Impact of preoperative pulmonary arterial hypertension on early and late outcomes in patients undergoing valve surgery for rheumatic heart disease
Background and Aims: 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 the...
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doaj-247059d640ce48808a07bb521596022c2020-11-24T21:45:09ZengWolters Kluwer Medknow PublicationsIndian Journal of Anaesthesia0019-50490976-28172018-01-01621296397110.4103/ija.IJA_374_18Impact of preoperative pulmonary arterial hypertension on early and late outcomes in patients undergoing valve surgery for rheumatic heart diseaseDeepak Prakash BordeBalaji AsegaonkarSujit KhadeManish PuranikAntony GeorgeShreedhar JoshiBackground and Aims: 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. Methods: 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. Results: 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%) (P = 0.09). Patients with severe PAH had higher incidence of prolonged ventilation (P = 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 (P = 0.03) on long-term follow-up [81.37% (mean duration 19.40 ± 14.10 months)], mortality was 8% and not statistically different (P = 0.25) across PAH categories. Conclusion: 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.http://www.ijaweb.org/article.asp?issn=0019-5049;year=2018;volume=62;issue=12;spage=963;epage=971;aulast=BordeIndianpulmonary hypertensionrheumatic heart disease |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Deepak Prakash Borde Balaji Asegaonkar Sujit Khade Manish Puranik Antony George Shreedhar Joshi |
spellingShingle |
Deepak Prakash Borde Balaji Asegaonkar Sujit Khade Manish Puranik Antony George Shreedhar Joshi Impact of preoperative pulmonary arterial hypertension on early and late outcomes in patients undergoing valve surgery for rheumatic heart disease Indian Journal of Anaesthesia Indian pulmonary hypertension rheumatic heart disease |
author_facet |
Deepak Prakash Borde Balaji Asegaonkar Sujit Khade Manish Puranik Antony George Shreedhar Joshi |
author_sort |
Deepak Prakash Borde |
title |
Impact of preoperative pulmonary arterial hypertension on early and late outcomes in patients undergoing valve surgery for rheumatic heart disease |
title_short |
Impact of preoperative pulmonary arterial hypertension on early and late outcomes in patients undergoing valve surgery for rheumatic heart disease |
title_full |
Impact of preoperative pulmonary arterial hypertension on early and late outcomes in patients undergoing valve surgery for rheumatic heart disease |
title_fullStr |
Impact of preoperative pulmonary arterial hypertension on early and late outcomes in patients undergoing valve surgery for rheumatic heart disease |
title_full_unstemmed |
Impact of preoperative pulmonary arterial hypertension on early and late outcomes in patients undergoing valve surgery for rheumatic heart disease |
title_sort |
impact of preoperative pulmonary arterial hypertension on early and late outcomes in patients undergoing valve surgery for rheumatic heart disease |
publisher |
Wolters Kluwer Medknow Publications |
series |
Indian Journal of Anaesthesia |
issn |
0019-5049 0976-2817 |
publishDate |
2018-01-01 |
description |
Background and Aims: 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. Methods: 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. Results: 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%) (P = 0.09). Patients with severe PAH had higher incidence of prolonged ventilation (P = 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 (P = 0.03) on long-term follow-up [81.37% (mean duration 19.40 ± 14.10 months)], mortality was 8% and not statistically different (P = 0.25) across PAH categories. Conclusion: 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. |
topic |
Indian pulmonary hypertension rheumatic heart disease |
url |
http://www.ijaweb.org/article.asp?issn=0019-5049;year=2018;volume=62;issue=12;spage=963;epage=971;aulast=Borde |
work_keys_str_mv |
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