Key result
Higher preoperative pulmonary arterial capacitance predicts ~52% lower death or HF admission risk after AVR.
Why the study?
To evaluate whether preoperative pulmonary arterial capacitance affects postoperative clinical outcomes in patients undergoing aortic valve replacement for severe aortic valve stenosis, even without pulmonary hypertension.
Does preoperative pulmonary arterial capacitance predict death or hospitalization for heart failure in patients undergoing aortic valve replacement for severe aortic valve stenosis?
Cohort (n=116)
No
Does preoperative pulmonary arterial capacitance predict death or hospitalization for heart failure in patients undergoing aortic valve replacement for severe aortic valve stenosis?
Preoperative pulmonary arterial capacitance is an independent predictor of long-term mortality or heart failure hospitalization in patients undergoing aortic valve replacement for severe aortic stenosis, even in the absence of pulmonary hypertension.
Answers are grounded in this paper and cite their sources.
Preoperative PAC may refine risk stratification after AVR for severe AS; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: Pulmonary arterial capacitance (PAC) is a determinant of right ventricular afterload and a strong independent predictor of unfavorable outcomes in advanced heart failure (HF) with pulmonary hypertension (PH). We aimed to test the hypothesis that preoperative PAC may affect postoperative clinical outcomes in patients undergoing aortic valve replacement (AVR) for severe aortic valve stenosis (AS), even in the absence of PH. METHODS AND PAC also showed an inverse relationship with pulmonary capillary wedge pressure (PCWP) (r=-0.15) and mean pulmonary arterial pressure (r=-0.29) and provided a stronger prediction of death or HF admission than PCWP or PVR (area under the ROC curve of 0.74 vs. 0.40 and 0.41, respectively, P=0.002). During a median follow-up of 36 months, PAC (hazard ratio, 0.48; 95% confidence interval, 0.30-0.78; P=0.003) was an independent predictor of death or hospitalization for HF. CONCLUSIONS: In these patients undergoing AVR for severe AS, even in the absence of PH, preoperative reduced PAC was independently associated with adverse surgical outcomes. It seems that preoperative PAC has potential as an independent predictor of long-term prognosis after AVR for severe AS.
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Yamashita et al. (2019) conducted a cohort in Severe aortic valve stenosis (n=116). Preoperative pulmonary arterial capacitance (PAC) was evaluated on All-cause death or admission for heart failure (HR 0.48, 95% CI 0.30-0.78, p=0.003). Preoperative pulmonary arterial capacitance was an independent predictor of all-cause death or heart failure admission (HR 0.48) in patients undergoing aortic valve replacement for severe aortic stenosis.
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