Outcomes after transfer to a tertiary center for postcardiotomy cardiopulmonary failure

Nicholas R. Teman, David S. Demos, Bradley N. Reames, Francis D. Pagani, Jonathan W. Haft

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Background Postcardiotomy shock affects 0.5% to 6% of cardiac operations and is associated with a high mortality. Many of these patients had their procedures performed at lower-volume cardiac surgery centers with limited resources. The objective of this study was to determine the outcomes in patients in postcardiotomy shock who were transferred to a tertiary care center for escalated care. Methods We performed a retrospective review of 104 postcardiotomy shock patients transferred to our institution between 2004 and 2012. Univariable and multivariable analyses were performed to determine predictors of in-hospital and overall survival. Results Seventy-eight percent of patients were receiving temporary mechanical support. The in-hospital mortality in our series was 46%. Multivariable predictors of in-hospital mortality included higher initial creatinine level on arrival and a history of known heart failure. Multivariable predictors of overall mortality included higher initial creatinine and lactate levels, lower initial ejection fraction, and a history of heart failure and hypertension. The Kaplan-Meier estimation of 5-year survival was 39% in all patients and 72% in patients who survived to hospital discharge. Conclusions Patients with postcardiotomy cardiac failure transported to a tertiary care center for advanced cardiac support had a nearly 50% survival, with excellent long-term survival of those discharged alive. Preservation of end-organ function, often with mechanical support, can improve survival.

Original languageEnglish (US)
Pages (from-to)84-90
Number of pages7
JournalAnnals of Thoracic Surgery
Volume98
Issue number1
DOIs
StatePublished - Jul 2014

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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