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Pulmonary hypertension adversely affects short- and long-term survival after mitral valve operation for mitral regurgitation: Implications for timing.

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Presentation on theme: "Pulmonary hypertension adversely affects short- and long-term survival after mitral valve operation for mitral regurgitation: Implications for timing."— Presentation transcript:

1 Pulmonary hypertension adversely affects short- and long-term survival after mitral valve operation for mitral regurgitation: Implications for timing of surgery  Mehrdad Ghoreishi, MD, Charles F. Evans, MD, Christopher R. DeFilippi, MD, Gerald Hobbs, PhD, Cindi A. Young, Bartley P. Griffith, MD, James S. Gammie, MD  The Journal of Thoracic and Cardiovascular Surgery  Volume 142, Issue 6, Pages (December 2011) DOI: /j.jtcvs Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

2 Figure 1 Patient population: exclusion criteria and final analysis population for cohort 1 and 2 studies. AV, Aortic valve; CABG, coronary artery bypass graft surgery; MR, mitral regurgitation; MS, mitral stenosis; MV, mitral valve; PPH, primary pulmonary hypertension; Redo, redo cardiac surgery; sPAP, systolic pulmonary artery pressure. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

3 Figure 2 Hospital mortality according to preoperative PH grade (P < .0001). PH, Pulmonary hypertension. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

4 Figure 3 Long-term survival according to preoperative PH. A, Actuarial survival according to a cutoff value of sPAP 40 mm Hg or greater. B, Survival according to preoperative PH grade. PH, Pulmonary hypertension; sPAP, Systolic pulmonary artery pressure. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

5 Figure 4 Survival curve according to preoperative PH (sPAP ≥ 40 mm Hg) in cohort 2 (patients with isolated degenerative MR due to flail leaflet). For all patients (A) and according to preoperative PH grade (B). MR, Mitral regurgitation; PH, pulmonary hypertension; sPAP, systolic pulmonary artery pressure. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

6 Figure 5 Mean sPAP at different time points. A, All patients (mean ± standard deviation sPAP at preoperative: 43 ± 16, predischarge: 39 ± 11, follow-up < 2 years: 39 ± 12, follow-up > 2 years: 38 ± 13 mm Hg). B, According to PH grade for all patients. C, For 404 patients with 2-year follow-up. Mean sPAP decreased markedly in patients with higher preoperative sPAP, but residual sPAP 40 mm Hg or greater was more common after surgery and during follow-up in these groups. Pulmonary pressures at predischarge relatively correlate with the late response of pulmonary pressure changes to surgery (no significant difference was identified in mean sPAP at predischarge and within 2 years follow-up, P = .95). ¥Median: 12 months (24 days to 24 months). §Median: 41 months (24–91 months). ∗P < .01 compared with preoperative value. MR, Mitral regurgitation; PH, pulmonary hypertension; sPAP, Systolic pulmonary artery pressure. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

7 Appendix Figure 1 Kaplan–Meier survival curve according to preoperative sPAP/sBP. sPAP, Systolic pulmonary artery pressure; sBP, systolic blood pressure. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

8 Appendix Figure 2 Hospital mortality according to preoperative PH grade among patients who underwent isolated MV operation for MR (n = 478). PH, Pulmonary hypertension. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

9 Appendix Figure 3 Long-term survival according to preoperative PH among patients who underwent isolated MV operation for MR (n = 478). PH, Pulmonary hypertension. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

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