Key result
Preoperative PAP >70 mmHg linked to ~193% higher in-hospital mortality after rheumatic mitral valve replacement.
Why the study?
The role of pulmonary artery pressure in predicting in-hospital and one-year mortality after valve replacement surgery in middle-aged and aged patients with rheumatic mitral disease was unclear.
Does preoperative pulmonary artery pressure predict in-hospital and 1-year mortality in middle-aged and aged patients undergoing valve replacement surgery for rheumatic mitral disease?
Observational (n=1,639)
No
Does preoperative pulmonary artery pressure predict in-hospital and 1-year mortality in middle-aged and aged patients undergoing valve replacement surgery for rheumatic mitral disease?
Preoperative pulmonary artery pressure measured by echocardiography is a significant independent predictor of in-hospital and 1-year mortality in patients undergoing valve replacement for rheumatic mitral disease.
Elevated preoperative PAP was associated with higher in-hospital mortality; leaves open whether it should guide risk stratification or interventions pending prospective validation.
OBJECTIVES: To investigate the role of pulmonary artery pressure (PAP) in predicting in-hospital death after valve replacement surgery in middle-aged and aged patients with rheumatic mitral disease. DESIGN: An observational study. SETTING: Guangdong General Hospital, China. PARTICIPANTS: 1639middle-aged and aged patients (mean age 57±6 years) diagnosed with rheumatic mitral disease, undergoing valve replacement surgery and receiving coronary angiography and transthoracic echocardiography before operation, were enrolled. INTERVENTIONS: All participants underwent valve replacement surgery and received coronary angiography before operation. PRIMARY AND SECONDARY OUTCOME MEASURES: In-hospital death and 1-year mortality after operation. METHODS: Included patients were divided into four groups based on the preoperative PAP obtained by echocardiography: group A (PAP≤30 mm Hg); group B (>30 mm Hg 50 mm Hg 70 mm Hg). The relationship between PAP and in-hospital death and cumulative rate of 1-year mortality was evaluated. RESULTS: In-hospital mortality rate increased gradually but significantly as the PAP level increased, with 1.9% in group A (n=268), 2.3% in group B (n=771), 4.7% in group C (n=384) and 10.2% in group D (n=216) (p<0.001). Multivariate analysis showed that PAP>70 mm Hg was an independent predictor of in-hospital death (OR=2.93, 95% CI 1.61 to 5.32, p<0.001). PAP>52.5 mm Hg had a sensitivity of 60.3% and specificity of 67.7% in predicting in-hospital death (area under the curve=0.672, 95% CI 0.602 to 0.743, p<0.001). Kaplan-Meier analysis showed that patients with PAP>52.5 mm Hg had higher 1-year mortality after operation than those without (log-rank=21.51, p<0.001). CONCLUSIONS: PAP could serve as a predictor of postoperative in-hospital and 1-year mortality after valve replacement surgery in middle-aged and aged patients with rheumatic mitral disease.
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Jiang et al. (2017) conducted an observational in Rheumatic mitral disease (n=1,639). Preoperative pulmonary artery pressure >70 mm Hg vs. Preoperative pulmonary artery pressure ≤30 mm Hg was evaluated on In-hospital death (OR 2.93, 95% CI 1.61 to 5.32, p=<0.001). Preoperative pulmonary artery pressure >70 mm Hg was an independent predictor of in-hospital death (OR 2.93) in patients undergoing valve replacement surgery for rheumatic mitral disease.
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