This single-centre observational study evaluated cumulative oxygen extraction burden during cardiopulmonary bypass in 110 adult LVAD-explant heart transplant recipients, comparing groups defined by median burden. After inverse probability weighting, higher burden was associated with postoperative renal replacement therapy (OR 4.16, 95% CI 1.35–12.83) and 2-year mortality (HR 7.61, 95% CI 1.49–38.73). Higher burden was also associated with lower immediate postoperative cardiac index and greater vasoactive inotrope requirements. These findings link intraoperative oxygen extraction burden with adverse postoperative outcomes in this transplant population.
Cumulative oxygen extraction burden may be a prognostic marker in LVAD-explant transplantation. This observational analysis does not establish that targeting it improves renal outcomes or survival.
Study limitation: Single-centre observational data remain vulnerable to residual confounding, and wide confidence intervals indicate substantial uncertainty in effect magnitude.
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