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Aims: Heart valve surgery is associated with a risk of serious postoperative complications including postoperative cardiogenic shock (described as postcardiotomy shock (PCS)). The indication for extracorporeal membrane oxygenation (ECMO) is cardiogenic shock, which is resistant to optimal causal and pharmacological treatment, including the supply of catecholamines and/or an intra-aortic balloon pump (IABP). The aim of this study was to assess the usefulness of the selected preoperative biomarkers in the prediction of postoperative cardiogenic shock requiring ECMO in patients undergoing heart valve surgery. Methods: A prospective study was conducted on a group of consecutive patients with significant valvular heart disease that underwent elective valve surgery. The primary endpoint at the intra-hospital follow-up was postoperative cardiogenic shock requiring ECMO. Univariate analysis, followed by multivariate regression analysis, were performed. Results: The study included 610 patients. The primary endpoint occurred in 15 patients. At multivariate analysis, the preoperative N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) level (OR 1.022; 95% CI 1.011–1.034; p = 0.001) remained an independent predictor of the primary endpoint. Conclusions: An elevated NT-proBNP level was associated with a higher risk of postoperative cardiogenic shock requiring the use of ECMO.

Piotr Duchnowski,1 Piotr Szymański,1 Mariusz Kuśmierczyk,2 Tomasz Hryniewiecki1 1Institute of Cardiology, Department of Acquired Cardiac Defects, Warsaw, Poland; 2Institute of Cardiology, Department of Cardiosurgery and Transplantology, Warsaw, PolandCorrespondence: Piotr DuchnowskiDepartment of Acquired Cardiac Defects, Institute of Cardiology, Alpejska 42, Warsaw 04-628, PolandTel +48 3434191Email duchnowski@vp.plBackground: The frailty syndrome is a serious health problem for an aging population. The occurrence of frailty in the group of symptomatic patients undergoing heart valve surgery may have additional clinical implications. The predictive ability of the FRAIL scale in patients undergoing heart valve surgery during a 30-day follow-up has not yet been described.Patients and Methods: A prospective study was conducted on a group of consecutive patients with hemodynamically significant valve disease (aortic stenosis, aortic regurgitation, mitral stenosis and mitral regurgitation) that underwent elective valve surgery in 2016– 2019. The primary endpoint was 30-day mortality. Univariate analysis, followed by multivariate regression analysis, was performed.Results: The study group included 672 consecutive patients (aortic valve stenosis, aortic regurgitation, mitral stenosis and mitral regurgitation) who underwent replacement or repair of the valve. Twenty-five patients died during the 30-day follow-up. At multivariate analysis, FRAIL scale result (OR 2.802; 95% CI 1.275– 6.157; p=0.01) and red cell distribution width (RDW) (OR 1.810; 95% CI 1.181– 2.775; p=0.006) remained independent predictors of the primary endpoint.Conclusion: The presented study showed the predictive ability of the FRAIL scale result in patients undergoing heart valve surgery for 30-day mortality.Keywords: valve surgery, EuroSCORE II, frailty syndrome, FRAIL scale