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Organ failures due to low cardiac output syndrome following open heart surgery
Insights
Low cardiac output syndrome (LOS) after open heart surgery leads to high mortality and organ failure, including respiratory and renal failure. Plasma exchange showed potential in treating multiple organ failure (MOF) in select cases.
Area of Science:
- Cardiovascular Surgery
- Intensive Care Medicine
- Critical Care
Background:
- Open heart surgery patients face risks, including low cardiac output syndrome (LOS).
- LOS significantly increases mortality and leads to various organ failures post-surgery.
Purpose of the Study:
- To investigate organ failures in patients with low cardiac output syndrome (LOS) following open heart surgery.
- To analyze the mortality rates associated with LOS and its complications.
- To evaluate the efficacy of plasma exchange (PE) in managing multiple organ failure (MOF) in LOS patients.
Main Methods:
- Retrospective analysis of 3003 open heart surgery patients from August 1977 to December 1984.
- Identification and classification of organ failures in 669 patients who developed LOS.
- Application of plasma exchange (PE) in 16 patients with multiple organ failure (MOF).
Main Results:
- Low cardiac output syndrome (LOS) occurred in 22.3% of patients, with a persistent high mortality rate of 22.8%.
- Organ failures were common, with respiratory failure (RF) in 49.9%, acute renal failure (ARF) in 29.9%, and hepatic failure (HF) in 18.4%.
- Mortality for patients with RF was 36.8%, and exceeded 50% for other organ failures; PE showed promise in treating MOF, with 3 successful cases.
Conclusions:
- Low cardiac output syndrome (LOS) remains a critical complication of open heart surgery with high mortality and organ failure rates.
- Effective management strategies for LOS-induced organ failures, including respiratory, renal, and hepatic failure, are crucial.
- Plasma exchange (PE) may offer a therapeutic option for patients with multiple organ failure (MOF) secondary to LOS.
Abstract:
During the period from August, 1977 to December, 1984, a total of 3003 patients who received open heart surgery were treated postoperatively at the ICU of National Cardiovascular Center. Low cardiac output syndrome (LOS) developed in 669 (22.3%) patients. Organ failures due to LOS were studied in these patients. Although the overall mortality of postoperative patients was 5.6% and improved to around 4% in the later years, death rate of patients with LOS was persistently high (22.8%) and showed no tendency to improve even in the latest years. Moreover, the clinical results of those LOS patients who developed organ failure were extremely poor; the mortality of patients with respiratory failure (RF) accounted for 36.8% and that of patients with other organ failure exceeded 50%. The incidence of impaired organs in LOS patients was 49.9% in RF, 29.9% in acute renal failure (ARF), 18.4% in hepatic failure (HF), 16.4% in disseminated intravascular coagulation (DIC), 15.5% in central nervous system failure (CNSF), and 11.1% in gastrointestinal bleeding (GIB). Pathophysiological mechanisms as well as the management of these major complications caused by LOS are also discussed. Some patients developed multiple organ failure (MOF). Plasma exchange (PE) was performed on 16 patients who developed MOF. Improvement of various organ functions was obtained and consequently three patients were successfully treated by means of PE. Removal of various substances toxic to organs, supplement of deficient substances and cessation of the vicious cycle produced by the interaction of impaired organs in patients with MOF are major roles of PE in the treatment of MOF.