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

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.

Table 2 Outcome.

Conclusions

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