction of the acute heart failure after cardiac valve surgery

Abstract

Background. Postoperative acute heart failure is a frequent complication in cardiac surgery, prolonging the length of stay in the intensive care unit and the hospital length of stay.Aim. To develop prognostic risk model of the acute heart failure in the early postoperative period.Methods. This prospective cohort observation study included 121 adult patients who underwent cardiac valve surgery with cardiopulmonary bypass. The need for vasopressor and inotropic support on the first postoperative day was chosen as the primary endpoint. Univariable and multivariable analysis of logistic regression were used to evaluate the influence of preoperative and intraoperative risk factors.Results. Univariable analysis showed risk factors of using vasopressor and inotropic support on the first day after surgical intervention: duration of cardiopulmonary bypass (OR 1.02, 95% CI 1.005–1.030, p = 0.005), aortic cross-clamping time (OR 1.02, 95% CI 1.001–1.030, p = 0.006), Logistic EuroSCORE II (OR 1.16, 95% CI 0.90–1.49, p = 0.03) and tricuspid valve surgery (OR 2.59, 95% CI 1.09–6.10, p = 0.03). As a result of multivariable analysis, the final model included aortic cross-clamping time and Logistic EuroSCORE II.Use of vasopressors and inotropes on the first day after surgical intervention was associated with an increase of the following parameters: duration of mechanical ventilation (p = 0.013), length of stay in the intensive care unit (p = 0.001), hospital length of stay (p = 0.003), and total postoperative blood loss (p = 0.005).Conclusion. Aortic cross-clamping time and Logistic EuroSCORE II have an independent predictive value for determining the risk of acute heart failure after cardiac surgery. Received 7 February 2022. Revised 29 March 2022. Accepted 11 April 2022. Funding. The study had no sponsorship. Conflict of interest. Authors declare no conflict of interest. Ethics approval. The local ethics committee of Saint Petersburg State University approved the study (protocol No. 3/2019). Contribution of the authors. The authors contributed equally to this article.