Volume 3 Supplement 1

ESICM LIVES 2015

Open Access

Right ventricular ejection fraction in postoperative cardiac surgery patients is independently associated with ICU morbidity and mortality

  • IT Bootsma1,
  • F de Lange1, 2,
  • M Koopmans1,
  • J Haenen2,
  • PW Boonstra3 and
  • EC Boerma1
Intensive Care Medicine Experimental20153(Suppl 1):A112

https://doi.org/10.1186/2197-425X-3-S1-A112

Published: 1 October 2015

Introduction

Left ventricular heart failure is a well-known risk factor in cardiac surgery. However, data on the clinical relevance of right ventricular (RV) failure are limited.1

Objectives

To establish the prognostic implications of RV failure in a large series of post cardiac surgery patients.

Methods

We performed a single-centre retrospective analysis of all high risk cardiac surgery patients in a four year period. By protocol these patients were equipped with a pulmonary artery catheter (Vigilance®, Baxter), enabling continuous RV ejection fraction (RVEF) measurements. RVEF was categorized into three subgroups: RVEF < 20%, 20-30% and >30%. Demographic data and hemodynamic variables were recorded. Primary outcome was predefined as the correlation between the average RVEF over the first 24 hours in the ICU and markers of morbidity.

Results

A total of 1115 patients were included. Patient characteristics are summarized in table 1. Patients with an RVEF < 20% had a significant longer duration of mechanical ventilation and lengths of stay in the ICU, higher ICU mortality, and increased use of inotropes and fluids. In a multivariate logistic regression model, RVEF appeared to be an independent risk factor for duration of mechanical ventilation, length of stay ICU, and ICU mortality.

Figure 1

Table 1

Baseline characterstics.

 

RVEF <20% (N = 218)

RVEF 20-30% (N = 750)

RVEF >30% (N = 147)

P-value

Age (years)

74[67-79]

70[63-77]

65[58-73]

< 0.001

Diabetes (%)

18

21

16

0.40

COPD (%)

22

17

12

0.04

NYHA III or IV (%)

50

37

35

0.01

Poor LVEF (%)

21

12

7

< 0.001

Additive euroSCORE 1

8[6-10]

7[5-9]

6[4-8]

< 0.001

Aortic cross-clamp (min)

98[70-128]

97[68-139]

93[65-134]

0.68

CABG (%)

13

12

11

0.43

Data are median [interquartile range] or percentage. RVEF right ventricular ejection fraction. COPD chronic obstructive pulmonary disease. euroSCORE European system for cardiac operative risk. NYHA New York heart association. LVEF left ventricular ejection fraction. CABG coronary-artery bypass grafting.

Table 2

Outcome.

 

RVEF <20% (N = 218)

RVEF 20-30% (N = 750)

RVEF > 30% (N = 147)

P-value

Mechanical ventilation (hours)

5,5[3,5-17,6]a

4,5[3,0-8,0]b

3,5[2,5-5,5]c

< 0,001

Length of stay ICU

2[2-5]a

2[2-3]b

2[2-2]c

< 0,001

Survival ICU (%)

96a

99b

99b

0,01

Use of inotropic drugs (%)

75a

61b

48c

< 0,001

Fluid balance (litres)

1,9[1,2-3,2]a

1,6[0,8-2,8]b

1,1[0,3-2,0]c

< 0,001

Data are median [interquartile range] or percentage. RVEF right ventricular ejection fraction. ICU intensive care unit. Groups are significantly different when p < 0,05. Subscript letters: Different letters indicate a significant difference of p < 0,05 between groups.

Conclusions

A RVEF < 20% is independently associated with increased ICU mortality and morbidity in high risk postoperative cardiac surgery patients.

Authors’ Affiliations

(1)
Intensive Care Medicine, Medical Centre Leeuwarden
(2)
Cardiothoracic Anesthesiology, Medical Centre Leeuwarden
(3)
Cardiothoracic Surgery, Medical Centre Leeuwarden

References

  1. Haddad F, et al: The Right Ventricle in Cardiac Surgery, a Perioperative Perspective: II. Pathophysiology, Clinical Importance, and Management. Anesthesia & Analgesia. 2009, 108: 422-33. 10.1213/ane.0b013e31818d8b92.View ArticleGoogle Scholar

Copyright

© Bootsma et al.; 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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