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

Acute heart failure in the early postoperative period in patients operated on heart valves

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

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

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DOI: https://doi.org/10.24022/1814-6910-2020-17-3-212-221

UDC: 616.12-008.46:616.12-007.1-089

Link: Clinical Physiology of Blood Circulaiton. 2020; 17 (3): 212-221

Quote as: Yudin G.V., Goncharov A.A., Rybka M.M., Mironenko V.A., Rychin S.V., Khinchagov D.Ya. Acute heart failure in the early postoperative period in patients operated on heart valves. Clinical Physiology of Circulation. 2020; 17 (3): 212–21 (in Russ.). DOI: 10.24022/1814-6910-2020-17-3-212-221

Received / Accepted:  17.03.2020/11.04.2020

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Abstract

Objective. To study the character of the clinical course and outcomes of the early postoperative period complicated by acute heart failure, as well as to identify risk factors for the development of this complication in patients with heart valves diseases.

Material and methods. Retrospective, cohort study that included 3919 primary operated patients with heart valves diseases (HVD), divided into two groups: the group with acute heart failure (AHF) – 257 patients and the non-AHF group – 3662 patients. The analysis of the character of the clinical course and outcomes of the early postoperative period was carried out and risk factors for the development of AHF were identified.

Results. The incidence of AHF is 6.6% (257), the mortality rate in the AHF group is 63.8% (164), in the group non-AHF – 0.2% (7), the total mortality from AHF is 4.9%. Risk factors for development of AHF: circulatory failure (CF) 2B stage Vasilenko–Strazhesko (OR 2.1; 95% CI 1.6–2.7, p<0.05), CF functional class (FC) IV NYHA (New York Heart Association) (OR 2.4; 95% CI 1.9–3.1, p<0.05), the presence of chronic renal failure (CRF) (OR 1.8; 95% CI 1.1 to 3.2, p<0.05), type 2 diabetes (OR 1.5; 95% CI of 1.1 to 2.2, p<0.05), coronary heart disease (CHD) (OR 1.7; 95% CI 1.3–2.2, p<0,05), the need for correction of mitral-aortic-tricuspid defect (OR 3.7; 95% CI 2.7–5.0, p<0,05), including coronary artery bypass grafting (CABG) (OR 4.0; 95% CI 2.7–5.9, p<0,05) and mitral-tricuspid defect in combination with CABG (OR 2; 95% CI 1.3–3.2, p<0.05). In the AHF group, the incidence of acute renal failure was 8.6% (22) versus 1.1% (39) in the non-AHF group (p<0.0001), multiply organ failure (MOF) was 67.3% (173) versus 0.2% (8) in the non-AHF group (p<0.0001), and the duration of mechanical lung ventilation (MLV) was 105 (54; 201) hours against 15 (11; 19) hours in the non-AHF group (p<0.0001), the period of stay in the intensive care unit (ICU) – 6 (3; 16) days against 2 (2; 2) days in the non-AHF group (p<0.0001), the length of hospital stay was 18 (10; 27) days and 14 (10; 17) days in the non-AHF group (p<0.0001).

Conclusion. Postoperative AHF causes the development of organ damage with the formation of MOF, an increase in the duration of MLV, the duration of stay in the ICU and the length of hospital stay in patients after correction of HVD, while the risk factors for AHF are the presence of CF 2 B for Vasilenko–Strazhesco, FC IV for NYHA, CRF, type 2 diabetes, CHD, the need to correct trivalvular defects, including in combination with CABG and mitral defects in combination with CABG.

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About Authors

  • Gennadiy V. Yudin, Cand. Med. Sc., Anesthesiologist; orcid.org/0000-0001-9976-6206 
  • Andrey A. Goncharov, Anesthesiologist-Intensivist; orcid.org/0000-0003-2122-7813 
  • Mikhail M. Rybka, Dr. Med. Sc., Professor, Head of Department of Anesthesiology-Intensive Care; orcid.org/0000-0001-8206-8794 
  • Vladimir A. Mironenko, Dr. Med. Sc., Head of Department of Reconstructive Surgery and Aortic Root; orcid.org/0000-0003-1533-6212 
  • Sergey V. Rychin, Dr. Med. Sc., Leading Researcher; orcid.org/0000-0002-5796-6872 
  • Dzhumber Ya. Khinchagov, Cand. Med. Sc., Anesthesiologist-Intensivist; orcid.org/0000-0002-4161-7416

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