Prediction of Post Operative Complication in Patients with Valvular Heart Surgery Based on O2 Challenge Test and A-A Gradient.

Abstract

Patients with valvular heart diseases may have more physiological lung derangements and therefore at current study we studied correlation of O2 challenge, A-AG tests and spirometry values of patients who underwent valve surgery on post op respiratory complications. Method: 180 adult patients undergoing non-emergency cardiac valvular surgery were studied. On operating room all patients had arterial blood gas profile (ABG) at room air, 20 minutes after putting on ventilator with 100% O2, and pump oxygenator. Pulmonary function tests, alveolar Oxygen Pressure, mean Arterial pressure of carbon dioxide and alveolar -arterial gradients measured. Results: FEV1, FVC and FEV1/FVC%, pressure of arterial Blood Gasses (O2 and CO2) with fraction of inspired oxygen of 100% and air (PO2-100 and PO2-air), were significantly different between patients with POPC and patients without POPC (p-value <0.05). Indeed PO2-100 and PO2-air were significantly lower in patients with POPC. A-AG100 (p-value: 0.02) and A -AG21 (p-value: 0.02) were significantly higher in patients with POPC in comparison with patients without POPC. The AUC of A-AG100 for predicting POPC was 0.59 (95% confidence interval (CI) 0.51-0.67). The optimal cut point of A-AG100 was 311 and showed evidence of high relatively sensitivity of 80% and a negative predictive value of 61%. Conclusion: Valvular heart surgery still has significant post op complication and mortality. There is significant correlation between A-AG100, A-AG21 percent, PaO2100, and FEV1/FVC with post op complications in these patients. We recommend measurement of these values in pre op evaluation of patient who need cardiac surgery.