Early extubation in current valve surgery requiring long cardiopulmonary bypass: Benefits and predictive value of preoperative spirometry

Abstract

Background: Early extubation (EEx) after cardiac surgery has been essentially studied in patients with short cardiopulmonary bypass (CPB). Whether preoperative spirometry can predict EEx remains controversial. Objectives: To investigate whether EEx can be a goal and predicted by preoperative spirometry in valve surgery requiring long CPB. Methods: Nonemergent consecutive 210 patients who underwent valve surgery from January 2014 to August 2019 were investigated retrospectively. Results: EEx (<8 h) was achieved in 93 (44.3%) patients without increasing adverse events. Patients with EEx had shorter ICU and hospital stays than those without EEx. Multivariate analysis showed that higher estimated glomerular filtration rate and mitral valve repair were significant protective factors for EEx. Conversely, moderate and severe chronic obstructive pulmonary disease defined by spirometry, longer operation, CPB, and aortic cross-clamp time were significant risk factors. Conclusions: EEx should be the goal in current valve surgery. Preoperative spirometry is a significant predictor.

Postoperative Changes in Pulmonary Function after Valve Surgery: Oxygenation Index Early after Cardiopulmonary Is a Predictor of Postoperative Course

“…We recently demonstrated that the early extubation rate was lower after valve surgery (approximately 44%) compared with the early extubation rate after relatively simple valve surgery and CABG [ 12 ]. CPB times for our valve surgeries were longer than the CPB times in previous studies [ 13 ]; therefore, pulmonary dysfunction after CPB might contribute to prolonged DMV. In fact, CPB time was an independent predictor of prolonged DMV in several previous studies [ 10 , 11 ].…”

Availability and threshold of the vasoactive-inotropic score for predicting early extubation in adults after rheumatic heart valve surgery: a single-center retrospective cohort study

“…Currently, EEx is widely considered the key objective of enhanced recovery in patients who underwent heart valve surgery with CPB [ 21 ]. Hiromoto et al reported that the incidence of EEx was 44.3% for valve surgery patients receiving CPB [ 19 ]. In the aforementioned study, the percentages of patients who underwent multiple valve surgeries (3.2% vs. 8.9%), MAZE (9.7% vs. 25.0%), and tricuspid valve repair (22.6% vs. 65.2%) in the EEx (+) group were significantly lower than those in the present study; these differences could have led to the prolongation of ACC and CPB durations, thereby increasing the risk of lung damage by initiating a systemic inflammatory response, hemodilution, intrapulmonary shunt, ischemic damage, ischemia-reperfusion, and atelectasis [ 22 , 23 ], resulting in the prolongation of mechanical ventilation support.…”

“…A 44.3% incidence of EEx was assumed based on a previous study [ 19 ]. In addition, a 5% acceptable margin of error and a 95% confidence interval (CI) were used.…”

The predictive value of Pressure Recording Analytical Method for the duration of mechanical ventilation in children undergoing cardiac surgery with an XGboost based machine learning model

“…With relevant trial validation, Most-care has been widely used for monitoring hemodynamic variations of the CHD patients in the perioperative period. On the other hand, although the prolonged DMV is a signi cant sign of worse prognosis and successful early extubation is a goal to promote recovery after cardiac surgery with both medical and economic bene ts [13][14]23], few previous reports have a focus on the heart-lung interaction or explore the in uence of cardiac function on it. Our study initiatively found correlations between the cardiac function presented by hemodynamic parameters and mechanical ventilation status.…”