BACKGROUND:Paralytic ileus is a major surrounding after cardiac surgery and worsens patients' prognosis. METHODS:We conducted a single-centre, randomized, double-blind, placebo-controlled phase 3 study. We enrolled patients over 18 years old who underwent non-urgent cardiac surgery. Eligible patients were randomly allocated to Naloxegol or matching placebo in an equal ratio. The participants were randomly assigned to one of the following groups: (1) Naloxegol 12,5 mg 2 h before index surgery, and then Naloxegol 25 mg once daily, or (2) matching placebo. Naloxegol or placebo was administered for up to 5 days and permanently stopped if the patient had transit recovery. The primary endpoint was the time of postoperative gastrointestinal transit recovery after the index cardiac surgery, defined as the time in hours between the anaesthetic induction and the emission of the first significant stool. RESULTS:Between October 14, 2020, and January 28, 2022, 299 participants were included in modified intention-to-treat efficacy analyses (151 in the Naloxegol group and 148 in placebo). The mean age was 62 ± 10.1 years old, 81.6% were male, 53.8% had hypertension, 20.7% had diabetes mellitus, and the median body mass index was 25.9 (IQR 23.7-29.4) kg/m2. Time-to-transit recovery did not differ between Naloxegol group and placebo (76.0, [IQR 69.3-93.5] vs. 78.3, [IQR 70.0-95.8] h, p value = 0.40). We did not observe any difference in the prespecified secondary efficacy between both groups. Pain levels and a number of serious adverse events were not different in both groups. CONCLUSIONS:Naloxegol was not found to be effective in improving the transit time recovery after elective cardiac surgery. The trial was registered on ClinicalTrials.gov (NCT04433390) on June 16th, 2020.

Post myocardial infarction ventricular septal defect (PMI-VSD) complicated by refractory cardiogenic shock is associated with an extremely high mortality rate. We sought to evaluate the factors associated with in-ICU mortality in patients with PMI-VSD-related cardiogenic shock. Patients with PMI-VSD complicated by cardiogenic shock, admitted in 10 French tertiary centers between 2008 and 2022, were retrospectively included. The primary outcome was in-ICU mortality. The timing of surgery was classified as early (≤ 7 days) or late (> 7 days). Multivariable analysis was performed to identify the variables associated with in-ICU mortality. A total of 138 patients were included (mean age 70 (± 10) years, female sex 54 Abbreviations: d day; ICU intensive care unit; SOFA sequential organ failure assessment; VA-ECMO veno-arterial extracorporeal membrane oxygenation; VSD ventricular septal defect; w with.VSD repair is equivalent to VSD surgical closure and do not include the patients (n=2) who underwent percutaneous closure only.

BACKGROUND:Postoperative atrial fibrillation (POAF) affects 30% of patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Beta-blockers are the first-line agents recommended for POAF prevention. Landiolol, an ultra-short-acting, highly selective beta-1-blocker, has been shown to be effective in reducing POAF in Asian patients at a low dose of 2 μg kg-1 min-1. The aim of this study was to evaluate the effect of a low dose of landiolol for the prevention of POAF in non-Asian patients after cardiac surgery. METHODS:This multicentre, double-blind, randomised, placebo-controlled superiority trial was conducted from January 2021 to July 2023 at three hospitals in France. Participants were non-Asians ≥65 yr undergoing elective cardiac surgery with CPB and a left ventricular ejection fraction ≥40%. Treatment was started in the ICU and continued for up to 24 h, after which oral beta-blockers were administered. The primary endpoint was the incidence of POAF while in the ICU, analysed by intention to treat. Secondary outcomes included in-hospital and 30-day POAF, ICU and hospital length of stay, and safety outcomes. RESULTS:A total of 318 participants (mean age: 71 [range: 68-76] yr; 21.4% female) were randomised. POAF in ICU occurred in 51/160 (31.9%) participants who received placebo, compared with 47/158 (29.8%) who received a low-dose landiolol infusion (relative risk: 0.93 [95% confidence interval, 0.67-1.30]; P=0.77). No differences were observed in secondary endpoints, including in-hospital POAF and safety outcomes. CONCLUSIONS:In non-Asian patients undergoing cardiac surgery with CPB, a low-dose 24-h infusion of landiolol, used as a bridge to oral beta-blockers, did not reduce the incidence of postoperative atrial fibrillation. CLINICAL TRIAL REGISTRATION:ClinicalTrials.gov (NCT04607122).

Background Tofacitinib, an oral JAK inhibitor, is indicated for the treatment of adult patients with moderate to severe active rheumatoid arthritis (RA) for which we have no real-life effectiveness data in a French RA population. Objectives To describe tofacitinib effectiveness profile according to concomitant use of csDMARD in a French prospective observational study, DeFacTo. Methods DeFacTo, is an ongoing observational study with the primary objective of identifying predictive factors of Tofacitinib maintenance in real-life RA patients. The results described here are based on a descriptive interim analysis of its effectiveness at 18 months. Results Among 314 pts enrolled in the study, 301 (POP1) were included in this effectiveness analysis, including 274 (POP2) patients with follow-up ≥ 18 months on 03/15/2022 (date of analysis) with a median exposure duration of 538 [Q1; Q3: 381; 554] days. At baseline, among POP2: 168 (POP3) patients were treated with tofacitinib used concomitantly with at least one csDMARDs vs 106 (POP4) tofacitinib monotherapy. In POP3 vs POP4 respectively, 76.8% vs 84.9% were female, with a mean (± SD) age of 59.5 (10.8) vs 59.9 (12.1), median disease duration of 8.6 years [Q1;Q3: 3.2; 18.6] vs 11.1 [Q1;Q3: 5.3; 19.4)], 40.3% vs 52.4% patients had erosions, 80.5% vs 76.5% had FR+ and 77.7% vs 75.0% had ACPA+. Median CRP was 7.0 [Q1;Q3: 2.9; 18.0] vs 8.0 [Q1;Q3: 3.0; 18.1], and mean DAS28-4 CRP was 4.4 ±1.1 vs 4.7 ±1.0, in POP3 and POP4 respectively. Result showed a decrease in inflammatory markers, pain, and DAS28-CRP activity scores in both groups. At 18 months of follow-up, 24.4% and 24.5% of the pts achieved DAS28-CRP remission in POP 3 and POP 4 respectively (Table 1). Note that missing data and treatment discontinuation were considered as failures which resulted in an underestimation of LDA and remission at 18 months. Conclusion This intermediate analysis from real-life study showed that tofacitinib in RA patients is effective with or without csDMARD. Acknowledgements This study was sponsored by Pfizer. Disclosure of Interests Cécile Gaujoux-Viala Speakers bureau: AbbVie; Amgen; Bristol-Myers Squibb; Celgene; Eli Lilly; Galapagos; Gilead Sciences, Inc.; Janssen; Medac; Merck-Serono; Mylan; Nordic Pharma; Novartis; Pfizer; Roche; Sandoz; Sanofi; and UCB, Consultant of: AbbVie; Amgen; Bristol-Myers Squibb; Celgene; Eli Lilly; Galapagos; Gilead Sciences, Inc.; Janssen; Medac; Merck-Serono; Mylan; Nordic Pharma; Novartis; Pfizer; Roche; Sandoz; Sanofi; and UCB, Andre BASCH Consultant of: Janssen, Novartis, Amgen, BMS, Abbvie, Lilly, Pfizer, MSD, UCB, Slim Lassoued: None declared, Fabienne COURY-LUCAS Consultant of: AbbVie, Bristol-Myers Squibb, Janssen, Lilly, MSD, Novartis and Pfizer, Grant/research support from: AbbVie, Biogen, Roche Chugai, Pfizer, and UCB, Meriem Kessouri Shareholder of: Pfizer, Employee of: Pfizer, Amine Saighi Shareholder of: Pfizer, Employee of: Pfizer, Yves Brault Shareholder of: Pfizer, Employee of: Pfizer, Pierre-Alexandre Squara Shareholder of: Pfizer, Employee of: Pfizer, Thierry Lequerre Consultant of: Abbvie, BMS, Boeringher, Lilly, Medac, MSD, Nordic Pharma, Novartis, Pfizer, Roche – Chugai, Sanofi, UCB, Carine Salliot Consultant of: Biogen, Lilly, Novartis, Roche Chugai, Pfizer.Table 1Characteristics at inclusion and effectiveness at 18 monthsBaseline, n=274At 18 month, n=274Difference from baseline to M18Variables in LS mean ± SE or % of ptsPatients with at least one concomitant csDMARD treatment (N=168)Patients without concomitant csDMARD treatment (N=106)Patients with at least one concomitant csDMARD treatment (N=168)Patients without concomitant csDMARD treatment (N=106)Patients with at least one concomitant csDMARD treatment (N=168)Patients without concomitant csDMARD treatment (N=106)PtGA*57.78 ± 1.6761.43 ± 2.0929.68 ± 2.9735.40 ± 3.38-28.10± 3.15-26.03± 3.87CRP* (mg/l)15.25± 1.8813.67± 1.455.16± 0.974.87± 0.82-10.09 ± 2.00-8.80 ± 1.52DAS28-4 CRP*4.38 ±0.094.68 ±0.102.49 ± 0.142.85 ± 0.13-1.88 ± 0.15-1.83 ± 0.16ACR-EULAR boolean criteriaⴕ3.00.912.514.29.513.3LDAⴕ, % pts- DAS28 CRP ≤3,2- DAS28 VS ≤3,211.97.13.82.835.723.237.725.523.816.133.922.7Remissionⴕ, % pts- DAS28 CRP <2,6- DAS28 VS <2,65.43.62.81.924.416.124.512.319.012.521.710.4* Missing data handled with mixed models for repeated measures ⱡ Missing data and treatment discontinuations considered failures (122 patients with missing data, 39 treatment discontinuations).

Trou, Baptiste; Pirtea, Paul; Ma, Sabrina; Aimé, Isabelle; Gross, Tommy; Kennel, Titouan; Jean-Marc, Ayoubi; Fischler, Marc; Squara, Pierre; Le Guen, Morgan Author Information

BACKGROUND:Axillary block is the standard for carpal tunnel release (CTR), providing effective anesthesia, and tolerance of tourniquet. Conversely, distal blocks are less used due to poor tolerance of tourniquet. Wide Awake Local Anesthesia No Tourniquet (WALANT), proposed for hand and wrist surgeries, avoids its use. This study assesses the benefits of the addition of WALANT to distal blocks during endoscopic CTR (eCTR). METHODS:This randomized, open-label, controlled trial prospectively enrolled 60 patients scheduled for eCTR. Patients were randomized to receive distal blocks at the wrist combined to either a high arm tourniquet (Distal block group) or a WALANT in the area of surgery (Distal + Walant group). The primary endpoint was the global pain score summing pain scores related to puncture, local anesthetic injection, pneumatic tourniquet, surgical procedure, tourniquet deflation, and residual sensitivity after surgery. RESULTS:Mean global pain score was significantly reduced in the Distal + Walant group (0.5 ± 1.4 vs. 2.2 ± 2.4; p < 0.001). No need for an additional anesthetic procedure was required in the Distal + Walant group. Even if the quality of visualization was high in both groups, it was better in the Distal block group (5 [5-5] vs. 4 [4-5]; p < 0.001). No rescue tourniquet was necessary for the Distal + Walant group. The rate of hematoma 15 days post-surgery was significantly reduced in the Distal + Walant group (20% vs. 57%; p < 0.01). CONCLUSIONS:The addition of WALANT to distal blocks is adapted for eCTR. This combined technique decreases perioperative pain scores, provides good surgery conditions, and reduces the risk of postoperative hematoma. CLINICAL TRIAL NUMBER AND REGISTRY URL:The trial was registered on ClinicalTrials.gov (NCT04494100) on July 31, 2020 https://clinicaltrials.gov/ct2/show/NCT04494100?term=CMC+ambroise+pare&cntry=FR&draw=4&rank=28.

Thymic activation improves the outcome of COVID-19 patients with severe pneumonia. The rs2204985 genetic polymorphism within the TCRA-TCRD locus, which affects thymic output in healthy individuals, was found here to modify SARS-CoV-2–specific immunity and disease severity in COVID-19 patients with severe pneumonia. Forty patients with severe COVID-19 pneumonia were investigated. The GG genotype at the rs2204985 locus was associated, independently of age and sex, with stronger and long-lasting anti–SARS-CoV-2 helper and cytotoxic T cell responses 6 months after recovery. The GG genotype was also associated with less severe lung involvement, higher thymic production, and higher counts of blood naïve T lymphocytes, including recent thymic emigrants, and a larger population of activated stem cell memory CD4 + T cells. Overall, GG patients developed a more robust and sustained immunity to SARS-CoV-2. Polymorphism at rs2204985 locus should be considered as an additional predictive marker of anti–SARS-CoV-2 immune response.

BackgroundTakotsubo cardiomyopathy (TTC) is a rare entity after cardiac surgery.AimsTo describe patients’ profile who developed postoperative TTC after cardiac surgery, management, and outcomes.MethodsWe performed a systematic literature search to extract cases of TTC after adult cardiac surgery (from 1990 to 2021). Additionally, we extracted all cases of TTC in a prospective single-center cohort database of 10,000+ patients (from 2007 to 2019). We then combined all cases in a single cohort to describe its clinical features.ResultsFrom 694 screened articles, we retained 71 individual cases published in 20 distinct articles (19 cases reports and 1 case-series). We combined these to 10 cases extracted from our cohort [among 10,682 patients (0.09%)]. Overall, we included 81 cases. Patients were aged 68 ± 10 years-old and 64/81 (79%) were women. Surgery procedures included mitral valve and/or tricuspid valve surgery in 70/81, 86%. TTC was diagnosed in the first days after surgery [median 4 (1–4) days]. Incidence of cardiogenic shock, defined as requirement of vasopressor and/or inotropic support was 24/29, 83% (data available on 29/81 patients). Refractory cardiogenic appeared in 5/81, 6% who required implantation of arterio-venous extra-corporeal membrane oxygenation, and 6/81, 7%, intra-aortic balloon pump. In-hospital mortality was 5/81, 6%.ConclusionThis systematic review, based on case reports and case series, showed that postoperative TTC appears as a rare complication after cardiac surgery and mainly occurred after mitral and/or tricuspid valve repair procedures. In this population, TTC is associated with high rate of cardiogenic shock.

IntroductionIt is unknown whether patent foramen ovale (PFO) reopening in the peri-operative setting of cardiac surgery affects the risk for stroke and post-operative outcomes.MethodsWe performed a single-center, retrospective study based on a prospectively collected database in a tertiary cardiac surgery center. Using logistic regression, we assessed risk factors of PFO finding around surgery and subsequent clinical complications.ResultsBetween January 2007 and July 2019, 11034 patients who underwent cardiac surgery in our center were included. A total of 233 patients (2.1%) presented a finding of PFO including 138 per-operative disclosures and 95 post-operative finding for hypoxemia. In the whole cohort, the mean age was 68.4 ± 11.5 years including 73.9% of men. Post-operative PFO finding was associated with more ischemic strokes compared with per-operative finding and control group [7(7.4%) vs. 3(2.2%) vs. 236(2.2), respectively; p = 0.003]. Moreover, patients with post-operative PFO reopening experienced a higher rate of pneumonia, reintubation, and longer length of stay in the ICU. Post-operative reopening of PFO, but not per-operative finding, was independently associated with ischemic strokes {adjusted odds-ratio = 3.5, 95% confidence interval (CI) [1.6–7.8]; p = 0.002}. Other variables associated with stroke incidence included age, mitral valve surgery, and ascending aorta surgery. Per- or post-operative PFO closure was associated with reduced adverse respiratory outcomes and a trend of the lower cerebral ischemic event.ConclusionPatent foramen ovale finding incidence in peri-operative cardiac surgery care was rare (2%) but post-operative finding of PFO was associated with a increased risk of ischemic strokes, worsened respiratory outcomes, and prolonged hospitalization.

In this study, we aimed to assess the efficacy of high-flow nasal oxygen (HFNO) to maintain blood peripheral oxygen saturation (SpO2) in patients undergoing suspension laryngoscopy under general anesthesia. Adult patients were included in this bicenter study. After face-mask oxygenation, HFNO at a flow rate of 70 L min −1 and fraction of inspired oxygen 100% was initiated at loss of consciousness. At the end of HFNO, blood gas analysis was performed. Of the 29 included patients, five (17.2%; 95% confidence interval [CI]: 7.6–34.5) presented SpO2 <95% during the first 15 minutes of the procedure and eight patients (27.6%; 95% CI: 14.7–45.7) presented SpO2 <95% throughout the procedure. Six patients (20.7%; 95% CI: 9.8–38.4) required rescue jet ventilation. Median apnea time before SpO2 <95% was 13.5 (interquartile range [IQR]: 10–17.7) minutes. Arterial carbon dioxide tension at the end of the procedure or at the time of study discontinuation was 9.73 (IQR: 8.8–10.9) kPa and was higher than 8 kPa in 88.9% (95% CI: 71.9–96.1) of patients. HFNO was associated with a relatively high incidence of suboptimal oxygen saturation and hypercapnia during suspension laryngoscopy under general anesthesia and may not be considered the reference technique.

Transient diaphragm dysfunction is common during the first week after cardiac surgery; however, the precise incidence, risk factors, and outcomes of persistent diaphragm dysfunction are not well described. In a single-centre prospective cohort study, we included all consecutive patients over 18 yr who underwent elective cardiac surgery. Diaphragm function was evaluated with ultrasound (M-mode) by recording the excursion of both hemidiaphragms at two different time points: preoperatively and after the seventh postoperative day in patients breathing without assistance. Significant diaphragm dysfunction after the seventh day of the index cardiac surgery was defined as a decrease in diaphragm excursion below the lower limit of normal: at rest, < 9 mm for women and < 10 mm for men; after a sniff test, < 16 mm for women and < 18 mm for men. Overall, 122 patients were included in the analysis. The median [interquartile range (IQR)] age was 69 [59–74] years and 96/122 (79

Since January 2020, the SARS-CoV-2 pandemic has severely affected hospital systems worldwide. In Europe, the first 3 epidemic waves (periods) have been the most severe in terms of number of infected and hospitalized patients. There are several descriptions of the demographic and clinical profiles of patients with COVID-19, but few studies of their hospital pathways. We used transition matrices, constructed from Markov chains, to illustrate the transition probabilities between different hospital wards for 90,834 patients between March 2020 and July 2021 managed in Paris area. We identified 3 epidemic periods (waves) during which the number of hospitalized patients was significantly high. Between the 3 periods, the main differences observed were: direct admission to ICU, from 14 to 18%, mortality from ICU, from 28 to 24%, length of stay (alive patients), from 9 to 7 days from CH and from 18 to 10 days from ICU. The proportion of patients transferred from CH to ICU remained stable. Understanding hospital pathways of patients is crucial to better monitor and anticipate the impact of SARS-CoV-2 pandemic on health system.

Abstract Background Treatment decisions on critically ill patients with circulatory shock lack consensus. In an international survey, we aimed to evaluate the indications, current practice, and therapeutic goals of inotrope therapy in the treatment of patients with circulatory shock. Methods From November 2016 to April 2017, an anonymous web-based survey on the use of cardiovascular drugs was accessible to members of the European Society of Intensive Care Medicine (ESICM). A total of 14 questions focused on the profile of respondents, the triggering factors, first-line choice, dosing, timing, targets, additional treatment strategy, and suggested effect of inotropes. In addition, a group of 42 international ESICM experts was asked to formulate recommendations for the use of inotropes based on 11 questions. Results A total of 839 physicians from 82 countries responded. Dobutamine was the first-line inotrope in critically ill patients with acute heart failure for 84% of respondents. Two-thirds of respondents (66%) stated to use inotropes when there were persistent clinical signs of hypoperfusion or persistent hyperlactatemia despite a supposed adequate use of fluids and vasopressors, with (44%) or without (22%) the context of low left ventricular ejection fraction. Nearly half (44%) of respondents stated an adequate cardiac output as target for inotropic treatment. The experts agreed on 11 strong recommendations, all of which were based on excellent (> 90%) or good (81–90%) agreement. Recommendations include the indications for inotropes (septic and cardiogenic shock), the choice of drugs (dobutamine, not dopamine), the triggers (low cardiac output and clinical signs of hypoperfusion) and targets (adequate cardiac output) and stopping criteria (adverse effects and clinical improvement). Conclusion Inotrope use in critically ill patients is quite heterogeneous as self-reported by individual caregivers. Eleven strong recommendations on the indications, choice, triggers and targets for the use of inotropes are given by international experts. Future studies should focus on consistent indications for inotrope use and implementation into a guideline for circulatory shock that encompasses individualized targets and outcomes.

Introduction The management of pain and anxiety remains a challenge in the intensive care unit. By distracting patients, virtual reality (VR) may have a role in painful procedures. We compared VR vs. an inhaled equimolar mixture of N 2 O and O 2 (Kalinox®) for pain and anxiety management during the removal of chest drains after cardiac surgery. Methods Prospective, non-inferiority, open-label study. Patients were randomized, for Kalinox® or VR session during drain removal. The analgesia/nociception index (ANI) was monitored during the procedure for objective assessment of pain and anxiety. The primary endpoint was the ΔANI (ANI min − ANI 0 ) during the procedure, based on ANIm (average on 4 min). We prespecified VR as non-inferior to Kalinox® with a margin of 3 points. Self-reported pain and anxiety were also analysed using numeric rate scale (NRS). Results 200 patients were included, 99 in the VR group and 101 in the Kalinox® group; 90 patients were analysed in both groups in per-protocol analysis. The median age was 68.0 years [60.0–74.8]. The ΔANI was − 15.1 ± 12.9 in the Kalinox® group and − 15.7 ± 11.6 in the VR group (NS). The mean difference was, therefore, − 0.6 [− 3.6 to 2.4], including the non-inferiority margin of 3. Patients in the VR group had a significantly higher pain NRS scale immediately after the drain removal, 5.0 [3.0–7.0] vs. 3.0 [2.0–6.0], p = 0.009, but no difference 10 min after. NRS of anxiety did not differ between the two groups. Conclusion Based on the ANI, the current study showed that VR did not reach the statistical requirements for a proven non-inferiority vs. Kalinox® in managing pain and anxiety during chest drain removal. Moreover, VR was less effective based on NRS. More studies are needed to determine if VR might have a place in the overall approach to pain and anxiety in intensive care units. Trial registration NCT, NCT03956264. Registered 20 May 2019, https://clinicaltrials.gov/ct2/show/NCT03956264

BACKGROUND:In cardiac surgery, risk is estimated with models such as EuroSCORE II and the Society of Thoracic Surgeons (STS) score. Performance of these scores may vary across various patient age ranges. AIM:To assess the effect of patient age on performance of the EuroSCORE II and STS scores, regarding postoperative mortality after surgical aortic valve replacement. METHODS:In a prospective cohort of patients, we assessed risk stratification of EuroSCORE II and STS scores for discrimination of in-hospital mortality with the area under the receiver operating characteristic curve (AUROC) and calibration with the Hosmer-Lemeshow test. Two groups of patients were compared: elderly (aged>75years) and younger patients. RESULTS:Of 1229 patients included, 635 (51.7%) were elderly. Mean EuroSCORE II score was 3.7±4.4% and mean STS score was 2.1±1.5%. Overall in-hospital mortality was 4.8% and was higher in the elderly compared with younger patients (6.6% vs. 2.8%; log-rank P=0.014). AUROC for the EuroSCORE II score was lower in elderly than in younger patients (0.731 vs. 0.784; P=0.025). Similarly, AUROC for the STS score was lower in elderly versus younger patients (0.738 vs. 0.768; P=0.017). In elderly patients, EuroSCORE II and STS scores were not adequately calibrated and significantly underestimated mortality. Age was independently associated with mortality, regardless of EuroSCORE II or STS score. CONCLUSIONS:In this cohort, EuroSCORE II and STS scores did not perform as well in elderly patients as in younger patients. Elderly patients may be at increased postoperative risk, regardless of risk score.

Introduction: Right ventricular failure (RVF) after cardiac surgery is an important risk factor for morbidity and mortality. Its diagnosis is challenging, and thus, its incidence and predictors are not well-established. We investigated the incidence, complications, and variables associated with clinically relevant post-operative RVF. Methods: We included all patients who underwent cardiac surgery with cardiopulmonary bypass between 2016 and 2019 in a cardiac surgery center with standardized diagnostic and therapeutic management of RVF. RVF was considered only if clinically relevant: associated with hemodynamic instability requiring catecholamine support and inhaled nitric oxide relayed by sildenafil. Results: Overall, 3,826 patients were included, of whom, 110 (2.9%) developed post-operative RVF. Mortality was not different among patients who developed post-operative RVF, compared with the rest of the cohort (1.8 vs. 0.7%, p = 0.17). Using a composite outcome that combined death, reintubation, stroke, and prolonged intensive care unit stay (more than 14 days) yielded an incidence of 6.6%, and RVF was associated with this composite outcome with an odds ratio of 3.6 (2.2–5.8), p < 0.001. In a multivariable model, pre-operative variables independently associated with post-operative RVF were pre-operative atrial fibrillation (AF) {adjusted odds ratio (adjOR) 3.22 [95% confidence interval (95%CI) = 1.94–5.36], p < 0.001}, left ventricle ejection fraction below 50% [adjOR = 2.55 (95%CI = 1.52–4.33), p < 0.001], systolic pulmonary artery pressure above 55 mmHg [adjOR = 8.64 (95%CI = 5.27–14.1); p < 0.001], mitral valve surgery [adjOR = 2.17 CI (95%CI = 1.28–3.66), p = 0.004], and tricuspid valve surgery [adjOR = 10.33 (95%CI = 6.14–17.4), p < 0.001]. In patients who developed post-operative RVF requiring treatment, 32 (29.1%) showed RV dysfunction before surgery. Conclusion: In this cohort study, 2.9% of patients developed clinically significant post-operative RVF. Moreover, RVF was associated with severe adverse outcomes, including death, strokes, reintubation, and prolonged intensive care unit stay.