Risk factors, resource use, and cost of postoperative low cardiac output syndrome

Duncan, Andra E.; Kartashov, Alex; Robinson, Scott B.; Randall, Doug; Zhang, Kan; Luber, John M.; James, Roberta; Halvorson, Sven; Bokesch, Paula M.

doi:10.1016/j.jtcvs.2020.06.125

Cited by 31 publications

(32 citation statements)

References 22 publications

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“…Low cardiac output syndrome was selected as an important clinically relevant outcome because it is associated with a 12-fold increase in risk for postoperative mortality after cardiac surgery, and those with low cardiac output syndrome comprised >60% of postoperative deaths in a large cross-sectional observational analysis of more than 59,000 patients. 9 Fourth-generation troponin T was routinely measured at approximately 2 AM on postoperative day 1 (Elecsys e411, Roche Diagnostics) at the Cleveland Clinic central laboratory. Normal troponin T values are <0.029 ng/mL.…”

Section: End Pointsmentioning

confidence: 99%

Procedure-Specific Relationships Between Postoperative Troponin T and a Composite of Mortality and Low Cardiac Output Syndrome: A Retrospective Cohort Analysis

Zhou¹,

Diehl²,

Sessler³

et al. 2022

Anesthesia &Amp; Analgesia

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BACKGROUND: Myocardial injury after coronary artery bypass grafting (CABG) is defined as troponin concentrations >10 times 99th percentile upper reference limit (URL) according to the Fourth Universal Definition. However, troponin concentrations after non-CABG cardiac surgery which indicate greater-than-expected myocardial injury and increased risk for complications remain unclear. Our goal was to assess procedure-specific relationships between troponin T and a composite outcome of low cardiac output syndrome and in-hospital mortality in cardiac surgical patients. METHODS: Patients having cardiac surgery between January 2010 and December 2017 were categorized into 4 groups by procedure: (1) CABG; (2) mitral valve repair; (3) aortic valve repair/replacement (AVR); (4) mitral valve replacement (MVR) or CABG + valve surgeries. Exclusion criteria were elevated preoperative troponin T, preoperative kidney failure, circulatory arrest, or preoperative/planned mechanical circulatory support. Logistic regression was used to assess the association between troponin T and composite outcome, both overall and by procedure, including assessment of the interaction between procedure and troponin T on outcome. RESULTS: Among 10,253 patients, 37 (0.4%) died and 393 (3.8%) developed the primary outcome. Troponin T concentrations differed by procedure (P < .001). Compared to CABG, AVR had 0.53 (99.2% confidence interval [CI], 0.50-0.56; unadjusted P < .001) times lower troponin T concentrations, while MVR/CABG + valve were 1.54 (99.2% CI, 1.45-1.62, unadjusted P < .001) times higher. There were linear relationships between log 2 troponin T concentration and log odds mortality/low cardiac output syndrome. The (unadjusted) relationships were parallel for various types of surgery (interaction P = .59), but at different levels of the outcome. CONCLUSIONS: The relative increase in odds for mortality/low cardiac output syndrome per a similar increase in troponin T concentrations did not differ among cardiac surgical procedures, but the absolute troponin T concentrations did. Troponin concentrations should thus be interpreted in context of surgical procedure. (Anesth Analg 2022;134:1260-9) KEY POINTS• Question: Do postoperative troponin T concentrations differ by cardiac surgical procedure, and does the relationship between troponin T and postoperative outcomes also vary by procedure? • Findings: Troponin T concentrations after cardiac surgery were significantly different by procedure, though the association between troponin T concentrations and a composite of mortality and low cardiac output syndrome was not different. • Meaning: Postoperative troponin T concentration should be interpreted in the context of cardiac surgical procedure, though risk for mortality/low cardiac output syndrome increased to a similar extent with rising troponin T concentration across all procedures. GLOSSARYASA = American Society of Anesthesiologists; ASD = absolute standardized difference; AVR = aortic valve replacement/repair; BMI = body mass index; BUN = blood...

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Section: End Pointsmentioning

confidence: 99%

Procedure-Specific Relationships Between Postoperative Troponin T and a Composite of Mortality and Low Cardiac Output Syndrome: A Retrospective Cohort Analysis

Zhou¹,

Diehl²,

Sessler³

et al. 2022

Anesthesia &Amp; Analgesia

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“…(1) The need for two or more inotropic agents (epinephrine, milrinone, dobutamine, or high-dose dopamine [more than 5 μg • kg −1 • min − This clinically relevant outcome of low cardiac output syndrome was selected because it was associated with a 12-fold increase in risk for postoperative mortality after cardiac surgery in a large cross-sectional observational analysis that included more than 59,000 patients. 22 Importantly, those with low cardiac output syndrome comprised greater than 60% of postoperative deaths.…”

Section: Perioperative Medicinementioning

confidence: 99%

“…Low cardiac output syndrome is a clinically meaningful outcome, with a specific definition. 22,[25][26][27] There are limitations, however, related to the selection of this outcome. Our definition included the need for two or more inotropic medications at 24 to 48 h, which aims to identify patients who experience sustained myocardial dysfunction/failure after cardiac surgery.…”

Section: Cardiac Outcomes In Morning and Afternoon Surgerymentioning

confidence: 99%

Association between In-hospital Mortality and Low Cardiac Output Syndrome with Morning versus Afternoon Cardiac Surgery

et al. 2021

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Background Recent work suggests that having aortic valve surgery in the morning increases risk for cardiac-related complications. This study therefore explored whether mortality and cardiac complications, specifically low cardiac output syndrome, differ for morning and afternoon cardiac surgeries. Methods The study included adults who had aortic and/or mitral valve repair/replacement and/or coronary artery bypass grafting from 2011 to 2018. The components of the in-hospital composite outcome were in-hospital mortality and low cardiac output syndrome, defined by requirement for at least two inotropic agents at 24 to 48h postoperatively or need for mechanical circulatory support. Patients who had aortic cross-clamping between 8 and 11 am (morning surgery) versus between 2 and 5 pm (afternoon surgery) were compared on the incidence of the composite outcome. Results Among 9,734 qualifying operations, 0.4% (29 of 6,859) died after morning, and 0.7% (20 of 2,875) died after afternoon surgery. The composite of in-hospital mortality and low cardiac output syndrome occurred in 2.8% (195 of 6,859) of morning patients and 3.4% (97 of 2,875) of afternoon patients: morning versus afternoon confounder-adjusted odds ratio, 0.96 (95% CI, 0.75 to 1.24; P = 0.770). There was no evidence of interaction between morning versus afternoon and surgery type (P = 0.965), and operation time was statistically nonsignificant for surgery subgroups. Conclusions Patients having aortic valve surgery, mitral valve surgery, and/or coronary artery bypass grafting with aortic cross-clamping in the morning and afternoon did not have significantly different outcomes. No evidence was found to suggest that morning or afternoon surgical timing alters postoperative risk. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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“…Constrictive pericarditis is a disabling and progressive disease as a result of the fibrous thickening and calcification of the pericardium, due to chronic inflammatory changes from various injuries that impair diastolic filling, reduce cardiac output, and ultimately result in left and right heart failure. Data of pathological classification of constrictive pericarditis, and the association of preoperative pericardial effusion and postoperative low cardiac output syndrome are rare [Depboylu 2017;Melo 2019;Duncan 2020].…”

Section: Introductionmentioning

confidence: 99%

Preoperative Pericardial Effusion is Associated with Low Cardiac Output Syndrome After Pericardiectomy for Constrictive Pericarditis

Wen

et al. 2021

HSF

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Background: Low cardiac output syndrome is the main cause of death after pericardiectomy. Methods: Patients who underwent pericardiectomy for constrictive pericarditis from January 2009 to October 2020 at our hospital were included in the study. Histopathologic studies of pericardium tissue from every patient were performed. All survivors were followed up. Results: Ninety-two consecutive patients underdoing pericardiectomy were included in the study. The incidence of postoperative low cardiac output syndrome was 10.7% (10/92). There were five operative deaths. Mortality and incidence of LCOS in the group with pericardial effusion were significantly higher than those in the group without pericardial effusion. Tuberculosis of the pericardium (60/92, 65.2%) was the most common histopathologic finding in this study. Both univariate and multivariate analyses showed that preoperative pericardial effusion is associated with increased rate of low cardiac output syndrome. Eighty-five survivors were in NYHA class I (85/87, 97.7%), and two were in class II (2/87, 2.3%) at the latest follow up. Conclusions: Preoperative pericardial effusion is associated with low cardiac output syndrome after pericardiectomy. Tuberculosis of the pericardium was the most common histopathologic finding in this study. For constrictive pericarditis caused by tuberculous bacteria, systematic antituberculosis drugs should be given. Preoperative pericardial effusion is associated with increased rate of low cardiac output syndrome. Perfect preoperative preparation is very important to reduce the incidence of postoperative low cardiac output syndrome and mortality. It is very important to use a large dose of diuretics with cardiotonic or vasopressor in a short time after the operation.

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Risk factors, resource use, and cost of postoperative low cardiac output syndrome

Cited by 31 publications

References 22 publications

Procedure-Specific Relationships Between Postoperative Troponin T and a Composite of Mortality and Low Cardiac Output Syndrome: A Retrospective Cohort Analysis

Procedure-Specific Relationships Between Postoperative Troponin T and a Composite of Mortality and Low Cardiac Output Syndrome: A Retrospective Cohort Analysis

Association between In-hospital Mortality and Low Cardiac Output Syndrome with Morning versus Afternoon Cardiac Surgery

Preoperative Pericardial Effusion is Associated with Low Cardiac Output Syndrome After Pericardiectomy for Constrictive Pericarditis

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