TY - JOUR
T1 - A contemporary analysis of pulmonary hypertension in patients undergoing mitral valve surgery
T2 - Is this a risk factor?
AU - Enter, Daniel H.
AU - Zaki, Anthony
AU - Duncan, Brett F.
AU - Kruse, Jane
AU - Andrei, Adin Cristian
AU - Li, Zhi
AU - Malaisrie, S. Chris
AU - Shah, Sanjiv J.
AU - Thomas, James D.
AU - McCarthy, Patrick M.
N1 - Publisher Copyright:
© 2016 The American Association for Thoracic Surgery.
PY - 2016/5/1
Y1 - 2016/5/1
N2 - Objective Pulmonary hypertension (PHT) has been considered a risk factor for mortality in cardiac surgery. Among mitral valve surgery (MVS) patients, we sought to determine if severe PHT increases mortality risk and if patients who undergo concomitant tricuspid valve surgery (TVS) incur additional risk. Methods Preoperative PHT was assessed in 1571 patients undergoing MVS, from 2004 to 2013. Patients were stratified into PHT groups as follows (mm Hg): none (<35); moderate (35-49); severe (50-79); and extreme (≥80). Propensity-score matching resulted in a total of 430 patients, by PHT groups, and 384 patients, by TVS groups. Results Patients with severe PHT had higher mortality, both 30-day (4% PHT vs 1% no PHT, P <.02) and late (defined as survival at 5 years): 75.5% severe versus 91.9% no PHT (P <.001). In propensity-score-matched groups, severe PHT was not a risk factor for 30-day (3% each, P = 1.0) or late mortality (86.2% severe vs 87.1% no PHT; P =.87). TVS did not increase 30-day (4.7% TVS vs 4.2% no TVS, P =.8) or late mortality (78.7% TVS vs 75.3% no TVS, P =.90). Late survival was lower in extreme PHT (75.4% vs no PHT 91.5%, P =.007), and a trend was found in 30-day mortality (11% extreme vs 3% no PHT, P =.16). Conclusions Mortality in MVS is unaffected by severe PHT or the addition of TVS, yet extreme PHT remains a risk factor. Severe PHT (50-79 mm Hg) should not preclude surgery; concomitant TVS does not increase mortality.
AB - Objective Pulmonary hypertension (PHT) has been considered a risk factor for mortality in cardiac surgery. Among mitral valve surgery (MVS) patients, we sought to determine if severe PHT increases mortality risk and if patients who undergo concomitant tricuspid valve surgery (TVS) incur additional risk. Methods Preoperative PHT was assessed in 1571 patients undergoing MVS, from 2004 to 2013. Patients were stratified into PHT groups as follows (mm Hg): none (<35); moderate (35-49); severe (50-79); and extreme (≥80). Propensity-score matching resulted in a total of 430 patients, by PHT groups, and 384 patients, by TVS groups. Results Patients with severe PHT had higher mortality, both 30-day (4% PHT vs 1% no PHT, P <.02) and late (defined as survival at 5 years): 75.5% severe versus 91.9% no PHT (P <.001). In propensity-score-matched groups, severe PHT was not a risk factor for 30-day (3% each, P = 1.0) or late mortality (86.2% severe vs 87.1% no PHT; P =.87). TVS did not increase 30-day (4.7% TVS vs 4.2% no TVS, P =.8) or late mortality (78.7% TVS vs 75.3% no TVS, P =.90). Late survival was lower in extreme PHT (75.4% vs no PHT 91.5%, P =.007), and a trend was found in 30-day mortality (11% extreme vs 3% no PHT, P =.16). Conclusions Mortality in MVS is unaffected by severe PHT or the addition of TVS, yet extreme PHT remains a risk factor. Severe PHT (50-79 mm Hg) should not preclude surgery; concomitant TVS does not increase mortality.
KW - mitral valve surgery
KW - pulmonary hypertension
KW - tricuspid valve surgery
UR - http://www.scopus.com/inward/record.url?scp=84959200134&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84959200134&partnerID=8YFLogxK
U2 - 10.1016/j.jtcvs.2015.12.063
DO - 10.1016/j.jtcvs.2015.12.063
M3 - Article
C2 - 26936008
AN - SCOPUS:84959200134
SN - 0022-5223
VL - 151
SP - 1288
EP - 1299
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 5
ER -