Impact of Right Ventricular Performance in Patients Undergoing Extracorporeal Membrane Oxygenation Following Cardiac Surgery

Philipp E Bartko, Dominik Wiedemann, Lore Schrutka, Christina Binder, Carlos G Santos-Gallego, Andreas Zuckermann, Barbara Steinlechner, Herbert Koinig, Gottfried Heinz, Alexander Niessner, Daniel Zimpfer, Günther Laufer, Irene M Lang, Klaus Distelmaier, Georg Goliasch

Research output: Journal article (peer-reviewed)Journal article

12 Citations (Scopus)

Abstract

BACKGROUND: Extracorporeal membrane oxygenation following cardiac surgery safeguards end-organ oxygenation but unfavorably alters cardiac hemodynamics. Along with the detrimental effects of cardiac surgery to the right heart, this might impact outcome, particularly in patients with preexisting right ventricular (RV) dysfunction. We sought to determine the prognostic impact of RV function and to improve established risk-prediction models in this vulnerable patient cohort.

METHODS AND RESULTS: Of 240 patients undergoing extracorporeal membrane oxygenation support following cardiac surgery, 111 had echocardiographic examinations at our institution before implantation of extracorporeal membrane oxygenation and were thus included. Median age was 67 years (interquartile range 60-74), and 74 patients were male. During a median follow-up of 27 months (interquartile range 16-63), 75 patients died. Fifty-one patients died within 30 days, 75 during long-term follow-up (median follow-up 27 months, minimum 5 months, maximum 125 months). Metrics of RV function were the strongest predictors of outcome, even stronger than left ventricular function (P<0.001 for receiver operating characteristics comparisons). Specifically, RV free-wall strain was a powerful predictor univariately and after adjustment for clinical variables, Simplified Acute Physiology Score-3, tricuspid regurgitation, surgery type and duration with adjusted hazard ratios of 0.41 (95%CI 0.24-0.68; P=0.001) for 30-day mortality and 0.48 (95%CI 0.33-0.71; P<0.001) for long-term mortality for a 1-SD (SD=-6%) change in RV free-wall strain. Combined assessment of the additive EuroSCORE and RV free-wall strain improved risk classification by a net reclassification improvement of 57% for 30-day mortality (P=0.01) and 56% for long-term mortality (P=0.02) compared with the additive EuroSCORE alone.

CONCLUSIONS: RV function is strongly linked to mortality, even after adjustment for baseline variables and clinical risk scores. RV performance improves established risk prediction models for short- and long-term mortality.

Original languageEnglish
Article numbere005455
JournalJournal of the American Heart Association
Volume6
Issue number8
DOIs
Publication statusPublished - 1 Aug 2017

Keywords

  • Aged
  • Area Under Curve
  • Cardiac Surgical Procedures/adverse effects
  • Echocardiography
  • Extracorporeal Membrane Oxygenation/adverse effects
  • Female
  • Hemodynamics
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Proportional Hazards Models
  • ROC Curve
  • Registries
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Ventricular Dysfunction, Right/diagnostic imaging
  • Ventricular Function, Left
  • Ventricular Function, Right
  • Extracorporeal membrane oxygenation
  • Extracorporeal circulation
  • Right ventricular function
  • Right ventricular dysfunction
  • Right ventricle

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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