Incidence and clinical consequences of right ventricular failure after cardiac surgery.

Bootsma, I.T. (2015) Incidence and clinical consequences of right ventricular failure after cardiac surgery. thesis, Medicine.

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Abstract

Introduction. Left ventricular (LV) heart failure is a well-known risk factor in cardiac surgery. However, data on the clinical relevance of right ventricular (RV) failure are limited. Objectives. To establish the incidence and clinical relevance of RV failure and the relation of RV failure to hemodynamic parameters associated with the RV function 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 incidence of RV failure. Secondary outcome was predefined as the correlation between the average RVEF over the first 24 hours in the ICU and markers of morbidity. Tertiary outcome was the correlation between RVEF, the mean pulmonary artery pressure (mPAP), and postoperative LV function. Results. A total of 1115 patients were included. Incidence of RVEF <20% was 19.6%. Patients with an RVEF <20% had a significant longer duration of mechanical ventilation and length of stay on 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 on the ICU, and ICU mortality. Furthermore, we observed a significant association between RVEF and hemodynamic parameters. Conclusion. A RVEF <20% is associated with increased ICU mortality and morbidity in postoperative cardiac surgery patients.

Item Type:	Thesis (Thesis)
Supervisor name:	Boerma, E.C. MD and Medical Centre of Leeuwarden
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:48
Last Modified:	25 Jun 2020 10:48
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/943

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