Predictive Risk Factors for Postoperative Respiratory Failure in Patients Undergoing Valvular Surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MENG Yi , DONG Yifei , DONG Shuqiang

Department of Cardiovascular Surgery, Lanzhou General Hospital of PLA, Lanzhou 730050, P. R. China;;
Email：menggyi@163. com.;

Corresponding author：

Keywords：

Valvular surgery; Postoperative respiratory failure; Risk factors

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Abstract： Objective To analyze risk factors associated with postoperative respiratory failure in patients with valvular surgery. Methods Between January 2001 and November 2010, clinical data of 618 patients with 339 males and 279 fameles at age of 10-74（44.01±13.95）years,undergoing valvular operations were investigated retrospectively. We divided the patients into two groups according to the presence （74 patients）or absence（544 patients）of postoperative respiratory failure. Its risk factors were evaluated by univariate and multivariate logistic regression analysis. Results The hospital mortality rate of valvular surgery was 6.1%（38/618）.The morbidity rate of respiratory failure was 12.0%（74/618） with hospital mortality rate at 17.6%（13/74） which was significantly higher than those patients without postoperative respiratory failure at 4.6%（25/544, χ2=18.994, P=0.000）. Univariate analysis showed age＞ 65 years（P=0.005）, New York Heart Association（NYHA）classⅣ（P=0.014）, election fraction＜ 50.0%（P=0.003）, cardiopulmonary bypass time＞ 3 h（P=0.001）, aortic cross clamping time＞ 2 h（P=0.008）, concomitant operation（ valvular operation with coronary artery bypass grafting, Bentall or radiofrequency ablation maze operation（P=0.000）, reoperation（P=0.012）, postoperative complications （P=0.000）, and blood transfusion＞ 2 000 ml（P=0.000） were important risk factors for postoperative respiratory failure. Multivariate logistic regression showed that concomitant operation（P=0.003）, reoperation（P=0.010）, postoperative complications（P=0.000）, and blood transfusion＞2 000 ml（P=0.012）were significant independent predictive risk factors. Conclusion This study suggest that patients with predictive risk factors of postoperative respiratory failure need more carefully treated. The morbidity of these patients would be reduced through improving perioperative management, shortening cardiopulmonary bypass time and reducing postoperative complications.

Citation： MENG Yi,DONG Yifei,DONG Shuqiang,et al .. Predictive Risk Factors for Postoperative Respiratory Failure in Patients Undergoing Valvular Surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(2): 168-171. doi: Copy

1.	Staton GW, Williams WH, Mahoney EM, et al. Pulmonary outcomes of off-pump vs on-pump coronary artery bypass surgery in a randomized trial.Chest, 2005, 127（3）：892-901.
2.	Clark SC. Lung injury after cardiopulmonary bypass. Perfusion, 2006, 21（4）：225-228.
3.	Apostolakis E, Filos K, Koletsis E, et al. Lung dysfunction following cardiopulmonary bypass. J Card Surg, 2010, 25（1）：47-55.
4.	周智恩, 孙小圣, 严善秀, 等.婴幼儿体外循环手术后呼吸功能衰竭的危险因素分析.中国体外循环杂志，2009, 7（3）：129-134.
5.	Filsoufi F, Rahmanian PB, Castillo JG, et al. Predictors and early and late outcomes of respiratory failure in contemporary cardiac surgery. Chest, 2008, 133（3）：713-721.
6.	许建屏, 史艺, 葛翼鹏, 等.瓣膜手术后呼吸功能衰竭的危险因素分析.中华胸心血管外科杂志, 2006, 22（4）：217-219.
7.	Filsoufi F, Rahmanian PB, Castillo JG, et al. Logistic risk model predicting postoperative respiratory failure in patients undergoing valve surgery .Eur J Cardiothorac Surgery, 2008, 34（5）：953-959.
8.	Kolh P, Kerzmann A, Honore C, et al. Aortic valve surgery in octogenarians： predictive factors for operative and long-term results. Eur J Cardiothorac Surg, 2007, 31 （4）：600-606.
9.	Arozullah AM, Daley J, Henderson WG, et al .Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. Ann Surg, 2000, 232（2）： 242-253.
10.	Canver CC, Chanda J. Intraoperative and postoperative risk factors for respiratory failure after coronary bypass. Ann Thorac Surg, 2003, 75（3）：853-857.
11.	Rahmanian PB, Adams DH, Castillo JG, et al. Predicting hospital mortality and analysis of long-term survival after major non-cardiac complications in cardiac surgery patients. Ann Thorac Surg, 2010, 90（4）：1221-1229.
12.	Zingone B, Gatti G, Rauber E, et al. Early and late outcomes of cardiac surgery in octogenarians. Ann Thorac Surg, 2009, 87（1）：71-78.
13.	段亮,肖明第,袁忠祥,等.同期行冠状动脉旁路移植及心瓣膜置换术80例.中国胸心血管外科临床杂志, 2007, 14（3）：169-172.
14.	Murphy GJ, Reeves BC, Rogers CA, et al. Increased mortality, postoperative morbidity, and cost after red blood cell transfusion in patients having cardiac surgery .Circulation, 2007, 116（22）：2544-2552.
15.	Scott BH, Seifert FC, Grimson R. Blood transfusion is associated with increased resource utilisation, morbidity and mortality in cardiac surgery. Ann Card Anaesth, 2008, 11（1）：15-19.
16.	Moskowitz D, McCullough JN, Shander A, et al. The impact of blood conservation on outcomes in cardiac surgery： Is it safe and effective? Ann Thorac Surg, 2010, 90（2）：451-458.

1. 　Staton GW, Williams WH, Mahoney EM, et al. Pulmonary outcomes of off-pump vs on-pump coronary artery bypass surgery in a randomized trial.Chest, 2005, 127（3）：892-901.
2. 　Clark SC. Lung injury after cardiopulmonary bypass. Perfusion, 2006, 21（4）：225-228.
3. 　Apostolakis E, Filos K, Koletsis E, et al. Lung dysfunction following cardiopulmonary bypass. J Card Surg, 2010, 25（1）：47-55.
4. 　周智恩, 孙小圣, 严善秀, 等.婴幼儿体外循环手术后呼吸功能衰竭的危险因素分析.中国体外循环杂志，2009, 7（3）：129-134.
5. 　Filsoufi F, Rahmanian PB, Castillo JG, et al. Predictors and early and late outcomes of respiratory failure in contemporary cardiac surgery. Chest, 2008, 133（3）：713-721.
6. 　许建屏, 史艺, 葛翼鹏, 等.瓣膜手术后呼吸功能衰竭的危险因素分析.中华胸心血管外科杂志, 2006, 22（4）：217-219.
7. 　Filsoufi F, Rahmanian PB, Castillo JG, et al. Logistic risk model predicting postoperative respiratory failure in patients undergoing valve surgery .Eur J Cardiothorac Surgery, 2008, 34（5）：953-959.
8. 　Kolh P, Kerzmann A, Honore C, et al. Aortic valve surgery in octogenarians： predictive factors for operative and long-term results. Eur J Cardiothorac Surg, 2007, 31 （4）：600-606.
9. 　Arozullah AM, Daley J, Henderson WG, et al .Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. Ann Surg, 2000, 232（2）： 242-253.
10. 　Canver CC, Chanda J. Intraoperative and postoperative risk factors for respiratory failure after coronary bypass. Ann Thorac Surg, 2003, 75（3）：853-857.
11. 　Rahmanian PB, Adams DH, Castillo JG, et al. Predicting hospital mortality and analysis of long-term survival after major non-cardiac complications in cardiac surgery patients. Ann Thorac Surg, 2010, 90（4）：1221-1229.
12. 　Zingone B, Gatti G, Rauber E, et al. Early and late outcomes of cardiac surgery in octogenarians. Ann Thorac Surg, 2009, 87（1）：71-78.
13. 　段亮,肖明第,袁忠祥,等.同期行冠状动脉旁路移植及心瓣膜置换术80例.中国胸心血管外科临床杂志, 2007, 14（3）：169-172.
14. 　Murphy GJ, Reeves BC, Rogers CA, et al. Increased mortality, postoperative morbidity, and cost after red blood cell transfusion in patients having cardiac surgery .Circulation, 2007, 116（22）：2544-2552.
15. 　Scott BH, Seifert FC, Grimson R. Blood transfusion is associated with increased resource utilisation, morbidity and mortality in cardiac surgery. Ann Card Anaesth, 2008, 11（1）：15-19.
16. 　Moskowitz D, McCullough JN, Shander A, et al. The impact of blood conservation on outcomes in cardiac surgery： Is it safe and effective? Ann Thorac Surg, 2010, 90（2）：451-458.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Predictive Risk Factors for Postoperative Respiratory Failure in Patients Undergoing Valvular Surgery

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