Ventilation Dependency after Cardiac Operation for Infective Endocarditis: Risk Factors and Focus on Preoperative Aortic Regurgitation

Introduction: The investigation was to elucidate predictors of ventilation dependency after cardiac operation for infective endocarditis. Methods: Patients with infective endocarditis undergoing cardiac operation were retrospectively investigated. Mechanical ventilation >72 hours was defined as ventilation dependency after cardiac operation. Results: 896 patients with infective endocarditis who underwent cardiac operation were assigned to group of mechanical ventilation ≤72 h (n = 704) and >72 h (n = 192). Multivariate analyses identified age, interval from symptoms to operation, vegetation size, aortic occlusion length, pump length, intensive care unit (ICU) retention length, serum creatinine before and 24 h after surgery, preoperative and postoperative left ventricular end diastolic dimension (LVEDD), preoperative aortic regurgitation and packed red blood cells to be associated with ventilation dependency after cardiac operation; ventilation dependency is significantly related to prolonged ICU stay (>3 d), 1- and 5-year mortality after cardiac operation. All-time mortality (45.3% versus 5.6%, p < 0.001) of mechanical ventilation >72 h group was higher than that of mechanical ventilation ≤72 h group. A significant positive correlation exists between preoperative aortic regurgitation and ventilation dependency after cardiac operation. A value of preoperative aortic regurgitation >5.25 cm2 was 100% sensitive and 64.6% specific for the diagnosis of ventilation dependency after cardiac operation. Conclusions: We found modifiable risk factors of ventilation dependency after cardiac operation including interval from symptoms to operation, vegetation size, aortic occlusion length, pump length, ICU retention length, serum creatinine before and 24 h after operation, preoperative and postoperative LVEDD, preoperative aortic regurgitation and packed red blood cells and optimization of pre-, peri-, and postoperative factors that can reduce incidence of ventilation dependency, contributing to better short- and long-term outcomes.