PAH Not Linked to Mortality in Valve Surgery for Rheumatic Heart Disease
Researchers divided 407 patients into 3 groups according to pulmonary arterial hypertension estimated on echocardiograph as mild, moderate, or severe.
Among individuals receiving valve surgery for rheumatic heart disease, neither short-term nor long-term outcomes are significantly affected by moderate-to-acute pulmonary arterial hypertension (PAH), according to recently published findings. The combination of mitral stenosis and acute PAH, however, was associated with greater mortality rates than no PAH.
This retrospective observational study included 407 participants who were assigned to one of 3 groups according to severity of PAH. Mild or no hypertension was defined as pulmonary artery systolic pressure (PASP) <30 mm Hg, moderate as PASP=31-55 mm Hg, and acute as PASP >55 mm Hg.
Mortality in hospitalization and major morbidities were the primary endpoints. Intergroup comparison of continuous variables was performed using variance analysis whereas the chi-square test was used to compare categorical data. Variables linked to mortality were identified using multiple and univariate regression whereas survival curves were approximated with the nonparametric Kaplan-Meier estimator.
The 3 groups did not differ significantly in terms of mortality under hospitalization (total=5.9% [n=24]; mild PAH group=2.8 [n=3]; moderate=4.5% [n=6]; acute=9.1% [n=15]; P =.09).
Prolonged ventilation was higher among persons with acute PAH (P =.007), although all 3 groups showed similar incidence of cardiac surgery-related acute kidney injury (P =.53), neurologic deficit (P =.9), and re-exploration for bleeding (P =.97).
Mortality was associated with >2 packed-cell transfusion, severe kidney injury, and prolonged ventilation, but it did not correlate with either moderate or acute PAH. Over a long-term mean follow-up period of 19.40±14.10 months, mortality was significantly higher among participants with mitral stenosis and acute PAH compared with mild or none (P =.03).
Limitations to this study include a retrospective, single-center study design, a long duration of study, the use of Doppler echocardiography instead of right heart catheterization to take pulmonary arterial pressure measurements, and the use of telephone calls to follow up with certain participants.
The study researchers concluded that "[moderate] and severe PAH does not affect short and long-term outcomes of patients undergoing mitral ± aortic valve surgery for [rheumatic heart disease]. Patients with [mitral stenosis] with severe PAH had higher mortality compared to those with no PAH, whereas mortality in patients with [mitral regurgitation] as primary pathology was not different across PAH categories."
Borde DP, Asegaonkar B, Khade S, Puranik M, George A, Joshi S. Impact of preoperative pulmonary arterial hypertension on early and late outcomes in patients undergoing valve surgery for rheumatic heart disease. Indian J Anaesth. 2018;62(12):963-971.