Related Experiment Videos
Right Ventricular Function After Cardiac Surgery Is a Strong Independent Predictor for Long-Term Mortality
Inge T Bootsma1, Fellery de Lange2, Matty Koopmans1
1Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
Insights
Right ventricular dysfunction after cardiac surgery significantly impacts mortality. Lower right ventricular ejection fraction (RVEF) is linked to increased 2-year all-cause mortality in cardiac surgery patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Critical Care Medicine
Background:
- Right ventricular dysfunction is a known complication following cardiac surgery.
- Its impact on long-term mortality in a heterogeneous patient population requires further elucidation.
Purpose of the Study:
- To investigate the association between right ventricular ejection fraction (RVEF) and all-cause mortality after cardiac surgery.
- To identify risk factors associated with impaired RVEF in this patient cohort.
Main Methods:
- Retrospective analysis of 1,109 cardiac surgery patients over a 4-year period.
- Continuous RVEF monitoring using pulmonary artery catheters in the first 24 postoperative hours.
- Assessment of 2-year all-cause mortality as the primary outcome.
Main Results:
- A significant difference in 2-year mortality was observed across RVEF subgroups: 4.1% (>30%), 8.2% (20-30%), and 16.7% (<20%) (p < 0.001).
- Independent predictors of mortality included lower RVEF (continuous and <20% categories).
- Additional risk factors identified were age, body weight, NYHA class, COPD, poor LV function, and higher risk scores.
Conclusions:
- Right ventricular function, assessed by RVEF, is an independent predictor of 2-year all-cause mortality in diverse cardiac surgery patients.
- Impaired RVEF is a critical indicator of prognosis post-cardiac surgery.
Objective:
To establish the all-cause mortality of right ventricular dysfunction after cardiac surgery in a heterogeneous group of cardiac surgery patients.
Design:
Retrospective analysis of a heterogeneous group of 1,109 cardiac surgery patients in a 4-year period.
Setting:
Single-center study in a tertiary teaching hospital.
Participants:
One thousand one hundred nine cardiac surgery patients. By protocol, patients were monitored with a pulmonary artery catheter, enabling continuous right ventricular ejection fraction (RVEF) measurements.
Interventions:
None.
Measurements And Main Results:
Measurements were performed once per minute for the first 24 postoperative hours and expressed as average over the complete period. Primary outcome was 2-year all-cause mortality. RVEF was categorized into 3 subgroups: <20%, 20-30%, and >30%. Median follow-up time was 739 days. Two-year mortality was significantly different across groups: 4.1% for patients with RVEF >30%, 8.2% in the group with RVEF 20-30%, and 16.7% for patients with RVEF <20%, p < 0.001. Additional risk factors for a poor RVEF were age, body weight, New York Heart Association class, chronic obstructive pulmonary disease, poor left ventricular function, and higher risk scores (Acute Physiology and Chronic Health Evaluation and European System for Cardiac Operative Risk Evaluation). In a multivariate analysis, RVEF as a continuous variable was associated independently with the primary outcome (odds ratio 0.95 confidence interval 0.91-0.99, p = 0.011.) Odds ratios for RVEF <20% were 1.88 (confidence interval 1.18-3.00, p = 0.008).
Conclusions:
Right ventricular function is associated independently with 2-year all-cause mortality in a heterogenic cardiac surgery population.