Abstract
Introduction
Pulmonary hypertension (PHT) is a known risk factor for coronary artery bypass grafting
(CABG), though less well understood for valve operations. We hypothesized PHT is associated
with lower risk during mitral valve operations compared to CABG.
Methods
Patients undergoing isolated mitral valve or CABG operations (2011-2019) in a regional
Society of Thoracic Surgeons (STS) database were stratified by pulmonary artery systolic
pressure (PASP). The association of PASP by procedure type was assessed by hierarchical
regression modeling, adjusting for STS predicted risk scores.
Results
Of the 2542 mitral and 11,059 CABG patients, the mitral population had higher mean
STS risk of mortality (3.6% versus 2.4%, P < 0.0001) and median PASP (42 mmHg versus 32 mmHg, P < 0.0001). PASP was independently associated with operative mortality and major morbidity
in both mitral and CABG patients. However, for mitral patients a 10-mmHg increase
in PASP was associated with lower odds of morbidity (odds ratio: 1.06 versus 1.13), mortality (odds ratio: 1.11 versus 1.18) and intensive care unit time (4.3 versus 7.6 h) compared with CABG patients (interaction terms P < 0.0001). Among mitral patients, median PASP was higher in stenotic versus regurgitant disease (57 mmHg versus 40 mmHg, P < 0.0001). However, there was no differential association of PASP on morbidity or
mortality (interaction terms P > 0.05).
Conclusions
Although mitral surgery patients tend to have higher preoperative pulmonary artery
pressures, PHT was associated with a lower risk for mitral outcomes compared with
CABG. Further research on the management and optimization of patients with PHT perioperatively
is needed to improve care for these patients.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: February 06, 2023
Accepted:
December 28,
2022
Received in revised form:
December 27,
2022
Received:
March 23,
2022
Identification
Copyright
Published by Elsevier Inc.
