Postoperative Changes in Pulmonary Function after Valve Surgery: Oxygenation Index Early after Cardiopulmonary Is a Predictor of Postoperative Course

Abstract

Objective: To determine pulmonary functional changes that predict early clinical outcomes in valve surgery requiring long cardiopulmonary bypass (CPB). Methods: This retrospective study included 225 consecutive non-emergency valve surgeries with fast-track cardiac anesthesia between January 2014 and March 2020. Blood gas analyses before and 0, 2, 4, 8, and 14 h after CPB were investigated. Results: Median age and EuroSCORE II were 71.0 years (25–75 percentile: 59.5–77.0) and 2.46 (1.44–5.01). Patients underwent 96 aortic, 106 mitral, and 23 combined valve surgeries. The median CPB time was 151 min (122–193). PaO2/FiO2 and AaDO2/PaO2 significantly deteriorated two hours, but not immediately, after CPB (both p < 0.0001). Decreased PaO2/FiO2 and AaDO2/PaO2 were correlated with ventilation time (r2 = 0.318 and 0.435) and intensive care unit (ICU) (r2 = 0.172 and 0.267) and hospital stays (r2 = 0.164 and 0.209). Early and delayed extubations (<6 and >24 h) were predicted by PaO2/FiO2 (377.2 and 213.1) and AaDO2/PaO2 (0.683 and 1.680), measured two hours after CPB with acceptable sensitivity and specificity (0.700–0.911 and 0.677–0.859). Conclusions: PaO2/FiO2 and AaDO2/PaO2 two hours after CPB were correlated with ventilation time and lengths of ICU and hospital stays. These parameters suitably predicted early and delayed extubations.

Post-cardiopulmonary bypass hypoxaemia in paediatric patients undergoing congenital heart disease surgery: risk factors, features, and postoperative pulmonary complications

“…Our study showed that intraoperative pleural cavity entry was a significant independent risk factor for hypoxaemia. Our results showed that hypoxaemia in paediatric cardiac surgery occurred very early [0(0-0) hours] after CPB; in most cases (83.8%), it occurred within 2 h. This phenomenon was similar to that observed in adult patients [17], e.g., PaO 2 /FiO 2 decreased significantly 2 h after CPB. Several factors may have contributed to the timing characteristics, as follows: the atelectasis produced in CPB explained most of the markedly increasing intrapulmonary shunting and hypoxaemia in the early post-CPB period (45 min after separation from CPB) [20]; the extravascular lung water increased by 52% after separation from CPB and decreased to the presurgical values 4 h postoperatively [21]; and the lung and chest wall mechanics were mainly affected from 20-30 min to 4 h after separation from CPB [22].…”

“…In studies involving adult patients [10,15,16], the incidence of hypoxaemia (PaO 2 / FiO 2 ≤ 200 as the marker) after CPB cardiac surgery has been reported to range from 30.6% to 54.2%. In a recent study [17], the morbidity of PaO 2 /FiO 2 < 300 measured 2 h after CPB cessation was reported to be as high as 39.1%. Herein, we used PaO 2 /FiO 2 ≤ 300 as the marker of hypoxaemia.…”

Clinical Evaluation of on-Table Extubation in Patients Aged Over 60 Years Undergoing Minimally Invasive Mitral or Aortic Valve Replacement Surgery

“…Compared to patients with a CPB time shorter than 75 min, the perioperative risk of death with a CPB time longer than 75 min increased sharply ( 16 ). Impaired pulmonary gas exchange is a common complication after cardiopulmonary bypass (CPB) ( 6 ). In our study, the mean CPB time in the OTE group was 112.87 ± 18.91 min, compared to 160.77 ± 52.17 min in the DE group.…”

“…The inclusion criteria were as follows: (1) patients above 60 years of age; (2) patients presenting with isolated mitral or aortic valve lesions; (3) Eurscore ≤5 (7). The exclusion criteria were as follows: (1) patients with potential surgical complications, such as severe chest deformity and a history of right chest surgery; (2) patients with femoral arteriovenous malformations; (3) patients with severe valvular heart disease whose cardiac structure form had seriously changed with left ventricular end-diastolic diameter >60 mm or ejection fraction (EF) <50%; (4) patients in poor general condition, accompanied by multiple organ failure, such as patients with New York Heart Association (NYHA) class grade IV heart failure (7), showing no improvement after treatment; (6) patients having emergency surgery, redo-surgery; (7) moderate pulmonary hypertension (pulmonary artery systolic pressure ≥50 mmHg); (8) patients with chronic obstructive pulmonary diseases.…”

“…In our current practice, on-table extubation (OTE) was attempted even for patients who underwent complicated cardiac surgery. The factors that preclude OTE are bleeding, hypothermia, cardiovascular instability, post-operation pain, post-cardiopulmonary bypass (CPB) pulmonary injury leading to reintubation and an increase in morbidity ( 5 , 6 ). This study was undertaken to evaluate the efficacy of on-table extubation versus delayed extubation in terms of postoperative complications, length of stay (LOS) in ICU, patient recovery, and hospital LOS in patients aged over 60 years that received minimally invasive mitral or aortic valve replacement surgery and to evaluate the factors associated with successful implementation of OTE.…”