LONG-TERM OUTCOME OF CARDIAC-SURGERY IN PATIENTS WITH MITRAL-STENOSISAND SEVERE PULMONARY-HYPERTENSION

Citation
Jj. Vincens et al., LONG-TERM OUTCOME OF CARDIAC-SURGERY IN PATIENTS WITH MITRAL-STENOSISAND SEVERE PULMONARY-HYPERTENSION, Circulation, 92(9), 1995, pp. 137-142
Citations number
23
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiac & Cardiovascular System",Hematology
Journal title
ISSN journal
0009-7322
Volume
92
Issue
9
Year of publication
1995
Supplement
S
Pages
137 - 142
Database
ISI
SICI code
0009-7322(1995)92:9<137:LOOCIP>2.0.ZU;2-N
Abstract
Background Pulmonary hypertension increases perioperative risk in pati ents having mitral valve replacement, but most studies have included p atients with mixed mitral valve disease and have not examined long-ter m outcome. Methods and Results We retrospectively examined the results and predictors of outcome of cardiac surgery in 43 patients (age, 6213 years [mean+/-SD]; 81% women) with a primary diagnosis of mitral st enosis and severe pulmonary hypertension (pulmonary artery systolic pr essure greater than or equal to 60 mm Hg or mean pressure greater than or equal to 50 mm Hg). Patients with more than mild mitral regurgitat ion were excluded. Thirty-eight patients (88%) were in NYHA functional class III or IV, and Il patients (26%) had an acute presentation requ iring urgent surgery. Preoperative hemodynamics demonstrated a mean mi tral valve area of 0.7+/-0.3 cm(2), mean pulmonary artery pressure of 50+/-9 mmHg, and pulmonary artery systolic pressure of 81+/-18 mm Hg. Other characteristics included right ventricular failure (18 patients) , coronary artery disease (16 patients), and critical aortic stenosis (11 patients). Forty patients underwent mitral valve replacement with St Jude prostheses; 3 had open commissurotomy. Additional surgical pro cedures included aortic valve replacement (42%), coronary artery bypas s graft surgery (26%), and tricuspid valvuloplasty (16%). There were 5 perioperative deaths (11.6%), and 7 other patients (16%) had major co mplications, including reoperation for hemorrhage, stroke, respiratory failure, myocardial infarction, or a >30-day hospitalization. Univari ate analysis of demographic, hemodynamic, and operative characteristic s identified the following predictors of perioperative death (P<.05): acute presentation, clinical evidence of right ventricular failure, im paired left ventricular ejection fraction, and increased left ventricu lar diastolic pressure. Predictors of complications (P<.05) were acute presentation, ECG evidence of right ventricular hypertrophy, and elev ated right ventricular systolic pressure. Multivariate analysis showed only acute presentation and right ventricular hypertrophy as predicto rs of perioperative death or major complications, respectively. Five- and 10-year actuarial survivals were 80% and 64%, respectively. The on ly predictor of long-term mortality was advanced age. Functional NYHA status was improved by one grade or more in 76% of survivors. Conclusi ons Patients referred to a tertiary care hospital in the United States with mitral stenosis and severe pulmonary hypertension often have oth er associated cardiac diseases and comorbid conditions. Cardiac surger y can be successfully performed with an acceptable mortality, and risk factors for poor perioperative outcome can be identified by preoperat ive clinical characteristics. Younger patients have the best long-term survival, and most Survivors experienced long-term improvement in fun ctional status.