Postoperative Changes in Pulmonary Function after Valve Surgery: Oxygenation Index Early after Cardiopulmonary Is a Predictor of Postoperative Course

Objective: To determine pulmonary functional changes that predict early clinical outcomes in valve surgery requiring long cardiopulmonary bypass (CPB). Methods: This retrospective study included 225 consecutive non-emergency valve surgeries with fast-track cardiac anesthesia between January 2014 and March 2020. Blood gas analyses before and 0, 2, 4, 8, and 14 h after CPB were investigated. Results: Median age and EuroSCORE II were 71.0 years (25–75 percentile: 59.5–77.0) and 2.46 (1.44–5.01). Patients underwent 96 aortic, 106 mitral, and 23 combined valve surgeries. The median CPB time was 151 min (122–193). PaO(2)/FiO(2) and AaDO(2)/PaO(2) significantly deteriorated two hours, but not immediately, after CPB (both p < 0.0001). Decreased PaO(2)/FiO(2) and AaDO(2)/PaO(2) were correlated with ventilation time (r(2) = 0.318 and 0.435) and intensive care unit (ICU) (r(2) = 0.172 and 0.267) and hospital stays (r(2) = 0.164 and 0.209). Early and delayed extubations (<6 and >24 h) were predicted by PaO(2)/FiO(2) (377.2 and 213.1) and AaDO(2)/PaO(2) (0.683 and 1.680), measured two hours after CPB with acceptable sensitivity and specificity (0.700–0.911 and 0.677–0.859). Conclusions: PaO(2)/FiO(2) and AaDO(2)/PaO(2) two hours after CPB were correlated with ventilation time and lengths of ICU and hospital stays. These parameters suitably predicted early and delayed extubations.