Analysis Of The Risk Factors Of Prolonged Mechanical Ventilation After Heart Valve Replacement In Adults

Objective: The study explores the risk factors for prolonged mechanical ventilation(PMV)during perioperative period of heart valve replacement,as a result of providing guidelines for the prevention and treatment of long-term mechanical ventilation.Methods: A retrospective analysis was conducted to identify risk factors for prolonged mechanical ventilation of the patients who underwent heart valve replacement in the Department of Cadiovascular Surgery in our hospital between September 2012 and September 2017.Results: A total of 502 cases with heart valve replacement were collected,with mechanical ventilation longer than 24 hours assigned in the PMV group(179 cases)and mechanical ventilation less than or equal to 24 hours assigned in the Non-PMV group(333 cases).Our results showed that the incidence rate of PMV was 33.7%,and the average time of mechanical ventilation after heart valve replacement was 29.2±36.4 hours.The risk factors revealed by the univariate analysis included:(1)preoperative: older than 60 years,atrial fibrillation,coronary heart disease,creatinine > 125 μmol/ L,and albumin <30g/L.(2)intraoperative: the complexity of the surgery(tricuspid valve replacement,combined valve replacement,mitral valve replacement,valve replacement combined with coronary artery bypass graft,valve replacement combined with left chamber atrial folding),CPB time,aortic cross clamping time,plasma transfusion volume;and(3)postoperative: creatinine >125 μmol/ L,acute kidney injury,hemoglobin < 90 g/L,transfusion of plasma(especially when over 700 m L),transfusion of red blood cells,albumin <30g/L,and ventilator associated pneumonia.The risk factors revealed by the Binary Logistic regression analysis included: valve replacement combined with coronary artery bypass graft(OR=4.503,95%CI 1.144-17.718,p=0.031);valve replacement combined with left chamber atrial folding(OR=4.859,95%CI 1.312-18.004,p=0.018);postoperative albumin < 30 g/L(OR=1.967,95%CI 1.164-3.323,p=0.012),postoperative transfusion of plasma > 700 m L(OR=4.634,95% CI 2.629-8.169,p=0.000).Conclusion: The risk factors we identified for PMV were as follows: valve replacement combined with coronary artery bypass graft,valve replacement combined with left chamber atrial folding,postoperative albumin < 30g/L,and postoperative transfusion of plasma > 700 m L.