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 Citation (Scopus)

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

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Survival
Shock
Heart Failure
Hospital Mortality
Tertiary Care Centers
Creatinine
Organ Preservation
Mortality
Thoracic Surgery
Lactic Acid
Hypertension

ASJC Scopus subject areas

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

Cite this

Outcomes after transfer to a tertiary center for postcardiotomy cardiopulmonary failure. / Teman, Nicholas R.; Demos, David S.; Reames, Bradley N.; Pagani, Francis D.; Haft, Jonathan W.

In: Annals of Thoracic Surgery, Vol. 98, No. 1, 07.2014, p. 84-90.

Research output: Contribution to journalArticle

Teman, Nicholas R. ; Demos, David S. ; Reames, Bradley N. ; Pagani, Francis D. ; Haft, Jonathan W. / Outcomes after transfer to a tertiary center for postcardiotomy cardiopulmonary failure. In: Annals of Thoracic Surgery. 2014 ; Vol. 98, No. 1. pp. 84-90.
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