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Pulmonary Hypertension and Operative Risk in Mitral Valve and Coronary Surgery

Robert B Hawkins1, Raymond J Strobel2, J Hunter Mehaffey2

  • 1Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.

The Journal of Surgical Research
|February 8, 2023
PubMed

Insights

Pulmonary hypertension (PHT) poses a lower risk for mitral valve surgery than for coronary artery bypass grafting (CABG). This finding highlights the need for optimized perioperative care for PHT patients undergoing cardiac procedures.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Pulmonary Hypertension

Background:

  • Pulmonary hypertension (PHT) is a known risk factor for coronary artery bypass grafting (CABG).
  • The impact of PHT on outcomes following mitral valve operations is less understood.
  • This study investigates the association between PHT and surgical risk in mitral valve operations compared to CABG.

Purpose of the Study:

  • To test the hypothesis that PHT is associated with a lower risk during mitral valve operations compared to CABG.
  • To analyze the association of pulmonary artery systolic pressure (PASP) with operative outcomes in patients undergoing mitral valve or CABG procedures.
  • To identify potential differences in risk stratification for patients with PHT undergoing different cardiac surgeries.

Main Methods:

  • Utilized data from a regional Society of Thoracic Surgeons (STS) database (2011-2019).
  • Included patients undergoing isolated mitral valve or CABG operations.
  • Stratified patients by pulmonary artery systolic pressure (PASP) and used hierarchical regression modeling, adjusting for STS predicted risk scores.

Main Results:

  • Mitral valve surgery patients had higher mean STS risk of mortality and median PASP compared to CABG patients.
  • Increased PASP was independently associated with operative mortality and major morbidity in both groups.
  • A 10-mmHg increase in PASP was associated with lower odds of morbidity, mortality, and ICU time in mitral patients compared to CABG patients (P < 0.0001).

Conclusions:

  • Despite higher preoperative pulmonary artery pressures, PHT was linked to lower risk for mitral valve surgery outcomes compared to CABG.
  • Further research is needed to optimize perioperative management of patients with PHT.
  • Improved understanding and care strategies for PHT patients undergoing cardiac surgery are essential.
Abstract

Keywords:
Mitral valveOutcomes researchPulmonary hypertensionResource utilization

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