Abstract 14054: Pre-operative Severe Pulmonary Hypertension is an Independent Predictor of Adverse Short and Long-term Outcomes in Cardiac Surgery
Introduction: Right heart catheterisation remains the gold standard in diagnosing patients with pulmonary hypertension but is not employed routinely in cardiac surgery. Unlike, in the EuroSCORE, the Society of Thoracic Surgeons does not at present recognize pulmonary hypertension as part of their risk stratification. Severe pulmonary hypertension (SPH) is defined as a systolic pulmonary artery pressure of >55mm Hg according to the EuroSCORE criteria.
Hypothesis: Short and long-term outcomes of pre-operative SPH are compromised following cardiac surgery.
Methods: Of the 13,556 consecutive patients who underwent cardiac surgery at our institution between July 1999 and July 2015, 1558 patients had right heart catheterisation studies pre-operatively. We analysed all pre-operative factors in the EuroSCORE.
Results: The mean logistic EuroScore in these patients was 9.4 +/- 12.8 demonstrating that these were a high risk cohort. The mean pulmonary artery pressure measured was 36.2mm Hg (+/- 17.2). whilst 16.6% (234/1588) had SPH. Multivariate logistic analysis revealed SPH to be an important predictor of in-hospital mortality (Hazard Ratio 2.400, p=0.001), post-operative renal failure (Hazard Ratio 1.920, p=0.005) and gastro-intestinal complications (Hazard Ratio 2.342, p<0.0001). Cox regression analysis revealed SPH to be an independent predictor of long-term mortality (Hazard ratio 1.83, 95% CI 1.22-2.76, p=0.004). The significant (Log-rank Mantel-Cox, p=0.000097) long-term survival between those with and without severe PAH who survived to discharge, can be seen in Figure 1.
Conclusions: We have shown that patients with SPH have compromised post-operative complications and long-term survival. This appears to be independent of preoperative factors including the primary cardiac pathology. Greater emphasis should be made in optimising pulmonary artery pressures pre-operatively as well as including PAH in American risk stratification models.
Author Disclosures: P. Ariyaratnam: None. M. Loubani: None.
- © 2016 by American Heart Association, Inc.