Abstract
Background Severe pulmonary hypertension (PH) and left ventricular diastolic dysfunction (LVDD)
are independently associated with poor outcomes in cardiac surgery. We evaluated the
relationship of several measures of LVDD, PH, and hemodynamic subtypes of PH including
precapillary pulmonary hypertension(pcPH) and isolated post-capillary pulmonary hypertension(ipcPH)
and combined pre and post capillary pulmonary hypertension(cpcPH) capillary PH to
postoperative outcomes in a cohort of patients who underwent elective isolated-AVR.
Methods We evaluated (n = 206) patients in our local STS database who underwent elective isolated-AVR between
2014 and 2018, with transthoracic echocardiogram (n = 177) or right heart catheterization (n = 183) within 1 year of operation (or both, n = 161). The primary outcome was a composite end point of death, prolonged ventilation,
ICU readmission, and hospital stay >14 days.
Results Severe PH was associated with worse outcomes (moderate: OR, 1.1, p = 0.09; severe: OR, 1.28, p = 0.01), but degree of LVDD was not associated with worse outcomes. Across hemodynamic
subtypes of PH, odds of composite outcome were similar (p = 0.89), however, patients with cpcPH had more postoperative complications (67 vs.
36%, p = 0.06) and patients with ipcPH had greater all-cause mortality at 1 (8 vs. 1%, p = 0.03) and 3 years (27 vs. 4%, p = 0.008).
Conclusion Severe PH conferred modestly greater risk of adverse events, and both LVDD grade
and the combination of severe PH and LVDD were not associated with worse outcomes.
However, hemodynamic stratification of PH revealed higher postoperative complications
and worse long-term outcomes for those with cpcPH and ipcPH. Preoperative stratification
of PH by hemodynamic subtype in valve replacement surgery may improve our risk stratification
in this heterogenous condition. Further evaluation of the significance of LVDD and
PH in other cardiac operations is warranted.
Keywords
aortic valve - cardiac - cardiology - heart valve surgery
