Longitudinal Outcomes of Cardiogenic Shock Patients Undergoing
Conventional Cardiac Surgery
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.