AUTHOR=Levy David , Laghlam Driss , Estagnasie Philippe , Brusset Alain , Squara Pierre , Nguyen Lee S. 

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

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.667328

DOI=10.3389/fcvm.2021.667328

ISSN=2297-055X

ABSTRACT=Introduction. Right ventricular failure (RVF) after cardiac surgery is an important risk factor of morbidity and mortality. Its diagnosis is challenging and thus, its incidence and predictors are not well-established. We investigated incidence, complications, and variables associated with clinically relevant postoperative RVF. 
Methods. We included all patients who underwent cardiac surgery with cardiopulmonary bypass, between 2016 and 2019 in a cardiac surgery center with standardized diagnostic and therapeutic management of RVF. RVF was considered only if clinically relevant: associated with hemodynamic instability requiring catecholamine support and inhaled nitric oxide relayed by sildenafil.
Results. Overall, 3826 patients were included, of whom, 110 (2.9%) developed postoperative RVF. Mortality was not different among patients who developed postoperative RVF, compared to the rest of the cohort (1.8% vs. 0.7%, p = 0.17). Using a composite outcome which combined death, reintubation, stroke and prolonged ICU stay (more than 14 days) yielded an incidence of 6.6% and RVF was associated with this composite outcome with an odds-ratio of 3.6 (2.2-5.8), p<0.001. In a multivariable model, preoperative variables independently associated with postoperative RVF were: preoperative atrial fibrillation (adjusted odds-ratio (adjOR) 3.22 (95% confidence interval (95CI)=1.94-5.36), p<0.001), left ventricle ejection fraction below 50% (adjOR=2.55 (95CI=1.52-4.33), p<0.001), systolic pulmonary artery pressure above 55 mmHg (adjOR=8.64 (95CI=5.27-14.1); p<0.001, mitral valve surgery (adjOR=2.17 CI (95CI=1.28-3.66), p=0.004) and tricuspid valve surgery (adjOR=10.33 (95CI=6.14-17.4), p<0.001). In patients who developed postoperative RVF requiring treatment, 32 (29.1%) showed RV dysfunction before surgery.
Conclusion. In this cohort study, 2.9% patients developed clinically significant postoperative RVF. Moreover, RVF was associated with severe adverse outcomes including death, strokes, reintubation and prolonged ICU stay.