title: Determinants of clinical right ventricular failure after congenital heart surgery in adults.
abstract: OBJECTIVE
  Right ventricular (RV) failure after cardiac surgery is a clinical entity with high morbidity and mortality. Patients with congenital heart disease (CHD) often undergo right-sided cardiac surgery. The authors aimed to identify determinants of RV failure after cardiac surgery to differentiate patients with increased risk.
  
  
  METHODS
  A retrospective chart review.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Adults with CHD operated on between January 2001 and January 2011.
  
  
  METHODS
  Clinical characteristics, laboratory tests, surgical data, and intensive care unit outcome were obtained from medical records.
  
  
  RESULTS
  The diagnosis of clinical RV failure was made by careful review of the medical records by 2 independent physicians. Patients only were identified as having RV failure if (1) they had elevated jugular venous pressure, (2) they had impaired postoperative RV function on transthoracic echocardiography, and (3) a diagnosis of RV failure was documented clearly in the medical charts by the treating physician. Data of 412 consecutive patients (median age 36 [range 18-74] years, 56% male) were studied. Eighteen patients had clinical RV failure (4.4%) postoperatively, of whom 6 patients died. Patients undergoing left- and both-sided surgery had an equal risk of developing clinical RV failure as compared with patients undergoing right-sided surgery. In multivariate logistic regression analysis, preoperative impaired RV function, supraventricular tachycardia, and cardiopulmonary bypass time >150 minutes were the strongest determinants of clinical RV failure (p<0.05, for all).
  
  
  CONCLUSIONS
  RV failure after cardiac surgery is a serious complication, and occurs regardless of the side of surgery. A tailored approach in patients with CHD at highest risk of RV failure should be considered.
authors.affiliation: Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands. m.j.schuuring@amc.uva.nl
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Schuuring
authors.forename: E Charlotte
authors.initials: EC
authors.lastname: van Gulik
authors.forename: Dave R
authors.initials: DR
authors.lastname: Koolbergen
authors.forename: Mark G
authors.initials: MG
authors.lastname: Hazekamp
authors.forename: Wim K
authors.initials: WK
authors.lastname: Lagrand
authors.forename: Ad P C M
authors.initials: AP
authors.lastname: Backx
authors.forename: Barbara J M
authors.initials: BJ
authors.lastname: Mulder
authors.forename: Berto J
authors.initials: BJ
authors.lastname: Bouma
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D002315:Cardiopulmonary Bypass; D002496:Central Venous Pressure / Q000502:physiology; D003422:Critical Care; D017548:Echocardiography, Transesophageal; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D049449:Luminescence; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D055815:Young Adult
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: adult CHD; cardiac surgery; congenital heart disease; right ventricular failure