title: Preexisting heart failure is an underestimated risk factor in cardiac surgery.
abstract: BACKGROUND
  Heart failure is characterised as a strong risk factor for systemic failure after cardiac surgery. However, the impact has never been substantiated.
  
  
  METHODS
  Patients with heart failure (n = 48) - scheduled for elective ventricular reconstruction or external constraint device-were compared with a one-to-one matched control group of patients without heart failure undergoing cardiac surgery between 2006 and 2009.
  
  
  RESULTS
  As expected, patients with heart failure more frequently experienced complications definitely related to pump failure (p = 0.01). However, complications not related to their pump failure were also more often observed, such as prolonged mechanical ventilation, sepsis and vasoplegia (p = 0.01). Overall, organ dysfunction-circulatory, renal, and pulmonary failure-was often observed in heart failure patients, contributing to a prolonged stay in the intensive care unit (p < 0.001) as well as in hospital (p = 0.01).
  
  
  CONCLUSIONS
  The adverse postoperative course in patients with heart failure is not only directly related to circulatory failure, but merely reflects a systemic dysregulation. Our findings suggest that heart failure impacts outcome and should therefore be included in prevailing risk classification systems. Offensive perioperative treatment strategies, focused on the main complications in patients with heart failure, will lead to improved results after cardiac surgery.
authors.affiliation: Department of Cardiothoracic Surgery, Leiden University Medical Center, K6-S, PO Box 9600, 2300, RC Leiden, the Netherlands, k.a.kortekaas@lumc.nl.
authors.forename: K A
authors.initials: KA
authors.lastname: Kortekaas
authors.forename: J H N
authors.initials: JH
authors.lastname: Lindeman
authors.forename: M I M
authors.initials: MI
authors.lastname: Versteegh
authors.forename: T
authors.initials: T
authors.lastname: Stijnen
authors.forename: R A E
authors.initials: RA
authors.lastname: Dion
authors.forename: R J M
authors.initials: RJ
authors.lastname: Klautz