A simple risk score predicting clinical right ventricular failure after congenital cardiac surgery in adults

Background: Right ventricular (RV) failure is a life-threatening syndrome characterized by edema, hypotension and in worse cases shock or multi organ failure. Congenital heart disease (CHD) patients often undergo right-sided surgery, and contribution of the RV to their cardiac pump function is essential. We aimed to identify determinants of RV failure after cardiac surgery and to determine prognosis in CHD patients.

Methods: Adults with CHD operated between January 2001 and January 2011 in theMedical Center were studied. Clinical characteristics, laboratory tests, surgical data and intensive care unit outcome were obtained from medical records. The diagnosis of clinical RV failure was made by careful review of the medical records by two independent physicians. Determinants of clinical RV failure were identified by logistic regression analysis.

Results: Data of 412 consecutive patients (median age 36 (range 18–74) years, 56% male) were studied. Eighteen patients were diagnosed with clinical RV failure (4.4%), of which six patients died. A risk score incorporating signifant determinants of multivariate analysis identified low-, medium- and high-risk subgroups. Patients undergoing left- and both-sided surgery had an equal risk of developing clinical RV failure as compared to patients undergoing right-sided surgery.

Conclusions: In CHD patients the use of a simple risk score based on multiple determinants identifies a high-risk subgroup on clinical RV failure after cardiac surgery and patients at highest risk of mortality.