February 18, 2021Journal of the American Heart AssociationOpen Access

Increased Mortality in Patients With Preoperative and Persistent Postoperative Pulmonary Hypertension Undergoing Mitral Valve Surgery for Mitral Regurgitation: A Cohort Study

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Severe mitral regurgitation (n=488). Intervention: 10-mm Hg increase in preoperative mean pulmonary artery pressure vs. Lower preoperative mean pulmonary artery pressure. Primary outcome: All-cause mortality (HR 1.38, 95% CI 1.13-1.68).

Q: What does this research mean for the field?

Each 10-mm Hg increase in preoperative mean pulmonary artery pressure is associated with an increased risk of death (HR 1.38; 95% CI 1.13-1.68) in patients undergoing mitral valve surgery for severe mitral regurgitation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

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Key result

Higher preoperative mean PAP is linked to ~38% greater mortality after mitral valve surgery.

HR 1.38
95% CI 1.13-1.68
n=488

Why the study?

Preoperative pulmonary hypertension carries excess mortality in severe mitral regurgitation after mitral valve surgery, but the links between PH phenotype, pulmonary vascular remodeling, and persistent postoperative PH are not well understood.

Does preoperative and persistent postoperative pulmonary hypertension increase mortality in patients undergoing mitral valve surgery for severe mitral regurgitation?

Population

488 patients undergoing MVS for severe mitral regurgitation

Comparison

Hemodynamic components of preoperative PH and postoperative residual PH

Design

Retrospective cohort study

Follow-up

Mean 3.9 years

Authors

MGMichael V. GenuardiHospital of the University of Pennsylvania DSDaniel ShpilskyMaine Medical Center AHAdam HandenUniversity of Chicago

Discussion

Member takes

Implication

May support preoperative PH assessment for risk stratification in mitral surgery; leaves open whether intervention improves survival.

Study Design

Type

Cohort (n=488)

Multicenter

Yes

Structured PICO

Does preoperative and persistent postoperative pulmonary hypertension increase mortality in patients undergoing mitral valve surgery for severe mitral regurgitation?

Population

488 adult patients (mean age 67.2 years, 44.9% female) with severe mitral regurgitation undergoing mitral valve surgery, followed for a mean of 3.9 years.

Exposure

Preoperative pulmonary hypertension (mean pulmonary artery pressure >20 mm Hg) and persistent postoperative pulmonary hypertension (pulmonary artery systolic pressure ≥35 mm Hg on echocardiogram 42-365 days post-surgery).

Comparator

Patients without preoperative pulmonary hypertension (mean pulmonary artery pressure ≤20 mm Hg) or without postoperative pulmonary hypertension.

Outcome

Post-MVS all-cause mortality over a mean 3.9 years of follow-up.hard clinical

Main Result

Hazard Ratio: 1.38 (95% CI 1.13–1.68)

Preoperative and persistent postoperative pulmonary hypertension are associated with significantly increased long-term mortality in patients undergoing mitral valve surgery for severe mitral regurgitation.

Limitations

Retrospective observational design
Missing data for some clinical variables such as NYHA functional status and serum creatinine
Lack of universal echocardiographic right ventricular assessment
Small number of patients with isolated precapillary disease limited phenotype comparisons
Potential confounding by concomitant tricuspid valve surgery
Retrospective nature of the study
Large proportion of missing right ventricular parameters
Small number of patients with isolated precapillary disease (N=16)

Cite This Study

Genuardi et al. (2021) conducted a cohort in Severe mitral regurgitation (n=488). 10-mm Hg increase in preoperative mean pulmonary artery pressure vs. Lower preoperative mean pulmonary artery pressure was evaluated on All-cause mortality (HR 1.38, 95% CI 1.13-1.68). In patients undergoing mitral valve surgery for severe mitral regurgitation, each 10-mm Hg increase in preoperative mean pulmonary artery pressure was associated with a 38% increased risk of death (HR 1.38).

synapsesocial.com/papers/6a1c5a6e1567d2fc4d5ffa2f https://doi.org/10.1161/jaha.120.018394

Topics

Mitral valve intervention Echocardiography

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February 18, 2021Journal of the American Heart AssociationOpen Access

Increased Mortality in Patients With Preoperative and Persistent Postoperative Pulmonary Hypertension Undergoing Mitral Valve Surgery for Mitral Regurgitation: A Cohort Study

View Full Paper

Ask AI

Bookmark

Key result

Higher preoperative mean PAP is linked to ~38% greater mortality after mitral valve surgery.

HR 1.38
95% CI 1.13-1.68
n=488

Why the study?

Does preoperative and persistent postoperative pulmonary hypertension increase mortality in patients undergoing mitral valve surgery for severe mitral regurgitation?

Population

488 patients undergoing MVS for severe mitral regurgitation

Comparison

Hemodynamic components of preoperative PH and postoperative residual PH

Design

Retrospective cohort study

Follow-up

Mean 3.9 years

Authors

MGMichael V. GenuardiHospital of the University of Pennsylvania DSDaniel ShpilskyMaine Medical Center AHAdam HandenUniversity of Chicago

Discussion

Member takes

Implication

May support preoperative PH assessment for risk stratification in mitral surgery; leaves open whether intervention improves survival.

Study Design

Type

Cohort (n=488)

Multicenter

Yes

Structured PICO

Does preoperative and persistent postoperative pulmonary hypertension increase mortality in patients undergoing mitral valve surgery for severe mitral regurgitation?

Population

488 adult patients (mean age 67.2 years, 44.9% female) with severe mitral regurgitation undergoing mitral valve surgery, followed for a mean of 3.9 years.

Exposure

Comparator

Patients without preoperative pulmonary hypertension (mean pulmonary artery pressure ≤20 mm Hg) or without postoperative pulmonary hypertension.

Outcome

Post-MVS all-cause mortality over a mean 3.9 years of follow-up.hard clinical

Main Result

Hazard Ratio: 1.38 (95% CI 1.13–1.68)

Limitations

Retrospective observational design
Missing data for some clinical variables such as NYHA functional status and serum creatinine
Lack of universal echocardiographic right ventricular assessment
Small number of patients with isolated precapillary disease limited phenotype comparisons
Potential confounding by concomitant tricuspid valve surgery
Retrospective nature of the study
Large proportion of missing right ventricular parameters
Small number of patients with isolated precapillary disease (N=16)

Cite This Study

synapsesocial.com/papers/6a1c5a6e1567d2fc4d5ffa2f https://doi.org/10.1161/jaha.120.018394

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

Topics

Mitral valve intervention Echocardiography

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