Different characteristics of postoperative heart failure after surgery for aortic stenosis and coronary disease.
OBJECTIVE
Postoperative heart failure (PHF) remains a major determinant of outcome after cardiac surgery. However, possible differences in characteristics of PHF after valve surgery and coronary surgery (CABG) have received little attention. Therefore, this issue was studied in patients undergoing aortic valve replacement (AVR) and CABG, respectively.


METHODS
Three hundred and ninety-eight patients undergoing isolated AVR for aortic stenosis were compared with 398 patients, matched for age and sex, undergoing on-pump isolated CABG. Forty-five AVR and 47 CABG patients required treatment for PHF and these were studied in detail.


RESULTS
The AVR group had longer aortic cross-clamp time and higher rate of isolated right ventricular heart failure postoperatively. Myocardial ischemia during induction and perioperative myocardial infarction were more common in the CABG group. One-year mortality was 8.9% in the AVR group vs 25.5% in the CABG group (p = 0.05).


CONCLUSIONS
The incidence of PHF was similar in both groups but different characteristics were found. Isolated right ventricular failure and PHF precipitated by septicemia were more common in AVR patients. PHF was more clearly associated with myocardial ischemia and infarction in CABG patients, which could explain their less favorable survival.
Vánky
Farkas
F
Department of Cardiothoracic Surgery, Linköping Heart Center, University Hospital, Linköping, Sweden.
Håkanson
Erik
E
Maros
Tamás
T
Svedjeholm
Rolf
R
D000368:Aged; D001024:Aortic Valve Stenosis / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D003327:Coronary Disease / Q000601:surgery*; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000401:mortality*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality* / Q000503:physiopathology*; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology