title: Impact of pulmonary hypertension on mortality after operation for isolated aortic valve stenosis.
abstract: BACKGROUND
  Pulmonary hypertension (PH) is a well-known independent risk factor for mortality and morbidity after cardiac surgery. However, no weight is given to PH in the current guidelines for the management of patients with aortic stenosis (AS) undergoing aortic valve replacement (AVR). The aim of our study was to evaluate the impact of preoperative PH on early and five-year survival in patients with severe AS undergoing isolated AVR.
  
  
  METHODS
  From January 2005 to July 2010, 422 consecutive patients with severe AS underwent isolated AVR. According to systolic pulmonary artery pressure (sPAP), PH was classified as none (sPAPS<35 mmHg, N=224), mild-moderate (35≤sPAP<50 mmHg, N=159) and severe (sPAP≥50 mmHg, N=39).
  
  
  RESULTS
  Overall in-hospital mortality was 2.8%. Unadjusted mortality was 0.9%, 3.8% and 10.2% for patients with normal, mild-moderate and severe PH (p=0.003). In multivariable analysis, severe PH (OR 4.1, 95 CI 1.1-15.3, p=0.04) and New York Heart Association class III-IV (OR 14.9, 95% CI 1.8-117.8, p=0.01) were independent risk factors of in-hospital mortality. Multivariable predictors of five-year survival were extracardiac arteriopathy (HR 2.8, 95%CI 1.6-4.9, p<0.0001), severe PH (HR 2.4, 95%CI 1.2-4.6 p=0.01), NHYA III-IV class (HR 2.3, 95% CI 1.3-4, p=0.003), preoperative serum creatinine (HR 2.2, 95%CI, 1.6-3.1,p<0.0001) and age (HR 1.08, 95%CI 1.03-1.13, p=0.01). Five-year survival was 86%±3% with normal sPAP, 81%±4% with mild-moderate PH and 63±10% with severe PH (p<0.001).
  
  
  CONCLUSIONS
  In patients undergoing isolated AVR with severe AS, severe PH is an independent predictor of in-hospital mortality and five-year survival.
authors.affiliation: Fondazione Toscana G. Monasterio, Massa, Italy; Bristol Heart Institute, University of Bristol, UK. Electronic address: antoniomiceli79@alice.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Miceli
authors.forename: Egidio
authors.initials: E
authors.lastname: Varone
authors.forename: Danyiar
authors.initials: D
authors.lastname: Gilmanov
authors.forename: Michele
authors.initials: M
authors.lastname: Murzi
authors.forename: Simone
authors.initials: S
authors.lastname: Simeoni
authors.forename: Giovanni
authors.initials: G
authors.lastname: Concistrè
authors.forename: Federica
authors.initials: F
authors.lastname: Marchi
authors.forename: Marco
authors.initials: M
authors.lastname: Solinas
authors.forename: Mattia
authors.initials: M
authors.lastname: Glauber
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality*; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
keywords: AVR; Aortic stenosis; Pulmonary hypertension