The impact of concomitant pulmonary hypertension on early and late outcomes following surgery for mitral stenosis Bo Yang, MD, PhD, Christina DeBenedictus,

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Presentation transcript:

The impact of concomitant pulmonary hypertension on early and late outcomes following surgery for mitral stenosis Bo Yang, MD, PhD, Christina DeBenedictus, BS, Tessa Watt, MD, Sean Farley, BS, Alona Salita, BS, Whitney Hornsby, PhD, Xiaoting Wu, PhD, Morley Herbert, PhD, Donald Likosky, PhD, Steven F. Bolling, MD The Journal of Thoracic and Cardiovascular Surgery Volume 152, Issue 2, Pages 394-400.e1 (August 2016) DOI: 10.1016/j.jtcvs.2016.02.038 Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A, Kaplan-Meier survival stratified by systolic PAP. PH was categorized as mild (35-44 mm Hg), moderate (45-59 mm Hg), or severe (>60 mm Hg). The curves were truncated at 12.5 years because no events were observed thereafter. B, Kaplan-Meier survival stratified by systolic PAP in the normal PAP–mild PH group and the moderate–severe PH group. The curves were truncated at 12.5 years because no events were observed thereafter. PAP, Pulmonary artery pressure; PH, pulmonary hypertension. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 394-400.e1DOI: (10.1016/j.jtcvs.2016.02.038) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Survival probability of patients based on degree of PH. A Cox proportional hazard model was developed to assess the effect of PH on time to death, adjusting for covariates including age, severe mitral valve regurgitation, status of severe tricuspid valve regurgitation, and history of right heart failure. The survival probability shown here is calculated given patient characteristics of age 61 years with no severe tricuspid valve regurgitation, no right heart failure, and no severe mitral valve regurgitation. The HR of death in patients with moderate or severe PH was 2.98 (95% CI, 1.54-5.75), exceeding that in the patients with normal PAP or mild PH. PH, Pulmonary hypertension; PAP, pulmonary artery pressure. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 394-400.e1DOI: (10.1016/j.jtcvs.2016.02.038) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Survival probability at 10 years for patients against PAP as a continuous variable. A Cox proportional hazard model was developed with log-transformed PAP as the exposure of interest. The survival probability shown here was calculated given patient characteristics of age 61 years with no severe tricuspid valve regurgitation and no right heart failure, with or without severe mitral valve regurgitation. MR, Mitral regurgitation; PA, pulmonary artery. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 394-400.e1DOI: (10.1016/j.jtcvs.2016.02.038) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Kaplan-Meier survival stratified by systolic PAP. PH was categorized as follows: mild, 35 to 44 mm Hg; moderate, 45 to 59 mm Hg; severe, >60 mm Hg; and unknown PAP. The curve was truncated at 12.5 years because no major events were observed thereafter. PAP, Pulmonary artery pressure; PH, pulmonary hypertension. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 394-400.e1DOI: (10.1016/j.jtcvs.2016.02.038) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 Kaplan-Meier survival stratified by systolic PAP using cases from 2003 to 2014 in the combined normal PAP–mild PH group versus the moderate–severe PH group. This cohort was from 2003 to 2014, which had a total of 218 patients, with 6 patients (2.7%) with unknown PAP. PAP, Pulmonary artery pressure; PH, pulmonary hypertension. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 394-400.e1DOI: (10.1016/j.jtcvs.2016.02.038) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Survival stratified by moderate–severe PH versus normal PAP–mild PH. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 394-400.e1DOI: (10.1016/j.jtcvs.2016.02.038) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions