• Sarah A Schubert, J Hunter Mehaffey, Alexander Booth, Leora T Yarboro, John A Kern, Kennedy Jamie L W JLW Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, VA., Gorav Ailawadi, and Sula Mazimba.
• Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, VA. Electronic address: ss9kw@virginia.edu.
• J. Cardiothorac. Vasc. Anesth. 2019 Mar 1; 33 (3): 677-682.

ObjectivesPulmonary 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.DesignRetrospective cohort study.SettingSingle academic hospital.ParticipantsThe 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.InterventionsNone.Measurements And Main ResultsThe 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).ConclusionsThe 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.Copyright © 2018 Elsevier Inc. All rights reserved.

35 keywords...

hide…