Prognostic factor for prolonged ventilator usage and ICU occupancy time after mitral valve replacement surgery: a retrospective cohort study

Abstract

This study was conducted to identify the prognostic factors for prolonged
ventilator usage time and ICU occupancy time after mitral valve replacement
(MVR) surgery. It was a retrospective cohort study involving 70 MVR surgery
patients at Dr. Sardjito General Hospital, Yogyakarta, Indonesia during the
period of January 2013 to December 2018. Prognostic factors as independent
variables including age, gender, heart failure, ejection fraction, pulmonary
hypertension, chronic pulmonary disease, active endocarditis, renal
insufficiency, duration of aortic cross clamp (AOX) time and cardiopulmonary
bypass (CPB) time were evaluated. Where as the dependent variables were
the prolongation of ventilator usage time (>24 h) and the intensive care unit
(ICU) occupancy time (>96 h). Of the total 70 studied patients, 25 patients
(35.7%) used ventilator >24 h, meanwhile 15 patients (21.4%) occupied the ICU
>96 h. Patients who used ventilator >24 h had CPB time ≥126.5 min (OR=10;
95%CI=2.581-41.252), renal insufficiency (OR= 14; 95%CI = 1.487-150.970), and
active endocarditis (OR=7; 95%CI = 1.257-45.213). Meanwhile, patients who
occupied the ICU >96 h had age ≥40 years old (OR=6.4; 95% CI = 1.26-15.3),
CPB time ≥126.5 min (OR=5.7; 95% CI = 1.8-38.1), and heart failure with NYHA
functional classification 3 (OR=9.8; (95% CI = 1.4-67.2). In conclusion, the
prognostic factors for prolonged ventilator usage time after MVR surgery are
CPB time ≥126.5 min, renal insufficiency and active endocarditis. Furthermore,
the prognostic factors for prolonged ICU occupancy time are age ≥40 years old,
heart failure with NYHA functional classification 3 and CPB time ≥126.5 min.