초록접수 현황
| 16F-284 | 구연 발표 |
Effect of Preoperative pulmonary hypertension on clinical outcomes in patients after mitral valve surgery
Do Jung Kim, Shin-Young Lee, Seung Hyun Lee, Hyun-Chel Choo, Kyung-Jong Yoo, Young-Nam Youn, Byung-Chul Chang, Sak Lee
Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
Background : Persistent pulmonary hypertension (PH) after mitral valve replacement (MVR) leads to an increased risk of surgical outcomes. The purpose of this study is to evaluate the effect of concomitant PHT on clinical outcomes in patients underwent MVR for mitral stenosis.
Methods : Total of 406 patients underwent MVR for mitral stenosis from January 2000 to December 2013. 273 patients were preoperatively diagnosed with PH. PH severity was based on systolic PAP and was categorized as follows: mild, 41 to 50; moderate, 51 to 69 mm Hg; and severe,≥70 mmHg. We categorized two groups by combining normal with mild (n=327,NPH) and moderate with severe (n=72, PH). Pre- and postoperative PAP, perioperative parameters and long term survival rate were analyzed between groups.
Results : There were no significant between-group differences in age or preoperative comorbidities except mean diastolic pressure gradient (MDPG) (mmHg, NPH vs. PH: 8.2±3.8 vs. 12.3±6.4, p <0.01). For PH, 30-day mortality was 0.3%, with no significant group differences. Postoperative sPAP(mmHg, NPH vs. PH: 31.2±6.1 vs.38.3±8.5, p <0.01), dPAP(15.3±3.7 vs. 19.1±3.0, p <0.01), and the change of sPAP (6.1±7.8 vs. 19.5±12.1, p<0.01) was significantly higher in PH. Tricuspid regurgitation (TR) free survival was similar between groups (p=0.19), however 5 and 10 years survival was significantly lower in PH group ( 96%, 90% vs. 87%,80%, p=0.04). Initial high sPAP didn`t show significant effect on late onset TR(2≤), however pre- and postoperative PAP change (5mmHg < ↓) was significant factor for late onset TR. (P=0.02)
Conclusion : MVR can be performed safely for patients with mitral stenosis and moderate to severe PH, but long-term survival is impaired by moderate to severe PH. Also adequate PAP reduction can prevent the late progressive TR regardless initial high PAP, so we have to carefully observe PAP after MVR.
Methods : Total of 406 patients underwent MVR for mitral stenosis from January 2000 to December 2013. 273 patients were preoperatively diagnosed with PH. PH severity was based on systolic PAP and was categorized as follows: mild, 41 to 50; moderate, 51 to 69 mm Hg; and severe,≥70 mmHg. We categorized two groups by combining normal with mild (n=327,NPH) and moderate with severe (n=72, PH). Pre- and postoperative PAP, perioperative parameters and long term survival rate were analyzed between groups.
Results : There were no significant between-group differences in age or preoperative comorbidities except mean diastolic pressure gradient (MDPG) (mmHg, NPH vs. PH: 8.2±3.8 vs. 12.3±6.4, p <0.01). For PH, 30-day mortality was 0.3%, with no significant group differences. Postoperative sPAP(mmHg, NPH vs. PH: 31.2±6.1 vs.38.3±8.5, p <0.01), dPAP(15.3±3.7 vs. 19.1±3.0, p <0.01), and the change of sPAP (6.1±7.8 vs. 19.5±12.1, p<0.01) was significantly higher in PH. Tricuspid regurgitation (TR) free survival was similar between groups (p=0.19), however 5 and 10 years survival was significantly lower in PH group ( 96%, 90% vs. 87%,80%, p=0.04). Initial high sPAP didn`t show significant effect on late onset TR(2≤), however pre- and postoperative PAP change (5mmHg < ↓) was significant factor for late onset TR. (P=0.02)
Conclusion : MVR can be performed safely for patients with mitral stenosis and moderate to severe PH, but long-term survival is impaired by moderate to severe PH. Also adequate PAP reduction can prevent the late progressive TR regardless initial high PAP, so we have to carefully observe PAP after MVR.
첨부파일 : 16F-284.docx
책임저자: Sak Lee
Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
발표자: Do Jung Kim, E-mail : phalcorpse@yuhs.ac