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.