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Impact of Right Ventricular Performance in Patients Undergoing Extracorporeal Membrane Oxygenation Following Cardiac Surgery
Background: Extracorporeal membrane oxygenation following cardiac surgery safeguards endâorgan 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 riskâprediction 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 60â74), and 74 patients were male. During a median followâup of 27 months (interquartile range 16â63), 75 patients died. Fiftyâone patients died within 30 days, 75 during longâterm followâup (median followâup 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 freeâwall strain was a powerful predictor univariately and after adjustment for clinical variables, Simplified Acute Physiology Scoreâ3, tricuspid regurgitation, surgery type and duration with adjusted hazard ratios of 0.41 (95%CI 0.24â0.68; P=0.001) for 30âday mortality and 0.48 (95%CI 0.33â0.71; P<0.001) for longâterm mortality for a 1âSD (SD=â6%) change in RV freeâwall strain. Combined assessment of the additive EuroSCORE and RV freeâwall strain improved risk classification by a net reclassification improvement of 57% for 30âday mortality (P=0.01) and 56% for longâterm 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 shortâ and longâterm mortality
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