Impact of Subclinical Congestion on Outcome of Patients Undergoing Mitral Valve Surgery
Abstract
:1. Introduction
2. Materials and Methods
2.1. Plasma Volume Equations
2.2. Statistical Analysis
3. Results
3.1. Baseline Characteristics
3.2. Alkaline Phosphatase Metabolism
3.3. Peri-and Postoperative Characteristics
3.4. Adverse Events and Survival
4. Discussion
Limitations
Author Contributions
Funding
Conflicts of Interest
Abbreviations
PVS | Plasma Volume Score |
ECMO | Extracorporeal Membrane oxygenation |
CHF | Chronic Heart Failure |
BMI | Body Mass Index |
AP | Alkaline Phosphatase |
CABG | Coronary Artery Bypass Graft |
References
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Overall Cohort (n = 187) | PVS ≤ 3.1 (n = 127) | PVS > 3.1 (n = 60) | p-Value | |
---|---|---|---|---|
Female, n (%) | 68 (36.4) | 67 (52.8) | 1 (1.7) | 0.000 |
Age, median (±IQR) | 67.0 (15) | 66.0 (16) | 69.0 (14) | 0.161 |
BMI, median (±IQR) | 26.0 (5.5) | 26.8 (6.1) | 24.4 (4.3) | 0.004 |
Logistic EuroSCORE, median (±IQR) | 10.9 (13.2) | 9.1 (13.1) | 13.7 (13.9) | 0.047 |
EuroSCORE II, median (±IQR) | 7.6 (10.0) | 6.8 (8.6) | 10.3 (13.8) | 0.004 |
Active smoker, n (%) | 32 (17.1) | 23 (18.1) | 9 (15.0) | 0.381 |
Chronic heart failure, n (%) | 90 (48.1) | 58 (45.7) | 32 (53.3) | 0.205 |
Hypertension, n (%) | 154 (82.4) | 102 (80.3) | 52 (86.7) | 0.258 |
Dyslipidemia, n (%) | 106 (56.7) | 68 (53.5) | 38 (63.3) | 0.482 |
Diabetes mellitus, n (%) | 59 (31.6) | 37 (29.1) | 22 (36.7) | 0.193 |
Diabetes mellitus (IDDM), n (%) | 12 (6.4) | 4 (3.1) | 8 (13.3) | 0.012 |
Chronic renal insufficiency, n (%) | 39 (20.9) | 19 (15.0) | 20 (33.3) | 0.004 |
Last preoperative creatinine (mg/dL), median (±IQR) | 1.1 (0.4) | 1.0 (0.3) | 1.2 (0.8) | 0.016 |
Preoperative Creatinine Clearance (mL/min), median (±IQR) | 67.3 (38.1) | 70.6 (35.3) | 58.0 (41.8) | 0.013 |
Preoperative dialysis, n (%) | 6 (3.2) | 2 (1.6) | 4 (6.7) | 0.085 |
Previous vascular stroke, n (%) | 19 (10.2) | 11 (8.7) | 8 (13.3) | 0.230 |
Neurological disease, n (%) | 8 (4.3) | 5 (3.9) | 3 (5.0) | 0.503 |
Prior myocardial infarction, n (%) | 75 (40.1) | 45 (35.4) | 30 (50.0) | 0.042 |
Coronary artery disease, n (%) | 115 (61.5) | 70 (55.1) | 45 (75.0) | 0.007 |
Prior CABG, n (%) | 15 (8.0) | 7 (5.5) | 8 (13.3) | 0.120 |
Prior PCI, n (%) | 34 (18.2) | 19 (15.0) | 15 (25.0) | 0.074 |
Prior valve surgery, n (%) | 22 (11.8) | 13 (10.2) | 9 (15.0) | 0.393 |
Thoracic aortic surgery n (%) | 7 (3.7) | 4 (3.1) | 3 (5.0) | 0.497 |
Atrial fibrillation, n (%) | 95 (50.8) | 66 (52.0) | 29 (48.3) | 0.379 |
AV-Block, n (%) | 6 (3.2) | 4 (3.1) | 2 (3.3) | 0.627 |
Prior pacemaker, n (%) | 17 (9.1) | 13 (10.2) | 4 (6.7) | 0.309 |
Prior ICD, n (%) | 9 (4.8) | 5 (3.9) | 4 (6.7) | 0.316 |
Endocarditis, n (%) | 5 (2.7) | 3 (2.4) | 2 (3.3) | 0.516 |
Liver cirrhosis, n (%) | 1 (0.5) | 0 (0.0) | 1 (1.7) | 0.321 |
NYHA class IV, n (%) | 32 (17.1) | 15 (11.8) | 17 (28.3) | 0.001 |
COPD Gold ≥ II, n (%) | 43 (23.0) | 28 (22.0) | 15 (25.0) | 0.389 |
Bronchodilators, n (%) | 40 (21.4) | 25 (19.7) | 15 (25.0) | 0.260 |
Left ventricular function, mean (±SD) | 38.4 (9.3) | 40.0 (8.8) | 36.0 (10.0) | 0.022 |
Severe mitral regurgitation, n (%) | 161 (86.1) | 110 (86.6) | 51 (85.0) | 0.850 |
Primary mitral regurgitation, n (%) | 81 (43.3) | 62 (28.8) | 19 (31.7) | |
Secondary mitral regurgitation, n (%) | 106 (56.7) | 65 (51.2) | 41 (68.3) | |
Moderate or severe tricuspid regurgitation, n (%) | 65 (34.8) | 44 (34.6) | 21 (35.0) | 0.883 |
Systolic pulmonary artery pressure in mmHg, median (±IQR) | 60.0 (34) | 60.0 (34.0) | 61.0 (30.0) | 0.449 |
Hematocrit, mean (±SD) | 37.8 (5.2) | 39.3 (5.1) | 34.8 (4.2) | 0.262 |
Preoperative alkaline phosphatase (AP) U/L, median (±IQR) | 69.0 (34) | 67.0 (31) | 73.5 (36) | 0.012 |
AP 1st post-op day U/L, median (±IQR) | 39.0 (20) | 38.0 (21) | 42.5 (18) | 0.178 |
AP 1st post-op day/preoperative AP %, median (±IQR) | 59.6 (17.2) | 60.3 (17.7) | 56.3 (16.2) | 0.065 |
Consumption of AP in U/L, median (±IQR) | 27.0 (20) | 27.0 (17) | 33.0 (29) | 0.012 |
Time between PVS calculation and surgery in d, median (±IQR) | 2.0 (3) | 2.0 (3) | 3.0 (3) | 0.265 |
Overall Cohort (n = 187) | PVS ≤ 3.1 (n = 127) | PVS > 3.1 (n = 60) | p-Value | |
---|---|---|---|---|
Urgent operation, n (%) | 56 (29.9) | 32 (25.2) | 24 (40.0) | 0.089 |
Cardiogenic shock, n (%) | 5 (2.7) | 2 (1.6) | 3 (5.0) | 0.189 |
Isolated mitral valve repair, n (%) | 17 (9.1) | 14 (11.0) | 3 (5.0) | 0.520 |
Combined mitral valve repair and CABG, n (%) | 47 (25.1) | 28 (22.0) | 19 (31.7) | 0.520 |
Isolated mitral valve replacement, n (%) | 7 (3.7) | 5 (3.9) | 2 (3.3) | 0.520 |
Combined mitral valve replacement and CABG, n (%) | 10 (5.3) | 7 (5.5) | 3 (5.0) | 0.520 |
Combined mitral and atrial fibrillation surgery, n (%) | 41 (21.9) | 34 (26.8) | 7 (11.7) | 0.014 |
Minimal invasive mitral valve procedure, n (%) | 8 (4.3) | 6 (4.7) | 2 (3.3) | 0.497 |
LV aneurysm surgery, n (%) | 3 (1.6) | 2 (1.6) | 1 (1.7) | 0.678 |
Cardiopulmonary bypass in min, mean (±SD) | 176.7 (60.4) | 172.5 (57.9) | 185.4 (65.2) | 0.601 |
Aortic cross clamp time in min, mean (±SD) | 107.4 (35.4) | 107.4 (34.7) | 107.6 (37.2) | 0.847 |
Intraoperative blood products, n (%) | 120 (64.1) | 75 (59.1) | 45 (75.0) | 0.024 |
Intraoperative red blood cell units, mean (±SD) | 2.0 (4.3) | 1.7 (4.8) | 2.5 (3.0) | 0.001 |
Intraoperative fresh frozen plasma units, mean (±SD) | 0.7 (2.2) | 0.5 (1.6) | 1.1 (3.0) | 0.089 |
Intraoperative platelet units, mean (±SD) | 0.41 (2.3) | 0.41 (2.7) | 0.42 (0.8) | 0.027 |
Postoperative blood products, n (%) | 55 (29.4) | 35 (27.6) | 20 (33.3) | 0.261 |
Postoperative red blood cell units, mean (±SD) | 1.0 (3.2) | 0.8 (2.3) | 1.4 (4.6) | 0.552 |
Postoperative fresh frozen plasma units, mean (±SD) | 0.2 (1.3) | 0.2 (0.8) | 0.4 (2.1) | 0.710 |
Postoperative platelet units, mean (±SD) | 0.09 (0.6) | 0.04 (2.6) | 0.18 (1.1) | 0.336 |
Implanted intraaortic balloon pump, n (%) | 1 (0.5) | 0 (0.0) | 1 (1.7) | 0.321 |
Implanted ECMO, n (%) | 20 (10.7) | 9 (7.1) | 11 (18.3) | 0.018 |
Reintubation, n (%) | 13 (7.0) | 6 (4.7) | 7 (11.7) | 0.079 |
Length of stay at ICU (total), median (±IQR) | 5.0 (8.0) | 4.0 (7.0) | 6.0 (11.0) | 0.015 |
Readmission at ICU, n (%) | 13 (7.0) | 7 (5.5) | 6 (10.0) | 0.204 |
Overall Cohort (n = 187) | PVS ≤ 3.1 (n = 127) | PVS > 3.1 (n = 60) | p-Value | |
---|---|---|---|---|
Neurological adverse events | ||||
Transient ischemic attack, n (%) | 1 (0.5) | 0 (0.0) | 1 (1.7) | 0.321 |
Postoperative stroke ≥ 72 h, n (%) | 7 (3.7) | 4 (3.1) | 3 (5.0) | 0.400 |
Continuous Coma ≥ 24 h, n (%) | 4 (2.1) | 3 (2.4) | 1 (1.7) | 0.615 |
Other neurological complications, n (%) | 15 (8.0) | 10 (7.9) | 5 (8.3) | 0.560 |
Renal failure | ||||
Acute Kidney Injury Stage III, n (%) | 16 (8.6) | 10 (7.9) | 6 (10.0) | 0.408 |
Postoperative hemofiltration, n (%) | 13 (7.0) | 8 (6.3) | 5 (8.3) | 0.408 |
Conduction disturbances | ||||
New AV-Block III, n (%) | 10 (5.3) | 7 (5.5) | 3 (5.0) | 0.594 |
New Atrial Fibrillation, n (%) | 36 (19.3) | 23 (18.1) | 13 (21.7) | 0.349 |
Pulmonary adverse events | ||||
Prolonged ventilation (>24 h), n (%) | 49 (26.2) | 27 (21.3) | 22 (36.7) | 0.021 |
Pneumonia, n (%) | 20 (10.7) | 11 (8.7) | 9 (15.0) | 0.146 |
Pulmonary embolism, n (%) | 1 (0.5) | 0 (0.0) | 1 (1.7) | 0.679 |
Miscellaneous adverse events | ||||
Acute peripheral ischemia, n (%) | 2 (1.1) | 1 (0.8) | 1 (1.7) | 0.540 |
Complication of anticoagulation, n (%) | 5 (2.7) | 3 (2.4) | 2 (3.3) | 0.516 |
Gastrointestinal complication, n (%) | 6 (3.2) | 5 (3.9) | 1 (1.7) | 0.373 |
Perioperative myocardial infarction, n (%) | 0 (0.0) | 0 (0.0) | 0 (0.0) | n.s. |
Cardiac tamponade, n (%) | 0 (0.0) | 0 (0.0) | 0 (0.0) | n.s. |
Aortic dissection, n (%) | 0 (0.0) | 0 (0.0) | 0 (0.0) | n.s. |
Multiorgan failure, n (%) | 9 (4.8) | 4 (3.1) | 5 (8.3) | 0.121 |
Cardiac arrest, n (%) | 15 (8.0) | 9 (7.1) | 6 (10.0) | 0.337 |
Reoperations | ||||
Due to bleeding/tamponade, n (%) | 17 (9.1) | 7 (5.5) | 10 (16.7) | 0.016 |
Due to valve dysfunction, n (%) | 5 (2.7) | 3 (2.4) | 2 (3.3) | 0.516 |
Due to other cardiac reason, n (%) | 36 (19.3) | 22 (17.3) | 14 (23.3) | 0.218 |
Due to other non-cardiac reason, n (%) | 25 (13.4) | 12 (9.4) | 13 (21.7) | 0.022 |
Length of stay in days, median (±IQR) | 13.0 (13) | 13.0 (12) | 15.0 (28) | 0.063 |
Hospital mortality n (%) | 19 (10.2) | 8 (6.3) | 11 (18.3) | 0.013 |
30-day all-cause mortality, n (%) | 8 (4.3) | 4 (3.1) | 4 (6.7) | 0.229 |
Hospital readmission within 30 days, n (%) | 10 (5.3) | 4 (3.1) | 6 (10.0) | 0.059 |
Multivariate Analysis | |||
---|---|---|---|
OR | 95% CI | p-Value | |
Demographics | |||
Age | 1.002 | 0.987–1.017 | 0.766 |
Gender | 1.313 | 0.926–1.861 | 0.126 |
Preoperative alkaline phosphatase | 1.001 | 0.995–1.008 | 0.658 |
Logistic EuroSCORE | 1.010 | 0.992–1.028 | 0.268 |
EuroSCORE II | 0.980 | 0.950–1.012 | 0.218 |
Procedure type | 1.44 | 0.969–2.150 | 0.071 |
PVS > 3.1 | 1.833 | 0.999–3.361 | 0.050 |
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Schaefer, A.-K.; Poschner, T.; Andreas, M.; Kocher, A.; Laufer, G.; Wiedemann, D.; Mach, M. Impact of Subclinical Congestion on Outcome of Patients Undergoing Mitral Valve Surgery. Biomedicines 2020, 8, 363. https://doi.org/10.3390/biomedicines8090363
Schaefer A-K, Poschner T, Andreas M, Kocher A, Laufer G, Wiedemann D, Mach M. Impact of Subclinical Congestion on Outcome of Patients Undergoing Mitral Valve Surgery. Biomedicines. 2020; 8(9):363. https://doi.org/10.3390/biomedicines8090363
Chicago/Turabian StyleSchaefer, Anne-Kristin, Thomas Poschner, Martin Andreas, Alfred Kocher, Günther Laufer, Dominik Wiedemann, and Markus Mach. 2020. "Impact of Subclinical Congestion on Outcome of Patients Undergoing Mitral Valve Surgery" Biomedicines 8, no. 9: 363. https://doi.org/10.3390/biomedicines8090363