Borde Deepak Prakash, Asegaonkar Balaji, Khade Sujit, Puranik Manish, George Antony, Joshi Shreedhar
Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India.
Department of Cardiac Surgery, Seth Nandlal Dhoot Hospital, Aurangabad, Maharashtra, India.
Indian J Anaesth. 2018 Dec;62(12):963-971. doi: 10.4103/ija.IJA_374_18.
There is conflicting evidence on adverse effect of Pulmonary Arterial Hypertension (PAH) on outcomes after cardiac surgery for rheumatic heart disease (RHD). The authors studied Indian patients with RHD and preoperative PAH, who undergo cardiac surgery with a hypothesis that they have poor short and long-term outcomes.
This was a retrospective observational study of 407 patients. The patients were divided in three groups based on PAH estimated on echocardiograph as; no or mild PAH (pulmonary artery systolic pressure (PASP) <30 mm of Hg); moderate PAH (PASP 31-55 mm of Hg) and severe PAH (PASP >55 mm of Hg). The primary endpoint was in-hospital mortality and major morbidities; while secondary endpoint was long-term survival.
In-hospital mortality was 24 (5.9%); and was not different in patients with severe, (9.1%), moderate (4.5%) or mild PAH (2.8%) ( = 0.09). Patients with severe PAH had higher incidence of prolonged ventilation ( = 0.007). Factors independently associated with mortality were; >2-packed cell transfusion, prolonged ventilation and acute kidney injury but not moderate and severe PAH. Patients with mitral stenosis (MS) and severe PAH had significantly higher mortality as compared to no or mild PAH ( = 0.03) on long-term follow-up [81.37% (mean duration 19.40 ± 14.10 months)], mortality was 8% and not statistically different ( = 0.25) across PAH categories.
Moderate and severe PAH does not affect short and long term outcomes of patients undergoing valve surgery for RHD. Patients with MS with severe PAH had higher mortality compared to those with no PAH.
关于肺动脉高压（PAH）对风湿性心脏病（RHD）心脏手术后结局的不良影响，证据存在冲突。作者对患有RHD和术前PAH且接受心脏手术的印度患者进行了研究，假设他们的短期和长期结局较差。
这是一项对407例患者的回顾性观察研究。根据超声心动图评估的PAH将患者分为三组：无或轻度PAH（肺动脉收缩压（PASP）<30 mmHg）；中度PAH（PASP 31 - 55 mmHg）和重度PAH（PASP>55 mmHg）。主要终点是住院死亡率和主要并发症；次要终点是长期生存率。
住院死亡率为24例（5.9%）；重度PAH患者（9.1%）、中度PAH患者（4.5%）或轻度PAH患者（2.8%）的住院死亡率无差异（P = 0.09）。重度PAH患者的机械通气时间延长发生率更高（P = 0.007）。与死亡率独立相关的因素有：输注超过2单位红细胞、机械通气时间延长和急性肾损伤，但不包括中度和重度PAH。二尖瓣狭窄（MS）合并重度PAH的患者在长期随访中（平均持续时间19.40±14.10个月）死亡率显著高于无或轻度PAH患者（P = 0.03），总体死亡率为8%，不同PAH类别之间无统计学差异（P = 0.25）。
中度和重度PAH不影响接受RHD瓣膜手术患者的短期和长期结局。MS合并重度PAH的患者比无PAH的患者死亡率更高。
