Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery

The value of systolic pressure in the pulmonary artery as a risk factor for organ dysfunction in patients operated on heart valves

Authors: Yudin G.V., Goncharov A.A., Rybka M.M., Mironenko V.A., Rychin S.V.

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, 121552, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2020-17-2-107-115

UDC: 616.12-007.42

Link: Clinical Physiology of Blood Circulaiton. 2020; 17 (2): 107-115

Quote as: Yudin G.V., Goncharov A.A., Rybka M.M., Mironenko V.A., Rychin S.V. The value of systolic pressure in the pulmonary artery as a risk factor for organ dysfunction in patients operated on heart valves. Clinical Physiology of Circulation. 2020; 17 (2): 107–15 (in Russ.). DOI: 10.24022/1814-6910-2020-17-2-107-115

Received / Accepted:  16.12.2019/26.12.2019

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Abstract

Objective. To determine the effect of increased pulmonary artery pressure on the risk of organ dysfunction in patients operated on heart valves.

Material and methods. The study is single-center, retrospective, randomized. A comparative analysis of the frequency and structure of organ dysfunction in the early postoperative period in 3945 patients with heart valves diseases, divided into 3 groups depending on the presence of high pulmonary artery pressure (PAP) and its value, according to the criteria of the risk scale of cardiac surgery EuroSCORE II: the group of normal PAP (systolic PAP (PAPsyst) not more than 31 mm Hg) – 2655 patients, the group of moderate PAP (PAPsyst 31–55 mm Hg) – 849 patients and the group of high PAP (PAPsyst over 55 mm Hg) – 441 patients.

Results. Increased PAP was a risk factor for early postoperative acute heart failure (odds ratio (OR) 1.9; 95% confidence interval (CI) 1.61–2.19, p<0.05), decreased contractility of the left ventricular myocardium (left ventricular ejection fraction less than 50%) (OR 2.0; 95% CI 1.79–2.29, p<0.05), impaired oxygenating lung function (OR 1.2; 95% CI 1.06–1.34, p<0.05), including acute respiratory distress syndrome (ARDS) (OR 4.0; 95% CI 3.39–4.61, p<0.05) and multiple organ failure (OR 1.8; 95% CI 1.47–2.13, p<0.05). The risk factor for hepatic dysfunction was only high PAP (OR 1.4; 95% CI 1.09–1.71, p<0.05). The presence of elevated PAP doubled postoperative mortality (OR 2.1; 95% CI 1.67–2.53, p<0.05).

Conclusion. Increased PAP is a risk factor for acute heart failure, impaired oxygenating lung function, ARDS, multiple organ failure in the early postoperative period and increased postoperative mortality in patients with heart valves diseases.

References

  1. Рыбка М.М. Аспекты патогенеза синдрома полиорганной недостаточности у кардиохирургических пациентов. Клиническая физиология кровообращения. 2016; 13 (2): 65–74. [Rybka M.M. Aspects of MOD pathogenesis in cardiac surgery patients. Clinical Physiology of Circulaiton. 2016; 13 (2): 65–74 (in Russ.).]
  2. Milot J., Perron J., Lacasse Y., Letourneau L., Létourneau L., Cartier P.C., Maltais F. Incidence and predictors of ARDS after cardiac surgery. Chest. 2001; 119: 884–8. DOI: 10.1378/chest.119.3.884
  3. Chen S.W., Chang C.H., Chu P.H., Chen T.H., Wu V.C., Huang Y.K. et al. Risk factor analysis of postoperative acute respiratory distress syndrome in valvular heart surgery. J. Crit. Care. 2016; 31: 139–43. DOI: 10.1016/j.jcrc.2015.11.002
  4. Rong L.Q., Di Franco A., Gaudino M. Acute respiratory distress syndrome after cardiac surgery. J. Thorac. Dis. 2016; 8 (10): 1177–86. DOI: 10.21037/jtd. 2016.10.74
  5. Chen M., Wang X., Liu S., Xie B., Xue S., Yan Y. et al. A clinical score to predict severe acute kidney injury in chinese patients after cardiac surgery. Nephron. 2019; 142 (4): 291–300. DOI: 10.1159/ 000499345
  6. O'Neal J.B., Shaw A.D. Billings F.T. Acute kidney injury following cardiac surgery: current understanding and future directions. Crit. Care. 2016, 4; 20 (1): 187. DOI: 10.1186/s13054-016-1352-z
  7. Ortega-Loubon C., Fernandez-Molina M., CarrascalHinojal Y., Fulquet-Carreras E. Cardiac surgeryassociated acute kidney injury. Ann. Card. Anaesth. 2016; 19 (4): 687–98. DOI: 10.4103/0971-9784. 191578
  8. Allen S.J. Gastrointestinal complications and cardiac surgery. J. Extra Corpor. Technol. 2014; 46 (2): 142–9. PMCID: PMC4566424
  9. Chaudhry R., Zaki J., Wegner R., Pednekar G., Pednekar G., Tse A., Sheinbaum R. et al. Gastrointestinal complications after cardiac surgery: a nationwide population-based analysis of morbidity and mortality predictors. J. Cardiothorac. Vasc. Anesth. 2017; 31 (4): 1268–74. DOI: 10.1053/j.jvca.2017.04.013
  10.  Viana F.F., Chen Y., Almeida A.A., Baxter H.D., Cochrane A.D., Smith J.A. Gastrointestinal complications after cardiac surgery: 10-year experience of a single Australian centre. ANZ J. Surg. 2013; 83 (9): 651–6. DOI: 10.1111/ans.12134
  11. Maganti M.D., Rao V., Borger M.A., Ivanov J., David T.E. Predictors of low cardiac output syndrome after isolated aortic valve surgery. Circulation. 2005; 112 (9 Suppl.): 1448–52.
  12. Maganti M., Badiwala M., Sheikh A., Scully H., Feindel C., David T.E. Predictors of low cardiac output syndrome after isolated mitral valve surgery. J. Thorac. Cardiovasc. Surg. 2010; 140 (4): 790–6. DOI: 10.1016/ j.jtcvs.2009.11.022
  13. Amabili P., Benbouchta S., Roediger L., Senard M., Hubert M.B., Donneau A.-F., Brichant J.-F. et al. Low cardiac output syndrome after adult cardiac surgery: predictive value of peak systolic global longitudinal strain. Anesth. Analg. 2018; 126 (5): 1476–83. DOI: 10.1213/ANE.0000000000002605
  14.  Maeder M.T., Schoch O.D., Kleiner R., Joerg L., Weilenmann D. Pulmonary hypertension associated with left-sided heart disease. Swiss Med. Wkly. 2017; 147: w14395. DOI: 10.4414/smw.2017.14395
  15. Hoeper M.M., Ghofrani H.A., Grunig E., Klose H., Olschewski H., Rosenkranz S. Pulmonary hypertension. Dtsch. Arztebl. Int. 2017; 114 (5): 73–84. DOI: 10.3238/arztebl.2016.0073
  16. Madeira M., Ranchordas S., Oliveira P., Nolasco T. Pulmonary hypertension in valvular heart disease surgery: risk and prognosis. Rev. Port. Cir. Cardiotorac. Vasc. 2017; 24 (3–4): 117. PMID: 29701349
  17. Nashef S.A., Roques F., Sharples L.D., Nilsson J., Smith C., Goldstone A.R. et al. EuroSCORE II. Eur. J. Cardiothorac. Surg. 2012; 41 (4): 734–44; discussion 744–5. DOI: 10.1093/ejcts/ezs043
  18. Ranieri V.M., Rubenfeld G.D., Thompson B.T., Ferguson N.D., Caldwell E., Fan E. et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012, 20; 307 (23): 2526–33. DOI: 10.1001/ jama.2012.5669

About Authors

  • Gennadiy V. Yudin, Cand. Med. Sc., Anesthesiologist-Intensivist; 0000-0001-9976-6206
  • Andrey A. Goncharov, Anesthesiologist-Intensivist; 0000-0003-2122-7813
  • Mikhail M. Rybka, Dr. Med. Sc., Head of Department of Anesthesiology; 0000-0001-8206-8794
  • Vladimir A. Mironenko, Dr. Med. Sc., Head of Department of Reconstructive Surgery and the Aortic Root; 0000-0003-1533-6212
  • Sergey V. Rychin, Dr. Med. Sc., Leading Researcher; 0000-0002-5796-6872

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