Postoperative Complications and Long-Term Outcomes
The most common complication following surgical intervention was
respiratory insufficiency requiring prolonged mechanical ventilation
(47.9%). 407 (67.4%) of patients required blood transfusion and 147
(24.3%) required reoperation. The rate of cerebrovascular accident was
15.9% (Table 2 ). Rates of overall readmission and heart
failure readmission were 46.03% and 18.87%, respectively.
Median follow up was 4.28 years (IQR 0.28 to 6.80 years). One-year
overall survival was 71.7%. Five-year survival was 62.1%
(Figure 1 ). Multivariable analysis revealed preoperative
risk-adjusted predictors of mortality consisting of increasing age (HR
1.03, 95% CI 1.02 to 1.04; P<0.001), history of peripheral
vascular disease (HR 1.75, 95% CI 1.23 to 2.49; P=0.002) and renal
failure requiring dialysis (HR 6.30, 95% CI 3.77 to 10.51;
P<0.001). Preoperative ECMO support was not associated with
increased risk-adjusted hazards for mortality, but intraoperative ECMO
(HR 7.43, 95% CI 3.52 to 15.66; P<0.001) and postoperative
ECMO (HR 13.67, 95% CI 5.98 to 31.25; P<0.001) were
associated with increased risk-adjusted hazards. Preoperative Impella
support was associated with increased hazards (HR 12.11, 95% CI 2.33 to
63.05; P=0.003). Of all cardiac procedures, aortic root
repair/replacement was associated with lower risk-adjusted hazards for
mortality (HR 0.41, 95% CI 0.20 to 0.83; P=0.013) (Table 3 ).
During longitudinal follow-up, 3 (0.5%) patients underwent eventual VAD
implantation. No patients in this study underwent heart transplantation
during follow-up.