A contemporary analysis of pulmonary hypertension in patients undergoing mitral valve surgery: Is this a risk factor?

Daniel H. Enter, Anthony Zaki, Brett F. Duncan, Jane Kruse, Adin-Cristian Andrei, Zhi Li, S Chris Malaisrie, Sanjiv J Shah, James David Thomas, Patrick M McCarthy*

*Corresponding author for this work

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1288-1299
Number of pages12
JournalJournal of Thoracic and Cardiovascular Surgery
Volume151
Issue number5
DOIs
StatePublished - May 1 2016

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Mitral Valve
Pulmonary Hypertension
Tricuspid Valve
Mortality
Propensity Score
Survival
Thoracic Surgery

Keywords

  • mitral valve surgery
  • pulmonary hypertension
  • tricuspid valve surgery

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

@article{bad211e2844f48b186e21f88ca070395,
title = "A contemporary analysis of pulmonary hypertension in patients undergoing mitral valve surgery: Is this a risk factor?",
abstract = "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.",
keywords = "mitral valve surgery, pulmonary hypertension, tricuspid valve surgery",
author = "Enter, {Daniel H.} and Anthony Zaki and Duncan, {Brett F.} and Jane Kruse and Adin-Cristian Andrei and Zhi Li and Malaisrie, {S Chris} and Shah, {Sanjiv J} and Thomas, {James David} and McCarthy, {Patrick M}",
year = "2016",
month = "5",
day = "1",
doi = "10.1016/j.jtcvs.2015.12.063",
language = "English (US)",
volume = "151",
pages = "1288--1299",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
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}

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 David

AU - McCarthy, Patrick M

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

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DO - 10.1016/j.jtcvs.2015.12.063

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