title: Effect of preoperative pulmonary hypertension on outcomes in patients with severe aortic stenosis following surgical aortic valve replacement.
abstract: Pulmonary hypertension (PH) is prevalent in patients with aortic stenosis (AS); however, previous studies have demonstrated inconsistent results regarding the association of PH with adverse outcomes after aortic valve replacement (AVR). The goal of this study was to evaluate the effects of preoperative PH on outcomes after AVR. We performed a regional prospective cohort study using the Northern New England Cardiovascular Disease Study Group database to identify 1,116 consecutive patients from 2005 to 2010 who underwent AVR ± coronary artery bypass grafting for severe AS with a preoperative assessment of pulmonary pressures by right-sided cardiac catheterization. PH was defined as a mean pulmonary artery pressure of ≥25 mm Hg, with severity based on the pulmonary artery systolic pressure-mild, 35 to 44 mm Hg; moderate, 45 to 59 mm Hg; and severe, ≥60 mm Hg. We found that PH was present in 536 patients (48%). Postoperative acute kidney injury, low-output heart failure, and in-hospital mortality increased with worsening severity of PH. In multivariate logistic regression, severe PH was independently associated with postoperative acute kidney injury (adjusted odds ratio 4.1, 95% confidence interval [CI] 1.7 to 10, p = 0.002) and in-hospital mortality (adjusted odds ratio 6.9, 95% CI 2.5 to 19.1, p <0.001). There was a significant association between PH and decreased 5-year survival (adjusted log-rank p value = 0.006), with severe PH being associated with the poorest survival (adjusted hazard ratio 2.4, 95% CI 1.3 to 4.2, p = 0.003). In conclusion, severe PH in patients with severe AS is associated with increased rates of in-hospital adverse events and decreased 5-year survival after AVR.
authors.affiliation: Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. Electronic address: david.m.zlotnick@hitchcock.org.
authors.forename: David M
authors.initials: DM
authors.lastname: Zlotnick
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Ouellette
authors.forename: David J
authors.initials: DJ
authors.lastname: Malenka
authors.forename: Joseph P
authors.initials: JP
authors.lastname: DeSimone
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Leavitt
authors.forename: Robert E
authors.initials: RE
authors.lastname: Helm
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Olmstead
authors.forename: Salvatore P
authors.initials: SP
authors.lastname: Costa
authors.forename: Anthony W
authors.initials: AW
authors.lastname: DiScipio
authors.forename: Donald S
authors.initials: DS
authors.lastname: Likosky
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Schmoker
authors.forename: Reed D
authors.initials: RD
authors.lastname: Quinn
authors.forename: Donato
authors.initials: D
authors.lastname: Sisto
authors.forename: John D
authors.initials: JD
authors.lastname: Klemperer
authors.forename: Gerald L
authors.initials: GL
authors.lastname: Sardella
authors.forename: Yvon R
authors.initials: YR
authors.lastname: Baribeau
authors.forename: Carmine
authors.initials: C
authors.lastname: Frumiento
authors.forename: Jeremiah R
authors.initials: JR
authors.lastname: Brown
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: O'Rourke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006328:Cardiac Catheterization; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009511:New England / Q000453:epidemiology; D057234:Preoperative Period; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome