Pulmonary hypertension adversely affects short- and long-term survival after mitral valve operation for mitral regurgitation

Implications for timing of surgery

Mehrdad Ghoreishi, Charles Evans, Christopher R. Defilippi, Gerald Hobbs, Cindi A. Young, Bartley P. Griffith, James S. Gammie

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Objective: We investigated the impact of preoperative pulmonary hypertension (PH) on early and late outcomes after mitral valve operation for mitral regurgitation. Methods: Systolic pulmonary artery pressure (sPAP) was measured before operation in 873 consecutive patients who underwent mitral valve surgery for mitral regurgitation between January 2002 and January 2010. PH was classified as none (sPAP < 40 mm Hg), mild (40 ≤ sPAP < 50 mm Hg), moderate (50 ≤ sPAP < 60 mm Hg), or severe (sPAP ≥ 60 mm Hg). Results: Increased preoperative sPAP was associated with greater left ventricular dysfunction and dilation, left atrial enlargement, more atrial fibrillation, and tricuspid regurgitation. Operative mortality was correlated with the degree of preoperative PH (2%, 3%, 8%, and 12% for none, mild, moderate, and severe PH, respectively, P < .0001). Long-term survival was related to preoperative sPAP (5-year survival: 88%, 79%, 65%, and 53% for none, mild, moderate, and severe PH, respectively; P < .0001). In multivariable analyses, sPAP was a predictor of both operative mortality (odds ratio, 1.023 per 1 mm Hg increase; 95% confidence interval, 1.003-1.044; P = .0270) and late death (hazard ratio, 1.018 per 1 mm Hg increase; 95% confidence interval, 1.007-1.028; P = .001). Among 284 patients with isolated degenerative mitral regurgitation due to leaflet prolapse, actuarial survival was 97.5%, 91.2%, and 80.5% for none, mild, and moderate to severe PH, respectively (P = .0002). Conclusions: Preoperative sPAP is a powerful predictor of early and late survival after mitral valve operation for mitral regurgitation. Even modest increases in sPAP adversely affect outcomes. Mitral valve operation should be performed before the development of PH.

Original languageEnglish (US)
Pages (from-to)1439-1452
Number of pages14
JournalJournal of Thoracic and Cardiovascular Surgery
Volume142
Issue number6
DOIs
StatePublished - Dec 1 2011

Fingerprint

Mitral Valve Insufficiency
Mitral Valve
Pulmonary Hypertension
Pulmonary Artery
Pressure
Survival
Confidence Intervals
Tricuspid Valve Insufficiency
Mortality
Prolapse
Left Ventricular Dysfunction
Atrial Fibrillation
Dilatation
Odds Ratio

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Ghoreishi, Mehrdad ; Evans, Charles ; Defilippi, Christopher R. ; Hobbs, Gerald ; Young, Cindi A. ; Griffith, Bartley P. ; Gammie, James S. / Pulmonary hypertension adversely affects short- and long-term survival after mitral valve operation for mitral regurgitation : Implications for timing of surgery. In: Journal of Thoracic and Cardiovascular Surgery. 2011 ; Vol. 142, No. 6. pp. 1439-1452.
@article{2e558848fc37488f9ad385654d436b4a,
title = "Pulmonary hypertension adversely affects short- and long-term survival after mitral valve operation for mitral regurgitation: Implications for timing of surgery",
abstract = "Objective: We investigated the impact of preoperative pulmonary hypertension (PH) on early and late outcomes after mitral valve operation for mitral regurgitation. Methods: Systolic pulmonary artery pressure (sPAP) was measured before operation in 873 consecutive patients who underwent mitral valve surgery for mitral regurgitation between January 2002 and January 2010. PH was classified as none (sPAP < 40 mm Hg), mild (40 ≤ sPAP < 50 mm Hg), moderate (50 ≤ sPAP < 60 mm Hg), or severe (sPAP ≥ 60 mm Hg). Results: Increased preoperative sPAP was associated with greater left ventricular dysfunction and dilation, left atrial enlargement, more atrial fibrillation, and tricuspid regurgitation. Operative mortality was correlated with the degree of preoperative PH (2{\%}, 3{\%}, 8{\%}, and 12{\%} for none, mild, moderate, and severe PH, respectively, P < .0001). Long-term survival was related to preoperative sPAP (5-year survival: 88{\%}, 79{\%}, 65{\%}, and 53{\%} for none, mild, moderate, and severe PH, respectively; P < .0001). In multivariable analyses, sPAP was a predictor of both operative mortality (odds ratio, 1.023 per 1 mm Hg increase; 95{\%} confidence interval, 1.003-1.044; P = .0270) and late death (hazard ratio, 1.018 per 1 mm Hg increase; 95{\%} confidence interval, 1.007-1.028; P = .001). Among 284 patients with isolated degenerative mitral regurgitation due to leaflet prolapse, actuarial survival was 97.5{\%}, 91.2{\%}, and 80.5{\%} for none, mild, and moderate to severe PH, respectively (P = .0002). Conclusions: Preoperative sPAP is a powerful predictor of early and late survival after mitral valve operation for mitral regurgitation. Even modest increases in sPAP adversely affect outcomes. Mitral valve operation should be performed before the development of PH.",
author = "Mehrdad Ghoreishi and Charles Evans and Defilippi, {Christopher R.} and Gerald Hobbs and Young, {Cindi A.} and Griffith, {Bartley P.} and Gammie, {James S.}",
year = "2011",
month = "12",
day = "1",
doi = "10.1016/j.jtcvs.2011.08.030",
language = "English (US)",
volume = "142",
pages = "1439--1452",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "6",

}

Pulmonary hypertension adversely affects short- and long-term survival after mitral valve operation for mitral regurgitation : Implications for timing of surgery. / Ghoreishi, Mehrdad; Evans, Charles; Defilippi, Christopher R.; Hobbs, Gerald; Young, Cindi A.; Griffith, Bartley P.; Gammie, James S.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 142, No. 6, 01.12.2011, p. 1439-1452.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Pulmonary hypertension adversely affects short- and long-term survival after mitral valve operation for mitral regurgitation

T2 - Implications for timing of surgery

AU - Ghoreishi, Mehrdad

AU - Evans, Charles

AU - Defilippi, Christopher R.

AU - Hobbs, Gerald

AU - Young, Cindi A.

AU - Griffith, Bartley P.

AU - Gammie, James S.

PY - 2011/12/1

Y1 - 2011/12/1

N2 - Objective: We investigated the impact of preoperative pulmonary hypertension (PH) on early and late outcomes after mitral valve operation for mitral regurgitation. Methods: Systolic pulmonary artery pressure (sPAP) was measured before operation in 873 consecutive patients who underwent mitral valve surgery for mitral regurgitation between January 2002 and January 2010. PH was classified as none (sPAP < 40 mm Hg), mild (40 ≤ sPAP < 50 mm Hg), moderate (50 ≤ sPAP < 60 mm Hg), or severe (sPAP ≥ 60 mm Hg). Results: Increased preoperative sPAP was associated with greater left ventricular dysfunction and dilation, left atrial enlargement, more atrial fibrillation, and tricuspid regurgitation. Operative mortality was correlated with the degree of preoperative PH (2%, 3%, 8%, and 12% for none, mild, moderate, and severe PH, respectively, P < .0001). Long-term survival was related to preoperative sPAP (5-year survival: 88%, 79%, 65%, and 53% for none, mild, moderate, and severe PH, respectively; P < .0001). In multivariable analyses, sPAP was a predictor of both operative mortality (odds ratio, 1.023 per 1 mm Hg increase; 95% confidence interval, 1.003-1.044; P = .0270) and late death (hazard ratio, 1.018 per 1 mm Hg increase; 95% confidence interval, 1.007-1.028; P = .001). Among 284 patients with isolated degenerative mitral regurgitation due to leaflet prolapse, actuarial survival was 97.5%, 91.2%, and 80.5% for none, mild, and moderate to severe PH, respectively (P = .0002). Conclusions: Preoperative sPAP is a powerful predictor of early and late survival after mitral valve operation for mitral regurgitation. Even modest increases in sPAP adversely affect outcomes. Mitral valve operation should be performed before the development of PH.

AB - Objective: We investigated the impact of preoperative pulmonary hypertension (PH) on early and late outcomes after mitral valve operation for mitral regurgitation. Methods: Systolic pulmonary artery pressure (sPAP) was measured before operation in 873 consecutive patients who underwent mitral valve surgery for mitral regurgitation between January 2002 and January 2010. PH was classified as none (sPAP < 40 mm Hg), mild (40 ≤ sPAP < 50 mm Hg), moderate (50 ≤ sPAP < 60 mm Hg), or severe (sPAP ≥ 60 mm Hg). Results: Increased preoperative sPAP was associated with greater left ventricular dysfunction and dilation, left atrial enlargement, more atrial fibrillation, and tricuspid regurgitation. Operative mortality was correlated with the degree of preoperative PH (2%, 3%, 8%, and 12% for none, mild, moderate, and severe PH, respectively, P < .0001). Long-term survival was related to preoperative sPAP (5-year survival: 88%, 79%, 65%, and 53% for none, mild, moderate, and severe PH, respectively; P < .0001). In multivariable analyses, sPAP was a predictor of both operative mortality (odds ratio, 1.023 per 1 mm Hg increase; 95% confidence interval, 1.003-1.044; P = .0270) and late death (hazard ratio, 1.018 per 1 mm Hg increase; 95% confidence interval, 1.007-1.028; P = .001). Among 284 patients with isolated degenerative mitral regurgitation due to leaflet prolapse, actuarial survival was 97.5%, 91.2%, and 80.5% for none, mild, and moderate to severe PH, respectively (P = .0002). Conclusions: Preoperative sPAP is a powerful predictor of early and late survival after mitral valve operation for mitral regurgitation. Even modest increases in sPAP adversely affect outcomes. Mitral valve operation should be performed before the development of PH.

UR - http://www.scopus.com/inward/record.url?scp=81255187862&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=81255187862&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2011.08.030

DO - 10.1016/j.jtcvs.2011.08.030

M3 - Article

VL - 142

SP - 1439

EP - 1452

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 6

ER -