Abstract 12089: The Association Between Post-Operative Pulmonary Hypertension and Survival After Mitral Valve Surgery
Introduction: Pulmonary hypertension (PH) is a common complication of mitral valve disease, but the prognostic significance of PH after mitral valve surgery (MVS) is unclear.
Hypothesis: Post-operative PH after mitral valve repair or replacement is associated with worse survival.
Methods: Retrospective study at a single, tertiary medical center (1995-2015) using echo database. Patients with moderate-severe or severe regurgitation and/or stenosis who had 1) preoperative transthoracic echocardiogram (TTE) within 6 months of MVS; 2) post-operative TTE at least 30 days after MVS; 3) right ventricular systolic pressure (RVSP) measurement on both TTEs. The primary endpoint of the study was survival after post-op TTE. Non-parametric Kaplan-Meier method was used to estimate distribution of time to death related to severity of pre-op and post-op RVSP. Cox proportional hazards modeling was used to evaluate the relationship between post-op RVSP and survival with adjustment for co-variates including pre-op RVSP.
Results: 259 patients met inclusion criteria. Median time to post-operative TTE from MVS was 244 (IQR 86, 421) days. The mean RVSP was 47.2 (16) mm Hg. Following MVS, a statistically significant decrease in the post-operative compared with pre-operative RVSP was observed for the overall cohort (mean RVSP 39.1 [14.0] mm Hg), specifically in patients with baseline RVSP ≥35 mm Hg, but 53 (20.5%) patients had post-op RVSP >50 mm Hg. PH after MVS was significantly associated with lower survival in follow-up in the unadjusted log-rank test for trend (Figure). Post-op RVSP, but not pre-op RVSP, was significantly associated with mortality in the Cox proportional hazards model with adjustment for age, race, comorbidities, mitral stenosis, and if performed, mitral replacement size (RVSP >50mm Hg vs. RVSP ≥35 mm Hg: HR 2.214, 95% CI 1.316, 3.724, p=0.0027).
Conclusion: Post-operative PH is significantly associated with lower survival after mitral valve surgery.
Author Disclosures: T.L. Kiefer: Research Grant; Significant; Gilead Sciences. Z. Samad: Research Grant; Modest; Gilead Sciences, Boston-Scientific-Duke Strategic Alliance for Research, Medtronic-Duke Strategic Alliance for Research. G. Pomann: None. V. Poon: None. W. Shatila: None. Y. Lokhnygina: None. E.J. Velazquez: None. A. Wang: Research Grant; Significant; Gilead Sciences, Abbott Vascular.
- © 2016 by American Heart Association, Inc.