TY - JOUR
T1 - Increased mortality in patients with preoperative and persistent postoperative pulmonary hypertension undergoing mitral valve surgery for mitral regurgitation
T2 - A cohort study
AU - Genuardi, Michael V.
AU - Shpilsky, Daniel
AU - Handen, Adam
AU - Vanspeybroeck, Gabrielle
AU - Canterbury, Ann
AU - Lu, Michael
AU - Shapero, Kayle
AU - Nieves, Ricardo A.
AU - Thoma, Floyd
AU - Mulukutla, Suresh R.
AU - Cavalcante, João L.
AU - Chan, Stephen Y.
N1 - Funding Information:
This work was supported by the National Institutes of Health (R01 HL124021, HL 122596, HL 138437, and UH2/UH3 TR002073); American Heart Association (18EIA33900027) (Dr Chan) and a University of Pittsburgh Medical Center Heart and Vascular Institute Fellow Research Grant (Dr Shpilsky).
Publisher Copyright:
© 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2021
Y1 - 2021
N2 - BACKGROUND: Preoperative pulmonary hypertension (PH) is associated with excess mortality among patients with severe mitral regurgitation undergoing mitral valve surgery (MVS). However, the links between PH phenotype, pulmonary vascular remod-eling, and persistent postoperative PH are not well understood. We aimed to describe the associations between components of pulmonary hemodynamics as well as postoperative residual PH with longitudinal mortality in patients with severe mitral regurgitation who received MVS. METHODS AND RESULTS: Patients undergoing MVS for severe mitral regurgitation from 2011 to 2016 were retrospectively identi-fied within our health system (n=488). Mean pulmonary artery pressure and other hemodynamic variables were determined by presurgical right-heart catheterization. Postoperative pulmonary artery systolic pressure was assessed on echocardiogram 42 to 365 days post-MVS. Longitudinal survival over a mean 3.9 years of follow-up was evaluated using Cox proportional hazards modeling to compare survival after adjustment for demographics, surgical characteristics, and comorbidities. Pre-MVS prevalence of PH was high at 85%. After adjustment, each 10-mm Hg increase in preoperative mean pulmonary artery pressure was associated with a 1.38-fold increase in risk of death (95% CI, 1.13–1.68). Elevated preoperative pulmonary vascular resistance, transpulmonary gradient, and right atrial pressure were similarly associated with increased mortality. Among 231 patients with postoperative echocardiogram, evidence of PH on echocardiogram (pulmonary artery systolic pressure ≥35 mm Hg) was associated with increased risk of death (hazard ratio [HR], 2.02 [95% CI, 1.17–3.47]); however, this was no longer statistically significant after adjustment (HR, 1.55 [95% CI, 0.85–2.85]). CONCLUSIONS: In patients undergoing MVS for mitral regurgitation, preoperative PH, and postoperative PH were associated with increased mortality.
AB - BACKGROUND: Preoperative pulmonary hypertension (PH) is associated with excess mortality among patients with severe mitral regurgitation undergoing mitral valve surgery (MVS). However, the links between PH phenotype, pulmonary vascular remod-eling, and persistent postoperative PH are not well understood. We aimed to describe the associations between components of pulmonary hemodynamics as well as postoperative residual PH with longitudinal mortality in patients with severe mitral regurgitation who received MVS. METHODS AND RESULTS: Patients undergoing MVS for severe mitral regurgitation from 2011 to 2016 were retrospectively identi-fied within our health system (n=488). Mean pulmonary artery pressure and other hemodynamic variables were determined by presurgical right-heart catheterization. Postoperative pulmonary artery systolic pressure was assessed on echocardiogram 42 to 365 days post-MVS. Longitudinal survival over a mean 3.9 years of follow-up was evaluated using Cox proportional hazards modeling to compare survival after adjustment for demographics, surgical characteristics, and comorbidities. Pre-MVS prevalence of PH was high at 85%. After adjustment, each 10-mm Hg increase in preoperative mean pulmonary artery pressure was associated with a 1.38-fold increase in risk of death (95% CI, 1.13–1.68). Elevated preoperative pulmonary vascular resistance, transpulmonary gradient, and right atrial pressure were similarly associated with increased mortality. Among 231 patients with postoperative echocardiogram, evidence of PH on echocardiogram (pulmonary artery systolic pressure ≥35 mm Hg) was associated with increased risk of death (hazard ratio [HR], 2.02 [95% CI, 1.17–3.47]); however, this was no longer statistically significant after adjustment (HR, 1.55 [95% CI, 0.85–2.85]). CONCLUSIONS: In patients undergoing MVS for mitral regurgitation, preoperative PH, and postoperative PH were associated with increased mortality.
KW - Mitral regurgitation
KW - Mitral valve surgery
KW - Mortality
KW - Pulmonary hypertension
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U2 - 10.1161/JAHA.120.018394
DO - 10.1161/JAHA.120.018394
M3 - Article
C2 - 33599144
AN - SCOPUS:85102537335
SN - 2047-9980
VL - 10
SP - 1
EP - 28
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 5
M1 - e018394
ER -