Right Ventricular Function After Cardiac Surgery Is a Strong Independent Predictor for Long-Term Mortality

Abstract

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.

Keywords: cardiac surgery; mortality; right ventricular function; thermodilution.

Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.