Background: Perioperative right ventricular (RV) dysfunction is a frequent complication of cardiac surgery linked to poor outcomes and may result from the loss of pericardial support. We investigated whether pericardial closure preserves early postoperative RV function. Methods: We compared patients with pericardial closure versus open pericardium. Co-primary endpoints were early postoperative RV longitudinal function by tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity (TASV). Adjusted comparisons used analysis-of-covariance (postoperative value adjusted for baseline) with prespecified covariates (baseline outcome, LV global longitudinal strain, left-ventricular ejection fraction, LVEDVI, sex, procedure; cardiopulmonary bypass and cross-clamp times when available). Holm correction-controlled multiplicity across the co-primary endpoints. Sensitivity linear mixed-effects models (time × group) were performed. Results: Pericardial closure was associated with better early RV longitudinal function after multivariable adjustment. TAPSE: adjusted mean difference (AMD, Closed–Open) 1.531 mm (95% CI 0.130–2.931; p = 0.033). TASV: AMD 1.694 cm/s (95% CI 0.437–2.951; p = 0.009; Holm-adjusted p = 0.018). Sensitivity analyses yielded consistent estimates. Conclusions: Pericardial closure was independently associated with improved early RV longitudinal function. These adjusted findings address baseline LV imbalances and support considering closure to preserve RV performance; confirmation in prospective trials is warranted.

Background: The interaction between chronic obstructive pulmonary disease (COPD) and coronary artery bypass grafting (CABG) is discussed controversial. Methods: In this population-based retrospective analysis including non-emergency CABG in Germany between 2015 and 2021, the aim was to compare in-hospital mortality, hospital length of stay (HLOS), and perioperative ventilation time (VT) in patients affected by COPD and not affected by COPD. In addition, we compared outcomes after off-pump coronary artery bypass (OPCAB) and on-pump coronary artery bypass (ONCAB) surgery and outcomes after CABG with a minimally invasive technique with and without cardiopulmonary bypass (CPB) in COPD patients. Results: Of the 274,792 analyzed cases undergoing non-emergency CABG, 7.7% suffered from COPD. COPD patients showed a higher in-hospital mortality (6.0% vs. 4.2%; p < 0.001), a longer HLOS (13 days (10–19) vs. 12 days (9–16); p < 0.001), and a longer VT (33 h (11–124) vs. 28 h (9–94); p < 0.001). In subgroup analyses, COPD patients undergoing OPCAB surgery showed a lower in-hospital mortality (3.5% vs. 6.4%; p < 0.001), a shorter HLOS (12 days (9–16) vs. 13 days (10–19); p < 0.001) and a shorter VT (20 h (10–69) vs. 36 h (11–135); p < 0.001) compared to ONCAB surgery. Regression analyses confirmed that using cardiopulmonary bypass in COPD patients is associated with a higher risk of in-hospital mortality (OR, 1.86; 95% CI: 1.51–2.29, p < 0.001), a longer HLOS (1.44 days; 95% CI: 0.91–1.97, p < 0.001), and a longer VT (33.67 h; 95% CI: 18.67–48.66, p < 0.001). In further subgroup analyses, COPD patients undergoing CABG with a minimally invasive technique without CPB showed a lower in-hospital mortality (3.5% vs. 16.5%; p < 0.001) and a shorter VT (20 h (10–69) vs. 65 h (29–210); p < 0.001) compared to CABG with a minimally invasive technique and CPB. Regression analyses confirmed that using CPB in COPD patients undergoing CABG with a minimally invasive technique is associated with a higher risk of in-hospital mortality (OR, 4.80; 95% CI: 2.42–9.51, p < 0.001). Conclusions: COPD negatively impacts outcomes after non-emergency CABG. According to our results, OPCAB surgery and CABG with a minimally invasive technique without CPB seem to be beneficial for COPD patients. Further studies should be performed to confirm this.

Objectives Perioperative right heart failure remains a severe complication after durable left ventricular assist device implantation. Accurate preoperative risk assessment is crucial to identify patients requiring advanced medical or mechanical biventricular support. Existing predictive risk models show limited comparability and lack consistent external validation. We aimed to validate commonly used right heart failure risk models using a standardized definition and, as a secondary exploratory analysis, to evaluate a parsimonious Firth-penalized model in our cohort. Methods We performed a single-center, retrospective observational study of 105 patients undergoing durable left ventricular assist device implantation from April 2015 to February 2023. Right heart failure was defined according to the Interagency Registry for Mechanically Assisted Circulatory Support definition. Preoperative EUROMACS, Michigan, CRITT, BiVAD, Utah, and a modified Utah score were calculated. The postoperative EUROMACS score, which includes cardiopulmonary bypass time, was analyzed separately as an early perioperative risk marker. Discrimination was assessed using receiver-operating characteristic analysis. The exploratory five-variable Firth model was internally validated by bootstrap optimism correction and calibration analysis. Results Moderate-severe right heart failure occurred in 21 patients (20.4%). Among established scores, AUC values ranged from 0.394 (Utah) to 0.729 (postoperative EUROMACS). The exploratory five-variable Firth model, including INTERMACS profile, total bilirubin, aspartate aminotransferase, diastolic pulmonary artery pressure, and pulmonary vascular resistance, showed an apparent AUC of 0.854. After 2,000 bootstrap resamples, the optimism-corrected AUC was 0.773, with an optimism-corrected Brier score of 0.149 and calibration slope of 0.586, indicating relevant optimism and potential overfitting. Conclusions Established right heart failure risk scores showed limited-to-moderate discrimination in this cohort. Postoperative EUROMACS achieved the highest AUC but should not be interpreted as a purely preoperative prediction tool. The exploratory Firth model identified a potentially informative combination of clinical status, hepatic laboratory markers, and pulmonary hemodynamics, but remains hypothesis-generating and requires external validation before clinical implementation.

Objectives Perioperative right heart failure remains a severe complication after durable left ventricular assist device implantation. Accurate preoperative risk assessment is crucial to identify patients requiring advanced medical or mechanical biventricular support. Existing predictive risk models show limited comparability and lack consistent external validation. We aimed to validate commonly used right heart failure risk models using a standardized definition and, as a secondary exploratory analysis, to evaluate a parsimonious Firth-penalized model in our cohort. Methods We performed a single-center, retrospective observational study of 105 patients undergoing durable left ventricular assist device implantation from April 2015 to February 2023. Right heart failure was defined according to the Interagency Registry for Mechanically Assisted Circulatory Support definition. Preoperative EUROMACS, Michigan, CRITT, BiVAD, Utah, and a modified Utah score were calculated. The postoperative EUROMACS score, which includes cardiopulmonary bypass time, was analyzed separately as an early perioperative risk marker. Discrimination was assessed using receiver-operating characteristic analysis. The exploratory five-variable Firth model was internally validated by bootstrap optimism correction and calibration analysis. Results Moderate-severe right heart failure occurred in 21 patients (20.4%). Among established scores, AUC values ranged from 0.394 (Utah) to 0.729 (postoperative EUROMACS). The exploratory five-variable Firth model, including INTERMACS profile, total bilirubin, aspartate aminotransferase, diastolic pulmonary artery pressure, and pulmonary vascular resistance, showed an apparent AUC of 0.854. After 2,000 bootstrap resamples, the optimism-corrected AUC was 0.773, with an optimism-corrected Brier score of 0.149 and calibration slope of 0.586, indicating relevant optimism and potential overfitting. Conclusions Established right heart failure risk scores showed limited-to-moderate discrimination in this cohort. Postoperative EUROMACS achieved the highest AUC but should not be interpreted as a purely preoperative prediction tool. The exploratory Firth model identified a potentially informative combination of clinical status, hepatic laboratory markers, and pulmonary hemodynamics, but remains hypothesis-generating and requires external validation before clinical implementation.

Objectives Perioperative right heart failure remains a severe complication after durable left ventricular assist device implantation. Accurate preoperative risk assessment is crucial to identify patients requiring advanced medical or mechanical biventricular support. Existing predictive risk models show limited comparability and lack consistent external validation. We aimed to validate commonly used right heart failure risk models using a standardized definition and, as a secondary exploratory analysis, to evaluate a parsimonious Firth-penalized model in our cohort. Methods We performed a single-center, retrospective observational study of 105 patients undergoing durable left ventricular assist device implantation from April 2015 to February 2023. Right heart failure was defined according to the Interagency Registry for Mechanically Assisted Circulatory Support definition. Preoperative EUROMACS, Michigan, CRITT, BiVAD, Utah, and a modified Utah score were calculated. The postoperative EUROMACS score, which includes cardiopulmonary bypass time, was analyzed separately as an early perioperative risk marker. Discrimination was assessed using receiver-operating characteristic analysis. The exploratory five-variable Firth model was internally validated by bootstrap optimism correction and calibration analysis. Results Moderate-severe right heart failure occurred in 21 patients (20.4%). Among established scores, AUC values ranged from 0.394 (Utah) to 0.729 (postoperative EUROMACS). The exploratory five-variable Firth model, including INTERMACS profile, total bilirubin, aspartate aminotransferase, diastolic pulmonary artery pressure, and pulmonary vascular resistance, showed an apparent AUC of 0.854. After 2,000 bootstrap resamples, the optimism-corrected AUC was 0.773, with an optimism-corrected Brier score of 0.149 and calibration slope of 0.586, indicating relevant optimism and potential overfitting. Conclusions Established right heart failure risk scores showed limited-to-moderate discrimination in this cohort. Postoperative EUROMACS achieved the highest AUC but should not be interpreted as a purely preoperative prediction tool. The exploratory Firth model identified a potentially informative combination of clinical status, hepatic laboratory markers, and pulmonary hemodynamics, but remains hypothesis-generating and requires external validation before clinical implementation.

Objectives Perioperative right heart failure remains a severe complication after durable left ventricular assist device implantation. Accurate preoperative risk assessment is crucial to identify patients requiring advanced medical or mechanical biventricular support. Existing predictive risk models show limited comparability and lack consistent external validation. We aimed to validate commonly used right heart failure risk models using a standardized definition and, as a secondary exploratory analysis, to evaluate a parsimonious Firth-penalized model in our cohort. Methods We performed a single-center, retrospective observational study of 105 patients undergoing durable left ventricular assist device implantation from April 2015 to February 2023. Right heart failure was defined according to the Interagency Registry for Mechanically Assisted Circulatory Support definition. Preoperative EUROMACS, Michigan, CRITT, BiVAD, Utah, and a modified Utah score were calculated. The postoperative EUROMACS score, which includes cardiopulmonary bypass time, was analyzed separately as an early perioperative risk marker. Discrimination was assessed using receiver-operating characteristic analysis. The exploratory five-variable Firth model was internally validated by bootstrap optimism correction and calibration analysis. Results Moderate-severe right heart failure occurred in 21 patients (20.4%). Among established scores, AUC values ranged from 0.394 (Utah) to 0.729 (postoperative EUROMACS). The exploratory five-variable Firth model, including INTERMACS profile, total bilirubin, aspartate aminotransferase, diastolic pulmonary artery pressure, and pulmonary vascular resistance, showed an apparent AUC of 0.854. After 2,000 bootstrap resamples, the optimism-corrected AUC was 0.773, with an optimism-corrected Brier score of 0.149 and calibration slope of 0.586, indicating relevant optimism and potential overfitting. Conclusions Established right heart failure risk scores showed limited-to-moderate discrimination in this cohort. Postoperative EUROMACS achieved the highest AUC but should not be interpreted as a purely preoperative prediction tool. The exploratory Firth model identified a potentially informative combination of clinical status, hepatic laboratory markers, and pulmonary hemodynamics, but remains hypothesis-generating and requires external validation before clinical implementation.