Univariate risk factors for prolonged mechanical ventilation in patients undergoing prosthetic heart valves replacement surgery

AbstractOBJECTIVESAbsent pulmonary valve syndrome is a rare congenital heart disease with severe airway compression due to dilatation of the pulmonary arteries (PAs). We investigated risk factors for death and prolonged mechanical ventilation (>7 days) and a threshold PA size for these outcomes.METHODSThis retrospective 2-centre cohort study included 68 patients with complete repair between January 1996 and December 2015.RESULTSMedian age at repair was 3.9 months (1.3–8.7 months), and median weight was 5 kg (4–7 kg). The mortality rate before hospital discharge was 12%, and the mortality rate at last follow-up was 19%. In multivariable analysis, risk factors for death were higher Nakata index [hazard ratio (HR) 1.001, 95% confidence interval (CI) 1.001–1.002; P < 0.001] and lower SpO2 (HR 1.06, 95% CI 1.02–1.09; P = 0.002). The accuracy of the Nakata index to predict death was excellent (area under the curve at 6 months: 0.92; P = 0.010). A Nakata index above 1500 mm2/m2 predicted mortality at 6 months with a sensitivity of 98% and a specificity of 82%. Twenty-five patients (37%) had prolonged mechanical ventilation. The only multivariable risk factor for prolonged ventilation was lower weight at repair (odds ratio 2.9, 95% CI 1.3–6.7; P = 0.008). Neither PA plasty nor the LeCompte manoeuvre had a protective effect on mortality or prolonged ventilation. A Nakata index above 1500 mm2/m2 remained a risk factor for mortality (P = 0.022) in patients who had a PA plasty or the LeCompte manoeuvre.CONCLUSIONSIn patients with absent pulmonary valve syndrome, the Nakata index predicts mortality with a cut-off of 1500 mm2/m2. Lower weight at repair is the only multivariable risk factor for prolonged ventilation. Neither PA plasty nor the LeCompte manoeuvre had a protective effect on these outcomes.

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Prevalence of and Risk Factors for Mechanical Ventilation Reinstitution in Patients Weaned From Prolonged Mechanical Ventilation

Respiratory Care ◽

10.4187/respcare.06807 ◽

2019 ◽

Vol 65 (2) ◽

pp. 210-216

Author(s):

Darío Villalba ◽

Gregorio Gil Rossetti ◽

Mariana Scrigna ◽

Jessica Collins ◽

Ana Rocco ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Prolonged Mechanical Ventilation

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Perioperative risk factors for prolonged mechanical ventilation after liver transplantation due to acute liver failure

Korean Journal of Anesthesiology ◽

10.4097/kjae.2013.65.3.228 ◽

2013 ◽

Vol 65 (3) ◽

pp. 228 ◽

Cited By ~ 4

Author(s):

Serin Lee ◽

Hyun Sik Jung ◽

Jong Ho Choi ◽

Jaemin Lee ◽

Sang Hyun Hong ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Liver Transplantation ◽

Liver Failure ◽

Acute Liver Failure ◽

Prolonged Mechanical Ventilation ◽

Perioperative Risk ◽

Perioperative Risk Factors

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175. There Was a Fungus Among Us: A Cohort of Fungal Infectious Endocarditis Cases in East Tennessee

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.250 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S110-S111

Author(s):

Morgan K Morelli ◽

William Lorson ◽

Mahmoud Shorman

Keyword(s):

Risk Factors ◽

Fungal Pathogen ◽

Heart Valves ◽

University Hospital ◽

Prosthetic Heart Valves ◽

Inclusion Criteria ◽

Persons Who Inject Drugs ◽

East Tennessee ◽

High Index Of Suspicion ◽

Healthcare Associated

Abstract Background Fungal infective endocarditis (IE) represents less than 2% of all IE cases, but it carries a mortality rate as high as 50%. While cases of IE are on the rise in recent years due to the increased prevalence of persons who inject drugs (PWID), there are few published studies of fungus as the cause. Candida species is the most likely fungal pathogen in IE. Known risk factors include prosthetic heart valves, healthcare-associated infections, and injection drug use. Since fungi are a rare culprit in endocarditis, there is little information on incidence, treatment recommendations, and outcomes. Methods A retrospective cohort of patients with Candida IE was analyzed between October 2013 and September 2018 at a university hospital in East Tennessee. Demographic, microbiologic, substance use status, mortality, and echocardiographic data were collected. Results Nine patients with Candida IE met inclusion criteria. Mean age was 37, 67% were males. Risk factors included PWID, oral opioid abuse, previous valve surgery and autoimmune disease. 5 (55%) were caused by Candida albicans, 3 (33.3%) Candida paraipsalosis, and 1 (11%) grew both Candida tropicalis and albicans. Valves involved: 4 (66.7%) native tricuspid, 2 (22%) native aortic. 2 (22%) had native mitral, 1 (11%) had both tricuspid and mitral valve involvement. Echinocandins were used in 5 (55%) and 2 (22%) underwent surgery. There was 1 (11%) in-hospital mortality and 2 (22%) within 1 year of discharge (Table 1). Conclusion Fungal IE is a rare disease with high mortality and increasing incidence, especially in PWID. High index of suspicion is required for early diagnosis. Treatment is traditionally a combination of surgery and antifungal therapy. Although, medical treatment alone can be successful in patients who are not surgical candidates, such as in PWID. Disclosures All authors: No reported disclosures.

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Risk factors for and outcomes of prolonged mechanical ventilation in patients received DeBakey type I aortic dissection repairment

Journal of Thoracic Disease ◽

10.21037/jtd-20-2736 ◽

2021 ◽

Vol 13 (2) ◽

pp. 735-742

Author(s):

Min Ge ◽

Zhigang Wang ◽

Tao Chen ◽

Yongqing Cheng ◽

Jiaxin Ye ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Aortic Dissection ◽

Prolonged Mechanical Ventilation ◽

Type I

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Outcome stratification of patients with impaired renal functions after isolated prosthetic mitral valve replacement

GSC Advanced Research and Reviews ◽

10.30574/gscarr.2021.6.1.0135 ◽

2021 ◽

Vol 6 (1) ◽

pp. 009-016

Author(s):

Hassan Salah Hassan ◽

Mohammed Ahmed Elbadawi ◽

Islam Ali Elsayed ◽

Osama Ahmed Arafat

Keyword(s):

Mechanical Ventilation ◽

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Renal Damage ◽

Prolonged Mechanical Ventilation ◽

Replacement Surgery ◽

Renal Functions ◽

Prosthetic Mitral Valve ◽

Valve Replacement Surgery

Objectives: Patients with impaired renal functions have a variable risk of morbidity and mortality in cardiovascular surgery. Poor outcome was reported among patients who underwent valve surgery. Current study is presumed to compare the early outcomes of patients having different degrees of impaired renal functions and undergoing mitral valve replacement surgery. Methods: 135 patients were admitted into the three highly specialized centers in Cairo and Ismailia–Egypt between Dec.2018 and Jan.2020 Preoperative, intraoperative and early post-operative data were recorded. Impairment may present as one of these strata: early reversible (G1-2 included strata 1 & 2 kidney disease patients), moderate G3-4 included strata 3 & 4 kidney disease patients) or advanced irreversible renal damage. (The 5th stratum or G5-KD included end stage renal disease patients undergoing 4-hour hemodialysis sessions, three times a week, with bicarbonate dialysate). We correlated outcome among each stratum with cardiac and renal functions in that stratum. Results: The more is the impairment of renal functions at any peri- operative stage, the longer is the need for prolonged mechanical ventilation and the longer is the hospital stay. We found that levels of serum creatinine were significantly increased postoperatively Also, the more is the reversibility of the renal impairment, even by renal dialysis, the much better is the outcome (P=.0019). We also found insignificant difference between different strata of irreversible renal impairment in the early outcome of the prosthetic mitral valve replacement surgery. The early reversible damage can be repaired peri-operatively. Conclusions: Prosthetic mitral valve replacement among patients with different degrees of impaired renal functions is not only feasible but also it does not seem to add any more deterioration into renal function. Prolonged mechanical ventilation and hospital stay are the only drawbacks of irreversibly impaired renal damage by dialysis or renal transplant.

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