Post-operative Right Ventricular Failure After Cardiac Surgery: A Cohort Study

Area of Science:

• Cardiology
• Cardiac Surgery
• Critical Care Medicine

Background:

• Right ventricular failure (RVF) post-cardiac surgery is a significant risk factor for morbidity and mortality.
• Accurate diagnosis and understanding of RVF incidence and predictors remain challenging.

Purpose of the Study:

• To investigate the incidence, complications, and associated variables of clinically relevant post-operative RVF.
• To identify pre-operative predictors of RVF in patients undergoing cardiac surgery.

Main Methods:

• A cohort of 3,826 patients undergoing cardiac surgery with cardiopulmonary bypass was analyzed.
• RVF was defined as clinically relevant, indicated by hemodynamic instability requiring specific medical support.
• Multivariable analysis was used to identify independent predictors of post-operative RVF.

Main Results:

• The incidence of clinically relevant post-operative RVF was 2.9% (110 patients).
• RVF was associated with a composite outcome of death, reintubation, stroke, and prolonged ICU stay (OR=3.6).
• Independent predictors included pre-operative atrial fibrillation, reduced left ventricle ejection fraction, elevated systolic pulmonary artery pressure, and mitral/tricuspid valve surgery.

Conclusions:

• Clinically significant post-operative RVF affects 2.9% of patients undergoing cardiac surgery.
• RVF is associated with severe adverse outcomes, emphasizing the need for vigilant monitoring and management.
• Pre-operative factors like atrial fibrillation and valve surgery significantly increase the risk of developing RVF.