Abstract 10634: Impact of Pulmonary Hypertension on Surgical Outcomes after Restrictive Mitral Annuloplasty in Patients with Ischemic Cardiomyopathy and Mitral Regurgitation
Background: Pulmonary hypertension (PH) in patients with left ventricular dysfunction is a predictor of operative mortality, but its impact on long-term outcome has not been sufficiently established.
Methods: We classified 156 patients undergoing RMA for end-stage ischemic cardiomyopathy (ejection fraction ≤40%) and functional mitral regurgitation into 3 groups on the basis of Doppler-derived systolic pulmonary artery pressure (PAP) at baseline: systolic PAP <40 mmHg (mild PH) (n=41), systolic PAP 40-59 mmHg (moderate PH) (n=71), and systolic PAP ≥60 mmHg (severe PH) (n=42). Follow-up was completed with a mean duration of 51±25 months.
Results: The actual operative mortality was 2.4% [95% confidential interval (CI), 0.4%-13%], 1.4% (95% CI, 0.2%-7.6%), and 2.4% (95% CI, 0.4%-12%) for mild, moderate, and severe PH group, respectively (p=0.90), which was lower than that estimated by the New EuroSCORE II models (9±8%, 12±10% and 14±11%, respectively). During the follow-up period, there were 44 mortality and 51 readmissions for heart failure. Actuarial survival at 5 years after surgery was 89%, 65%, and 56%, for mild, moderate, and severe PH, respectively (p=0.005). Freedom from adverse events (all cause mortality/readmission for heart failure) at 5 years was 86%, 47%, and 7%, respectively, which were related to the degree of preoperative PH (p<0.0001) (Figure). Multivariate Cox regression analysis with adjustments for baseline characteristic variables showed that preoperative moderate (hazard ratio 3.1, 95% CI: 1.1-11, p=0.04) and severe (hazard ratio 3.4, 95% CI: 1.4-13, p=0.04) PH were associated with late adverse events.
Conclusions: The operative mortality after RMA was relatively low in patients with varying degrees of preoperative PH, but patients with severe PH showed high rate of mortality and adverse events. New medical treatment strategy should be established to expect improved long-term survival after RMA in patients with severe PH.
- © 2012 by American Heart Association, Inc.