September 6, 2022MedicinaOpen Access

Impact of Pulmonary Hypertension on Mortality after Surgery for Aortic Stenosis

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Why the study?

Although patients with aortic stenosis and pulmonary hypertension have worse outcomes, few data exist on this association, predictors of pulmonary hypertension, or its role as a perioperative risk factor in surgical aortic valve replacement.

Does severe pulmonary hypertension increase early postoperative mortality in patients with aortic stenosis undergoing surgical aortic valve replacement?

Structured PICO

Does severe pulmonary hypertension increase early postoperative mortality in patients with aortic stenosis undergoing surgical aortic valve replacement?

Population

340 patients with aortic stenosis (AS) undergoing surgical aortic valve replacement (AVR)

Intervention

Presence of severe pulmonary hypertension (PHT)

Comparator

Absence of severe pulmonary hypertension (PHT)

Outcome

Early postoperative mortalityhard clinical

Severe pulmonary hypertension is a strong independent predictor of early postoperative mortality in patients undergoing surgical aortic valve replacement for aortic stenosis.

Implication

May aid preoperative risk stratification in surgical AS; leaves open whether modifying predictors improves outcomes.

Abstract

Background and Objectives: The prognosis of patients with aortic stenosis (AS) adding pulmonary hypertension (PHT) is worse than in those with normal pulmonary artery pressure (PAP), and there are few results reported for the association between PHT and adverse outcomes of AS. We aimed to determine the predictive factors for the development of PHT in patients with surgical AS and to identify those factors that may predict the surgical prognosis. We aimed to identify the independent predictors for PHT regression at 2 years after surgery. Additionally, we tried to evaluate the involvement of PHT as an additional perioperative risk factor in patients with AS undergoing surgical aortic valve replacement (AVR). Materials and Methods: We carried out a two-year prospective study on 340 patients with AS undergoing surgical AVR. Results: The independent predictors for the occurrence of PHT in patients with surgical AS were: age > 75 years (RR = 6, p = 0.001), a restrictive left ventricle diastolic filling pattern (LVDFP) (RR = 9, p = 0.001) and associated moderate mitral regurgitation (MR) (RR = 9, p = 0.0001). The presence of severe PHT increased by 7.6 times the early postoperative risk of death, regardless of the presence of other parameters. The independent predictors for early postoperative mortality were: severe PHT, restrictive left ventricle diastolic pattern, age > 75 years, interventricular septum (IVS) thickness >18 mm and the presence of comorbidities. Conclusions: The presence of a severe PHT in patients with AS undergoing surgical AVR is associated with an early postoperative increased mortality rate. The mean PAP is a more reliable parameter for prognosis appreciation than the LV systolic function.