Document Detail


Prognostic implications of pulmonary hypertension in patients with severe aortic stenosis.
MedLine Citation:
PMID:  21320709     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: We sought to determine the clinical outcomes of patients undergoing surgical aortic valve replacement with hemodynamically confirmed severe pulmonary hypertension and aortic stenosis and compare them with the outcomes of patients not undergoing aortic valve replacement and patients undergoing aortic valve replacement with mild-to-moderate pulmonary hypertension. METHODS: A total of 317 patients with severe aortic stenosis (aortic valve area < 1 cm(2)) underwent right heart catheterization along with left heart catheterization between 2004 and 2009. Severe pulmonary hypertension (mean pulmonary artery pressure > 35 mm Hg) was present in 81 patients, of whom 35 (43.2%) underwent surgical aortic valve replacement. We compared the clinical outcomes of these 35 patients with the 46 patients with severe pulmonary hypertension who did not undergo surgical aortic valve replacement. RESULTS: Thirty-day mortality after aortic valve replacement was 2.85% in patients with severe pulmonary hypertension and 10.86% in patients not undergoing aortic valve replacement (P = .001). During a mean follow-up of 339.0 ± 343.7 days, overall mortality in patients undergoing aortic valve replacement was 14.2% in patients with severe pulmonary hypertension and 50% in patients with severe pulmonary hypertension who did not undergo aortic valve replacement (P < .0001). On the other hand, among patients who underwent surgery, overall mortality was similar in both the mild-to-moderate pulmonary hypertension group (23 patients [20.3%]) and the severe pulmonary hypertension group at the end of the follow-up period (P = .4). In a multivariate analysis, the presence of chronic obstructive pulmonary disease and the lack of reduction in mean pulmonary artery pressure were independent predictors of mortality in these high-risk patients undergoing aortic valve replacement, whereas baseline mean pulmonary artery pressure was not a predictor. Preoperative pulmonary capillary wedge pressure was a significant predictor of postoperative reduction in mean pulmonary artery pressure. CONCLUSION: In patients with severe aortic stenosis and severe pulmonary hypertension who undergo aortic valve replacement, baseline pulmonary artery pressure does not unfavorably affect survival. Aortic valve replacement should be considered for patients with aortic stenosis with severe pulmonary hypertension, especially with higher pulmonary capillary wedge pressure.
Authors:
Akin Cam; Sachin S Goel; Shikhar Agarwal; Venu Menon; Lars G Svensson; E Murat Tuzcu; Samir R Kapadia
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-12
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  -     ISSN:  1097-685X     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-2-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio.
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