1
|
Wang D, Wang S, Wu J, Le S, Xie F, Li X, Wang H, Huang X, Du X, Zhang A. Nomogram Models to Predict Postoperative Hyperlactatemia in Patients Undergoing Elective Cardiac Surgery. Front Med (Lausanne) 2021; 8:763931. [PMID: 34926506 PMCID: PMC8674505 DOI: 10.3389/fmed.2021.763931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/03/2021] [Indexed: 12/15/2022] Open
Abstract
Objectives: Postoperative hyperlactatemia (POHL) is common in patients undergoing cardiac surgery and is associated with poor outcomes. The purpose of this study was to develop and validate two predictive models for POHL in patients undergoing elective cardiac surgery (ECS). Methods: We conducted a multicenter retrospective study enrolling 13,454 adult patients who underwent ECS. All patients involved in the analysis were randomly assigned to a training set and a validation set. Univariate and multivariate analyses were performed to identify risk factors for POHL in the training cohort. Based on these independent predictors, the nomograms were constructed to predict the probability of POHL and were validated in the validation cohort. Results: A total of 1,430 patients (10.6%) developed POHL after ECS. Age, preoperative left ventricular ejection fraction, renal insufficiency, cardiac surgery history, intraoperative red blood cell transfusion, and cardiopulmonary bypass time were independent predictors and were used to construct a full nomogram. The second nomogram was constructed comprising only the preoperative factors. Both models showed good predictive ability, calibration, and clinical utility. According to the predicted probabilities, four risk groups were defined as very low risk (<0.05), low risk (0.05–0.1), medium risk (0.1–0.3), and high risk groups (>0.3), corresponding to scores of ≤ 180 points, 181–202 points, 203–239 points, and >239 points on the full nomogram, respectively. Conclusions: We developed and validated two nomogram models to predict POHL in patients undergoing ECS. The nomograms may have clinical utility in risk estimation, risk stratification, and targeted interventions.
Collapse
Affiliation(s)
- Dashuai Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Su Wang
- Department of Emergency Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jia Wu
- Key Laboratory for Molecular Diagnosis of Hubei Province, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sheng Le
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fei Xie
- Department of Cardiovascular Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ximei Li
- Department of Nursing, Huaihe Hospital of Henan University, Kaifeng, China
| | - Hongfei Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaofan Huang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinling Du
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Anchen Zhang
- Department of Cardiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
2
|
Kesävuori RI, Vento AE, Lundbom NMI, Iivonen MRM, Huuskonen AS, Raivio PM. Unilateral pulmonary oedema after minimally invasive and robotically assisted mitral valve surgery. Eur J Cardiothorac Surg 2021; 57:504-511. [PMID: 31596497 DOI: 10.1093/ejcts/ezz271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/29/2019] [Accepted: 09/02/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Unilateral pulmonary oedema (UPO) is a severe complication of minimally invasive cardiac surgery. UPO rates and UPO-related mortality vary considerably between different studies. Due to lack of consistent diagnostic criteria for UPO, the aim of this study was to create a reproducible radiological classification for UPO. Also, risk factors for UPO after robotic and minimally invasive mitral valve operations were evaluated. METHODS Two hundred and thirty-one patients who underwent elective minimally invasive mitral valve surgery between January 2009 and March 2017 were evaluated. Chest radiographs of the first postoperative morning were categorized into 3 UPO grades based on the severity of radiological signs of pulmonary oedema described in this study. The radiographs were analysed by 2 independent radiologists and interobserver agreement was evaluated. The clinical significance of the classification was evaluated by comparing postoperative PaO2/FiO2 values and total ventilation times between the different UPO grades. Also, multivariable logistic regression analysis was employed to identify risk factors for UPO. RESULTS Interobserver agreement was substantial (Kappa = 0.780). Median total ventilation times were significantly longer with increasing severity of UPO, 15 (interquartile range 12-18) h for no UPO, 18 (interquartile range 15-24) h for grade I UPO and 25 (interquartile range 21-31) h for grade II UPO. Pulmonary hypertension [adjusted odds ratios (AOR) 2.51, 95% confidence intervals (CI) 1.43-4.40; P = 0.001], moderate or severe heart failure (AOR 2.88, 95% CI 1.27-6.53; P = 0.011), body mass index (AOR 1.14, 95% CI 1.02-1.28; P = 0.017) and cardiopulmonary bypass time (AOR 1.02, 95% CI 1.01-1.03; P < 0.001) were identified as independent risk factors for UPO and robotic approach (AOR 0.27, 95% CI 0.12-0.62; P = 0.002) as protective against UPO. CONCLUSIONS Due to the variability of the diagnostic criteria for UPO in previous studies, a radiological classification for UPO is required to reliably assess the rates and risk factors for UPO. The radiological classification described in this study demonstrated high interobserver agreement and correlated with total ventilation times and postoperative PaO2/FiO2 values.
Collapse
Affiliation(s)
- Risto I Kesävuori
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.,Department of Radiology, HUS Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland
| | - Antti E Vento
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Nina M I Lundbom
- Department of Radiology, HUS Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland
| | - Mikko R M Iivonen
- Department of Radiology, HUS Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland
| | - Antti S Huuskonen
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Peter M Raivio
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
3
|
Puehler T, Friedrich C, Lutter G, Kornhuber M, Salem M, Schoettler J, Ernst M, Saad M, Seoudy H, Frank D, Schoeneich F, Cremer J, Haneya A. Outcome of Unilateral Pulmonary Edema after Minimal-Invasive Mitral Valve Surgery: 10-Year Follow-Up. J Clin Med 2021; 10:2411. [PMID: 34072399 PMCID: PMC8198899 DOI: 10.3390/jcm10112411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/17/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022] Open
Abstract
The study was approved by the institutional review board (IRB) at the University Medical Center Campus Kiel, Kiel, Germany (reference number: AZ D 559/18) and registered at the German Clinical Trials Register (reference number: DRKS00022222). OBJECTIVE Unilateral pulmonary edema (UPE) is a complication after minimally invasive mitral valve surgery (MIMVS). We analyzed the impact of this complication on the short- and long-term outcome over a 10-year period. METHODS We retrospectively observed 393 MIMVS patients between 01/2009 and 12/2019. The primary endpoint was a radiographically and clinically defined UPE within the first postoperative 24 h, secondary endpoints were 30-day and long-term mortality and the percentage of patients requiring ECLS. Risk factors for UPE incidence were evaluated by logistic regression, and risk factors for mortality in the follow-up period were assessed by Cox regression. RESULTS Median EuroSCORE II reached 0.98% in the complete MIMVS group. Combined 30-day and in-hospital mortality after MIMVS was 2.0% with a 95, 93 and 77% survival rate after 1, 3 and 10 years. Seventy-two (18.3%) of 393 patients developed a UPE 24 h after surgery. Six patients (8.3%) with UPE required an extracorporeal life-support system. Logistic regression analysis identified a higher creatinine level, a worse LV function, pulmonary hypertension, intraoperative transfusion and a longer aortic clamp time as predictors for UPE. Combined in hospital mortality and 30-day mortality was slightly but not significantly higher in the UPE group (4.2 vs. 1.6%; p = 0.17). Predictors for mortality during follow-up were age ≥ 70 years, impaired RVF, COPD, drainage loss ≥ 800 mL and length of ventilation ≥ 48 h. During a median follow-up of 4.6 years, comparable survival between UPE and non-UPE patients was seen in our analysis after 5 years (89 vs. 88%; p = 0.98). CONCLUSIONS In-hospital outcome with UPE after MIMVS was not significantly worse compared to non-UPE patients, and no differences were observed in the long-term follow-up. However, prolonged aortic clamp time, worse renal and left ventricular function, pulmonary hypertension and transfusion are associated with UPE.
Collapse
Affiliation(s)
- Thomas Puehler
- Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, Arnold-Heller-Str. 3, House C 2, D-24105 Kiel, Germany; (C.F.); (G.L.); (M.K.); (M.S.); (J.S.); (M.E.); (F.S.); (J.C.); (A.H.)
- DZHK (German-Centre for Cardiovascular-Research), Partner Site Hamburg/Kiel/Lübeck, D-24105 Kiel, Germany;
| | - Christine Friedrich
- Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, Arnold-Heller-Str. 3, House C 2, D-24105 Kiel, Germany; (C.F.); (G.L.); (M.K.); (M.S.); (J.S.); (M.E.); (F.S.); (J.C.); (A.H.)
| | - Georg Lutter
- Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, Arnold-Heller-Str. 3, House C 2, D-24105 Kiel, Germany; (C.F.); (G.L.); (M.K.); (M.S.); (J.S.); (M.E.); (F.S.); (J.C.); (A.H.)
- DZHK (German-Centre for Cardiovascular-Research), Partner Site Hamburg/Kiel/Lübeck, D-24105 Kiel, Germany;
| | - Maike Kornhuber
- Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, Arnold-Heller-Str. 3, House C 2, D-24105 Kiel, Germany; (C.F.); (G.L.); (M.K.); (M.S.); (J.S.); (M.E.); (F.S.); (J.C.); (A.H.)
| | - Mohamed Salem
- Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, Arnold-Heller-Str. 3, House C 2, D-24105 Kiel, Germany; (C.F.); (G.L.); (M.K.); (M.S.); (J.S.); (M.E.); (F.S.); (J.C.); (A.H.)
| | - Jan Schoettler
- Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, Arnold-Heller-Str. 3, House C 2, D-24105 Kiel, Germany; (C.F.); (G.L.); (M.K.); (M.S.); (J.S.); (M.E.); (F.S.); (J.C.); (A.H.)
| | - Markus Ernst
- Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, Arnold-Heller-Str. 3, House C 2, D-24105 Kiel, Germany; (C.F.); (G.L.); (M.K.); (M.S.); (J.S.); (M.E.); (F.S.); (J.C.); (A.H.)
| | - Mohammed Saad
- Department of Internal Medicine III, Cardiology and Angiology, Campus Kiel, University-Medical-Center Schleswig-Holstein, D-24105 Kiel, Germany; (M.S.); (H.S.)
| | - Hatim Seoudy
- Department of Internal Medicine III, Cardiology and Angiology, Campus Kiel, University-Medical-Center Schleswig-Holstein, D-24105 Kiel, Germany; (M.S.); (H.S.)
| | - Derk Frank
- DZHK (German-Centre for Cardiovascular-Research), Partner Site Hamburg/Kiel/Lübeck, D-24105 Kiel, Germany;
- Department of Internal Medicine III, Cardiology and Angiology, Campus Kiel, University-Medical-Center Schleswig-Holstein, D-24105 Kiel, Germany; (M.S.); (H.S.)
| | - Felix Schoeneich
- Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, Arnold-Heller-Str. 3, House C 2, D-24105 Kiel, Germany; (C.F.); (G.L.); (M.K.); (M.S.); (J.S.); (M.E.); (F.S.); (J.C.); (A.H.)
| | - Jochen Cremer
- Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, Arnold-Heller-Str. 3, House C 2, D-24105 Kiel, Germany; (C.F.); (G.L.); (M.K.); (M.S.); (J.S.); (M.E.); (F.S.); (J.C.); (A.H.)
- DZHK (German-Centre for Cardiovascular-Research), Partner Site Hamburg/Kiel/Lübeck, D-24105 Kiel, Germany;
| | - Assad Haneya
- Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, Arnold-Heller-Str. 3, House C 2, D-24105 Kiel, Germany; (C.F.); (G.L.); (M.K.); (M.S.); (J.S.); (M.E.); (F.S.); (J.C.); (A.H.)
| |
Collapse
|