• James A Brown, Sarah Yousef, Jianhui Zhu, Floyd Thoma, Derek Serna-Gallegos, Rama Joshi, Kathirvel Subramaniam, David J Kaczorowski, Danny Chu, Edgar Aranda-Michel, Valentino Bianco, and Ibrahim Sultan.
• Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA.
• J. Cardiothorac. Vasc. Anesth. 2023 Jun 1; 37 (6): 927932927-932.

ObjectiveTo determine the impact of diastolic dysfunction (DD) on survival after routine cardiac surgery.DesignThis was an observational study of consecutive cardiac surgeries from 2010 to 2021.SettingAt a single institution.ParticipantsPatients undergoing isolated coronary, isolated valvular, and concomitant coronary and valvular surgery were included. Patients with a transthoracic echocardiogram (TTE) longer than 6 months prior to their index surgery were excluded from the analysis.InterventionsPatients were categorized via preoperative TTE as having no DD, grade I DD, grade II DD, or grade III DD.Measurements And Main ResultsA total of 8,682 patients undergoing a coronary and/or valvular surgery were identified, of whom 4,375 (50.4%) had no DD, 3,034 (34.9%) had grade I DD, 1,066 (12.3%) had grade II DD, and 207 (2.4%) had grade III DD. The median (IQR) time of the TTE prior to the index surgery was 6 (2-29) days. Operative mortality was 5.8% in the grade III DD group v 2.4% for grade II DD, 1.9% for grade I DD, and 2.1% for no DD (p = 0.001). Atrial fibrillation, prolonged mechanical ventilation (>24 hours), acute kidney injury, any packed red blood cell transfusion, reexploration for bleeding, and length of stay were higher in the grade III DD group compared to the rest of the cohort. The median follow-up was 4.0 (IQR: 1.7-6.5) years. Kaplan-Meier survival estimates were lower in the grade III DD group than in the rest of the cohort.ConclusionsThese findings suggested that DD may be associated with poor short-term and long-term outcomes.Copyright © 2023 Elsevier Inc. All rights reserved.

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