title: The impact of pulmonary hypertension on morbidity and mortality following major lung resection.
abstract: OBJECTIVE
  Pulmonary hypertension is considered a poor prognostic factor for or even a contraindication to major lung resection, but evidence for this claim is lacking. This study evaluates the impact of pulmonary hypertension on morbidity and mortality following pulmonary lobectomy.
  
  
  METHODS
  Adult patients who underwent a lobectomy for cancer and had a transthoracic echocardiogram (TTE) performed within the year prior to the operation were included. Pulmonary hypertension was defined as an estimated right ventricular systolic pressure (RVSP) of ≥36 mmHg by TTE. The preoperative characteristics, intraoperative data and postoperative outcomes of patients with and those without pulmonary hypertension based on TTE were compared. A model for morbidity including published risk factors as well as pulmonary hypertension was developed by multivariable logistic regression.
  
  
  RESULTS
  There were 279 patients without pulmonary hypertension and 19 patients with pulmonary hypertension. Patients with pulmonary hypertension had a lower preoperative forced expiratory volume in 1 s and diffusing capacity of the lung for carbon monoxide than patients without pulmonary hypertension and a higher incidence of tricuspid regurgitation and mitral regurgitation, but the groups were otherwise similar. The mean RVSP in the group of patients with pulmonary hypertension was 47 mmHg. Perioperative mortality (0.0 vs 2.9%; P = 1.0) and postoperative complications (57.9 vs 47.7%; P = 0.48) were not significantly different between patients with and those without pulmonary hypertension. The presence of pulmonary hypertension was not a predictor of adverse outcomes in either univariate or multivariate analysis.
  
  
  CONCLUSIONS
  Lobectomy may be performed safely in selected patients with pulmonary hypertension, with complication rates comparable with those experienced by patients without pulmonary hypertension.
authors.affiliation: Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Wei
authors.affiliation: Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: D'Amico
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, NC, USA.
authors.forename: Zainab
authors.initials: Z
authors.lastname: Samad
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, NC, USA.
authors.forename: Rasha
authors.initials: R
authors.lastname: Hasan
authors.affiliation: Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC, USA mark.berry@dm.duke.edu.
authors.forename: Mark F
authors.initials: MF
authors.lastname: Berry
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004452:Echocardiography; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality*; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications; D012189:Retrospective Studies
keywords: Lobectomy; Lung cancer; Pulmonary hypertension