Prolonged Mechanical Ventilation Following Elective Adult Valve Replacement Incidence, Predictors Factors and Early Outcome

Abstract

Context: Prolonged mechanical ventilation (PMV) is associated with poor outcomes in the short and long term with major economic impact. Aims: This study aimed to determine the incidence, predictors and early outcome of PMV after adult elective valve replacement (EVR) under cardiopulmonary bypass (CPB). Settings and Design: This is single center retrospective study. Methods and Material: Adult patients undergoing EVR under CPB were included. Patients died within 24 hours of surgery were excluded. PMV was defined as a total of mechanical ventilation time ≥ 24 hours. In the case of re-intubation, the cumulative duration of intubation was taken into account. The anesthesia was performed according to standardized protocols and the surgery was performed by the same team. Results: During the Study Period, 328 patients were enrolled. 9.1% (30/328) of patients required PMV. Independent risk factors of PMV included preoperative renal dysfunction (OR: 11.073, (2.680–45.748); p: 0.001), use of Intra aortic counter-pulsation balloon (OR: 52.013, (2.169-1247.02); p: 0.015), and number of inotropic and vasoactive drugs (OR: 3.531, (1.335–9.337); p: 0.011). PMV was associated with a long stay in both intensive care unit (168 hours vs. 48 hours; p: <0.001) and hospital ward (23.50 days vs. 13 days; p: <0.001) and increased hospital mortality (94.1% vs. 5.9%; p: <0.001). Conclusions: The identification of risk factors of PMV after EVR is crucial as it is the first step for a preventive approach to avoid this complication and improve outcome after valve surgery.