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Longitudinal Outcomes of Cardiogenic Shock Patients Undergoing Conventional Cardiac Surgery
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  • Nicholas Hess,
  • Ibrahim Sultan,
  • Yisi Wang,
  • Floyd Thoma,
  • Arman Kilic
Nicholas Hess
University of Pittsburgh Medical Center
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Ibrahim Sultan
University of Pittsburgh
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Yisi Wang
University of Pittsburgh Medical Center Health System
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Floyd Thoma
University of Pittsburgh Medical Center Health System
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Arman Kilic
University of Pittsburgh Medical Center Health System
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Abstract

Background: Cardiogenic shock is a known risk factor for early mortality following conventional cardiac surgery, however its impact on longitudinal outcomes is less established. This study evaluated longer-term outcomes of conventional cardiac surgery in patients with cardiogenic shock. Methods: This was a retrospective review of conventional cardiac operations performed in patients presenting with cardiogenic shock between 2010 and 2020. The primary outcome was survival, and secondary outcomes included postoperative complications, and rates of heart failure readmission. Multivariable Cox proportional hazards modeling was conducted to identify risk-adjusted predictors of mortality. Results: 604 patients were included, representing 4% of all cardiac cases. Median follow up was 4.3 (IQR 0.3-6.8) years. Aortic root repair/replacement (31.6%) was most commonly performed. 11.1% of patients required preoperative cardiopulmonary resuscitation. Bridging modalities included intravenous inotropes (35.4%), intra-aortic balloon pump (33.4%), Impella (0.5%), or venoarterial extracorporeal membrane oxygenation (3.3%). Operative mortality was 21.5%. Complications included reoperation (24.3%), stroke (15.9%) renal failure (19.2%), and prolonged ventilation (47.9%). Unadjusted 1- and 5-year survival were 71.7% and 62.1%. Risk-adjusted preoperative predictors for mortality included peripheral vascular disease (HR 1.75, 95% CI 1.23-2.49), dialysis dependency (HR 6.30, 95% CI 3.77–10.51) and increasing age (HR 1.02, 95% CI 1.02–1.04). Three patients eventually underwent ventricular assist device implantation and no patients underwent heart transplantation. Conclusions: Despite high initial rates of morbidity and mortality following conventional cardiac surgery in patients presenting with cardiogenic shock, 62% survive to 5 years and most do not require heart failure readmission or advanced heart failure surgical therapy.