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SHR Neuro Krebs Kardio Lipid Stoffw Microb

Bartko, PE; Wiedemann, D; Schrutka, L; Binder, C; Santos-Gallego, CG; Zuckermann, A; Steinlechner, B; Koinig, H; Heinz, G; Niessner, A; Zimpfer, D; Laufer, G; Lang, IM; Distelmaier, K; Goliasch, G.
Impact of Right Ventricular Performance in Patients Undergoing Extracorporeal Membrane Oxygenation Following Cardiac Surgery.
J Am Heart Assoc. 2017; 6(8): Doi: 10.1161/JAHA.116.005455 [OPEN ACCESS]
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Co-Autor*innen der Med Uni Graz
Zimpfer Daniel

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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.
Find related publications in this database (using NLM MeSH Indexing)
Aged - administration & dosage
Area Under Curve - administration & dosage
Cardiac Surgical Procedures - adverse effects, mortality
Echocardiography - administration & dosage
Extracorporeal Membrane Oxygenation - adverse effects, mortality
Female - administration & dosage
Hemodynamics - administration & dosage
Humans - administration & dosage
Kaplan-Meier Estimate - administration & dosage
Male - administration & dosage
Middle Aged - administration & dosage
Predictive Value of Tests - administration & dosage
Proportional Hazards Models - administration & dosage
ROC Curve - administration & dosage
Registries - administration & dosage
Risk Assessment - administration & dosage
Risk Factors - administration & dosage
Time Factors - administration & dosage
Treatment Outcome - administration & dosage
Ventricular Dysfunction, Right - diagnostic imaging, etiology, mortality, physiopathology
Ventricular Function, Left - administration & dosage
Ventricular Function, Right - administration & dosage

Find related publications in this database (Keywords)
extracorporeal circulation
extracorporeal membrane oxygenation
right ventricle
right ventricular dysfunction
right ventricular function
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