Pulmonary-Systemic Pressure Ratio Correlates with Morbidity in Cardiac Valve Surgery.
Aged
Arterial Pressure
/ physiology
Cardiac Catheterization
/ mortality
Cardiac Surgical Procedures
/ mortality
Cohort Studies
Female
Heart Valve Prosthesis Implantation
/ mortality
Humans
Hypertension, Pulmonary
/ mortality
Male
Middle Aged
Morbidity
/ trends
Postoperative Complications
/ diagnosis
Preoperative Care
/ mortality
Retrospective Studies
cardiac catheterization/intervention
cardiac function, physiology
pulmonary vascular resistance/hypertension
Journal
Journal of cardiothoracic and vascular anesthesia
ISSN: 1532-8422
Titre abrégé: J Cardiothorac Vasc Anesth
Pays: United States
ID NLM: 9110208
Informations de publication
Date de publication:
03 2019
03 2019
Historique:
received:
30
04
2018
pubmed:
24
9
2018
medline:
8
6
2019
entrez:
24
9
2018
Statut:
ppublish
Résumé
Pulmonary hypertension portends worse outcomes in cardiac valve surgery; however, isolated pulmonary artery pressures may not reflect patients' global cardiac function accurately. To better account for the interventricular relationship, the authors hypothesized that patients with greater pulmonary-systemic ratios (mean pulmonary arterial pressure)/(mean systemic arterial pressure) would correlate with worse outcomes after valve surgery. Retrospective cohort study. Single academic hospital. The study comprised 314 patients undergoing valve surgery with or without coronary artery bypass grafting (2004-2016) with Society of Thoracic Surgeons predicted risk scores and preoperative right heart catheterization. None. The pulmonary-systemic ratio was calculated as follows: mean pulmonary arterial pressure/mean systemic arterial pressure. Patients were stratified by pulmonary-systemic ratio quartile. Logistic regression was used to assess the risk-adjusted association between pulmonary-systemic ratio or mean pulmonary arterial pressure. Median pulmonary-systemic ratio was 0.33 (Q1-Q3: 0.23-0.65); median pulmonary arterial pressure was 29 (21-30) mmHg. Patients with the highest pulmonary-systemic ratio had the highest rates of morbidity and mortality (p < 0.0001). A high pulmonary-systemic ratio was associated with longer duration in the intensive care unit (p < 0.0001) and hospital (p < 0.0001). After risk-adjustment, pulmonary-systemic ratio and pulmonary arterial pressure were independently associated with morbidity and mortality, but the pulmonary-systemic ratio (odds ratio 23.88, p = 0.008, Wald 7.1) was more strongly associated than the pulmonary arterial pressure (odds ratio 1.035, p = 0.011, Wald 6.5). The pulmonary-systemic ratio is more strongly associated with risk-adjusted morbidity and mortality in valve surgery than pulmonary arterial pressure. By integrating ventricular interactions, this metric may better characterize the risk of valve surgery.
Identifiants
pubmed: 30243869
pii: S1053-0770(18)30826-7
doi: 10.1053/j.jvca.2018.08.190
pmc: PMC6379101
mid: NIHMS1507763
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
677-682Subventions
Organisme : NHLBI NIH HHS
ID : T32 HL007849
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2018 Elsevier Inc. All rights reserved.
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