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

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.