title: Does the Society of Thoracic Surgeons risk score accurately predict operative mortality for patients with pulmonary hypertension?
abstract: OBJECTIVE
  This study assessed the impact of pulmonary hypertension (PH) on morbidity and mortality after the most common cardiac operations and evaluated the accuracy of the Society of Thoracic Surgeons (STS) risk model for patients with PH.
  
  
  METHODS
  At a single center between 1994 and 2010, all adult cardiac operations performed with recorded preoperative mean pulmonary arterial pressure (MPAP) and STS predicted mortality were reviewed. MPAP was defined as normal (<25 mm Hg) or as mild (25-34 mm Hg), moderate (35-44 mm Hg), or severe (≥ 45 mm Hg) PH. Multivariate analysis was performed to elucidate the contribution of PH to morbidity and mortality.
  
  
  RESULTS
  In all, 3343 patient records were reviewed. Coronary artery bypass grafting (CABG) was the most common procedure (67.5%), followed by aortic valve replacement (24.9%) and mitral valve procedures (6.3%). Postoperative complications and mortality increased with increasing MPAP. Multivariable analysis found that both moderate (odds ratio, 7.17; P < .001) and severe (odds ratio, 13.73; P < .001) PH were significantly associated with increased mortality, even after accounting for STS risk. A subset analysis of isolated CABG cases revealed markedly increased mortality for all categories of PH (mild odds ratio, 1.99; moderate odds ratio, 11.5; severe odds ratio, 38.9; P < .001).
  
  
  CONCLUSIONS
  Morbidity and mortality were independently associated with PH. Observed mortality was significantly higher than predicted by the STS model for patients with moderate and severe PH, particularly in isolated CABG. Addition of PH to the STS risk model should be considered, or alternative tools should be used to assess risk in these patients.
authors.affiliation: Division of Cardiology, University of Virginia Health System, Charlottesville, Va 22908, USA.
authors.forename: Jamie L W
authors.initials: JL
authors.lastname: Kennedy
authors.forename: Damien J
authors.initials: DJ
authors.lastname: LaPar
authors.forename: John A
authors.initials: JA
authors.lastname: Kern
authors.forename: Irving L
authors.initials: IL
authors.lastname: Kron
authors.forename: James D
authors.initials: JD
authors.lastname: Bergin
authors.forename: Sandeep
authors.initials: S
authors.lastname: Kamath
authors.forename: Gorav
authors.initials: G
authors.lastname: Ailawadi
mesh_terms: D000368:Aged; D062186:Arterial Pressure; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality*; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006331:Heart Diseases / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality; D011651:Pulmonary Artery / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014768:Virginia / Q000453:epidemiology