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| Impact of Pulmonary Hypertension on Outcomes Following Aortic Valve Replacement for Aortic Valve Stenosis |
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Spencer J. Melby, Marci Bailey, Marc R. Moon, Nader Moazami, Jennifer S. Lawton, Brian R. Lindman, Ralph J. Damiano Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO Objective: The presence of chronic pulmonary hypertension (CPH) historically has been considered a significant risk factor affecting early and late outcomes following valve replacement. However, few studies have rigorously looked at its effect on outcome. Moreover, there have been a number of recent advances in the management of pulmonary hypertension and right heart failure following cardiac surgery. The purpose of this study was to determine if pulmonary hypertension remains a risk factor in the modern era in outcomes following aortic valve replacement (AVR) for aortic valve stenosis. Methods: From January 1996 to June 2009, 1,080 patients underwent AVR for primary aortic valve stenosis, of which 574 (53%) had normal systolic pulmonary artery pressures (sPAP) and 506 (47%) had CPH. CPH was defined as mild (sPAP 35-44 mmHg), moderate (45-59mmHg), or severe (≥ 60mmHg). In the group of patients with CPH, 204 had postoperative echocardiograms. Results: Operative mortality was significantly higher in patients with CPH (47/506, 9% vs. 31/574, 5%, p=0.02). The incidence of postoperative stroke was similar (p=0.14), but patients with CPH had an increased median hospital LOS (8 vs. 7 days, p=0.001) and an increased incidence of prolonged ventilation (26% vs. 17%; p<0.001). In the mild CPH group, sPAP did not fall following AVR (39 ± 3 vs. 37 ± 11 mmHg, p=0.2). In contrast, sPAP fell after AVR in patients with moderate CPH ( 51 ± 4 vs. 45 ± 16, p=0.01) and severe CPH (69 ± 12 vs. 45 ± 14, p<0.001). Five-year survival (Kaplan-Meier) was 78 ± 6% with normal sPAP and 77 ± 7% with mild CPH postoperatively, compared to 64 ± 8% with moderate CPH and 45 ± 12% with severe CPH (p<0.001, Figure). Conclusion: In patients undergoing AVR for aortic valve stenosis, CPH increased operative mortality, and patients with persistent moderate or severe CPH after AVR had decreased long-term survival. The presence of CPH does not currently factor into STS risk scores. This data suggests that CPH has significant impact on outcomes in patients undergoing AVR and should be considered in preoperative assessment. 
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Copyright © 2012 American Association for Thoracic Surgery
All rights reserved. IMPORTANT REMINDER: The preceding information is intended only to provide
general guidance and not as a definitive basis for diagnosis or treatment in any particular case.
It is very important that you consult a doctor about any specific medical problem or question.
All rights reserved. IMPORTANT REMINDER: The preceding information is intended only to provide
general guidance and not as a definitive basis for diagnosis or treatment in any particular case.
It is very important that you consult a doctor about any specific medical problem or question.