Enter Daniel H, Zaki Anthony, Duncan Brett F, Kruse Jane, Andrei Adin-Cristian, Li Zhi, Malaisrie S Chris, Shah Sanjiv J, Thomas James D, McCarthy Patrick M
Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Ill.
Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Ill.
J Thorac Cardiovasc Surg. 2016 May;151(5):1288-97. doi: 10.1016/j.jtcvs.2015.12.063. Epub 2016 Jan 22.
Pulmonary hypertension (PHT) has been considered a risk factor for mortality in cardiac surgery. Among mitral valve surgery (MVS) patients, we sought to determine if severe PHT increases mortality risk and if patients who undergo concomitant tricuspid valve surgery (TVS) incur additional risk.
Preoperative PHT was assessed in 1571 patients undergoing MVS, from 2004 to 2013. Patients were stratified into PHT groups as follows (mm Hg): none (<35); moderate (35-49); severe (50-79); and extreme (≥80). Propensity-score matching resulted in a total of 430 patients, by PHT groups, and 384 patients, by TVS groups.
Patients with severe PHT had higher mortality, both 30-day (4% PHT vs 1% no PHT, P < .02) and late (defined as survival at 5 years): 75.5% severe versus 91.9% no PHT (P < .001). In propensity-score-matched groups, severe PHT was not a risk factor for 30-day (3% each, P = 1.0) or late mortality (86.2% severe vs 87.1% no PHT; P = .87). TVS did not increase 30-day (4.7% TVS vs 4.2% no TVS, P = .8) or late mortality (78.7% TVS vs 75.3% no TVS, P = .90). Late survival was lower in extreme PHT (75.4% vs no PHT 91.5%, P = .007), and a trend was found in 30-day mortality (11% extreme vs 3% no PHT, P = .16).
Mortality in MVS is unaffected by severe PHT or the addition of TVS, yet extreme PHT remains a risk factor. Severe PHT (50-79 mm Hg) should not preclude surgery; concomitant TVS does not increase mortality.
肺动脉高压（PHT）一直被认为是心脏手术死亡的一个危险因素。在二尖瓣手术（MVS）患者中，我们试图确定重度PHT是否会增加死亡风险，以及同期接受三尖瓣手术（TVS）的患者是否会面临额外风险。
对2004年至2013年期间接受MVS的1571例患者进行术前PHT评估。患者按以下PHT分组（毫米汞柱）：无（<35）；中度（35 - 49）；重度（50 - 79）；极重度（≥80）。倾向评分匹配后，PHT分组共纳入430例患者，TVS分组共纳入384例患者。
重度PHT患者的死亡率更高，30天死亡率（重度PHT为4%，无PHT为1%，P < 0.02）和远期死亡率（定义为5年生存率）均如此：重度PHT组为75.5%，无PHT组为91.9%（P < 0.001）。在倾向评分匹配组中，重度PHT不是30天（均为3%，P = 1.0）或远期死亡率的危险因素（重度PHT为86.2%，无PHT为87.1%；P = 0.87）。TVS并未增加30天死亡率（TVS为4.7%，无TVS为4.2%，P = 0.8）或远期死亡率（TVS为78.7%，无TVS为75.3%，P = 0.90）。极重度PHT患者的远期生存率较低（75.4%对比无PHT患者的91.5%，P = 0.007），且在30天死亡率方面发现有趋势差异（极重度为11%，无PHT为3%，P = 0.16）。
MVS患者的死亡率不受重度PHT或同期行TVS的影响，但极重度PHT仍是一个危险因素。重度PHT（50 - 79毫米汞柱）不应成为手术禁忌；同期行TVS不会增加死亡率。
