Performance of Severity Indices to Estimate Postoperative Complications of Myocardial Revascularization

Role of Intraoperative Left Ventricular Global Longitudinal Strain in Hemodynamic and Cognitive Outcomes in On-Pump Coronary Artery Bypass Surgery: A Prospective Observational Study

BACKGROUND

The role of left ventricular global longitudinal strain (LVGLS) in coronary artery bypass grafting (CABG) and outcomes such as low cardiac output syndrome (LCOS) is not well established. The authors investigated the relationship between LVGLS before and after induction of anesthesia, their differences, and their relationship with LCOS and other outcomes.

METHODOLOGY

A prospective observational study was conducted in a public/private hospital with 50 adult patients scheduled for on-pump CABG with normal left ventricular ejection fraction (LVEF). Acoustic windows necessary to obtain the 2D-LVGLS were acquired with transthoracic echocardiography (TTE) before induction of anesthesia (LVGLSBI) and after with mechanical ventilation (LVGLSAI) using transesophageal echocardiography (TEE). LCOS was defined as the use of epinephrine, dobutamine, and/or milrinone at minimum IV doses of 1 μg/min-1, 2.5 μg/kg-1/min-1, and 0.375 μg/kg-1/min-1, respectively, for a minimum of 24 h after cardiopulmonary bypass.

RESULTS

A dedicated workstation (EchoPAC Software v203, GE) was used for offline calculation of LVGLS. LVGLSBI did not have a significant correlation with LCOS (mean difference, 1.66; 95% CI, --3.63 to 3.05; P = 0.862), nevertheless, it was an independent risk factor of in-hospital mortality (OR, 0.74; 95% CI, 0.57-0.95; P = 0.02), 3-month mortality (OR, 0.80; 95% CI, 0.64-0.99; P = 0.05), and delirium (OR, 0.65; 95% CI, 0.43-0.97; P = 0.03) in the multivariate analysis. LVGLSAI was also an independent risk factor for 3-month mortality (OR, 0.78; 95% CI, 0.62-0.99; P = 0.04).

CONCLUSIONS

In CABG surgeries, LVGLS was a predictor of adverse outcomes in both awake and anesthetized patients with normal LVEF.

Comparison of vasoactive-inotropic score, vasoactive-ventilation-renal score, and modified vasoactive-ventilation-renal score for predicting the poor prognosis after coronary artery bypass grafting

BACKGROUND

Exploring reliable prediction scoring systems is valuable for the poor prognosis of patients after coronary artery bypass grafting (CABG). Herein, we explored and compared the predictive performance of vasoactive-inotropic score (VIS), vasoactive-ventilation-renal (VVR) score, and modified VVR (M-VVR) score in the poor prognosis of patients undergoing CABG.

METHODS

A retrospective cohort study was performed in Affiliated Hospital of Jining Medical University, and data of 537 patients were collected from January 2019 to May 2021. The independent variables were VIS, VVR, and M-VVR. Study endpoint of interest was the poor prognosis. Association between VIS, VVR, M-VVR and poor prognosis was assessed using logistic regression analysis, and odds ratios (OR) and 95% confidence intervals (CIs) were reported. The performance of VIS, VVR, and M-VVR to predict the poor prognosis was assessed by calculating the area under the curve (AUC), and differences of the AUC of the three scoring systems were compared using DeLong test.

RESULTS

After adjusting gender, BMI, hypertension, diabetes, surgery methods, and left ventricular ejection fraction (LVEF), VIS (OR: 1.09, 95%CI: 1.05-1.13) and M-VVR (OR: 1.09, 95%CI: 1.06-1.12) were associated with the increased odds of poor prognosis. The AUC of M-VVR, VVR, and VIS was 0.720 (95%CI: 0.668-0.771), 0.621 (95%CI: 0.566-0.677), and 0.685 (95%CI: 0.631-0.739), respectively. DeLong test displayed that the performance of M-VVR was better than VVR (P = 0.004) and VIS (P = 0.003).

CONCLUSIONS

Our study found the good prediction performance of M-VVR for the poor prognosis of patients undergoing CABG, indicating that M-VVR may be a useful prediction index in the clinic.