Abstract
SATO, N., UCHIDA, N., MIURA, M., OHMI, M., FUKUJU, T., TABAYASHI, K., HANEDA, K. and MOHRI, H. Risk Analysis of Low Cardiac Output Syndrome after Valve Replacement. Tohoku J. Exp. Med., 1993, 171 (1), 77-88-In order to obtain a better understanding of the pathogenesis of the postoperative low cardiac output syndrome (LOS), a multivariate regression analysis was performed, evaluating predictive risk factors quantitatively as a function of plural preoperative variables. A total of 145 cases including 76 MVR (MS 36 MR 40), 42 AVR and 27 DVR were analized in this study. Ten historical, 10 hemodynamic and 4 operative risk factors were collected to compose the data file with corresponding status of postoperative cardiac function which was classified as follows. Patients who were not associated with postoperative LOS (Score 1), associated with the LOS which required and responded to ordinal dosage of a catecholamine (Score 2) associated with the LOS which required and responded to maximal dosage of the catecholamine and/or mechanical circulatory support (Score 3), and died of LOS (Score 4). Variables with significant relationships to postoperative LOS, regression equation to LOS score and their multiple correlation coefficients (R) of each group were as follows. MVR group: technical trouble (TT), extracerporeal circulation time (ECCT), change of myocardial preservation methods, ΔLVSWI/ΔLVEDP, diseased duration, aortic cross clamping time, CTR, Y=-1.16+ 1.01(TT)+0.05(ECCT)+0.16(ΔLVSWI/ΔLVEDP)+0.02(CTR), R=0.76. AVR group: LVMMI, ECCT, cardiac failure, NYHA, Y=-0.71+ 0.03(LVMMI)+0.004(ECCT)+0.22(NYHA), R=0.78. DVR group: ΔLVWI/ΔLVEDP, LVMMI, NYHA, LV diastolic eccentricity ratio, ECCT, Y=-0.50+0.60 (ΔLVWI/ΔLVEDP)+0.003(LVMMI)+1.18(NYHA)+0.38(ΔLVSWI/ΔLVEDP)+0.003(ECCT), R=0.87. It was demonstrated that preoperative ergometer exercise study during cardiac catheterization was useful in prediction of postoperative outcomes, especially in the MVR (MS) group.
