Coronary Bypass Surgery in Patients with Pulmonary Hypertension: Assessment of Early and Long Term Results

Abstract

IntroductionPulmonary hypertension (PH) is one of the main causes of increased mortality and morbidity rates in open heart surgery. Left heart disease is probably the most frequent cause of PH. 1) Left-sided ventricular or valvular diseases may lead to an increase in left atrial pressure, and the passive backward transmission of this pressure may result in increased pulmonary arterial pressure (PAP). 2) Despite intensive postoperative medical treatment, an increase is observed in mortality and morbidity rates following coronary bypass surgery in patients with PH and right heart failure. 3,4) PH has a significant effect on right ventricular afterload. Various studies have shown that patients with right ventricle dysfunction display higher rates of early perioperative mortality and poor long term survival. 5,6) In this study, we investigated the effect of preoperative PH on the early-and long term results of patients who underwent isolated coronary artery bypass surgery, as well as its effect on the quality of life and the changes in The late mortality of cases was 5.79%. In our study, during 33.9 ± 17 (9-100) months follow up period, life expectancy was calculated as 94.7 months. Conclusion: Preoperative evaluation of these patients for appropriate medical treatment at peroperative and postoperative period, coronary bypass can be performed with low morbidity and mortality rates. In the late period after surgical revascularization PH showed no significant change and had no adverse effect on quality of life.

Does pulmonary hypertension affect early-term outcomes of off-pump coronary artery bypass surgery?

“…When the limited number of studies investigating the effect of pulmonary artery pressures and PHT on surgical outcomes after cardiac surgery were reviewed, it was observed that the studies included some methodological differences, and the results of the studies were inconsistent with each other. In the literature, some of these limited studies investigating the effect of PHT on surgical outcomes were conducted in patients undergoing conventional on-pump CABG 5,10,11 , while others were conducted on patients undergoing valvular heart surgery 12,13 . In a study conducted on 177 patients undergoing conventional on-pump CABG by Çatav et al 10 , the patients were divided into three groups according to their SPAP values.…”

“…The study revealed that early-term mortality rates following on-pump CABG were statistically similar, and there was no significant difference between both groups with respect to perioperative early mortality, while the PHT group had a greater inotrope requirement, a longer mechanical ventilation time, and an increased length of ICU stay. Moreover, Akca et al 11 assessed the effect of preoperative PHT on not only early-term but also long-term results by screening a larger patient population. Among 2325 patients undergoing elective isolated conventional on-pump CABG, 287 patients with high preoperative SPAP ≥30 mmHg were evaluated, and of them, 69 patients with complete data who were on follow-up were included in their study.…”

Double Valve Replacement in a Patient with Severe Rheumatic Heart Disease and Acute Decompensated Heart Failure

“…Pulmonary HTN is a noted cause of perioperative morbidity and mortality as pertains to cardiac surgery. Bypass itself can worsen pHTN acutely due to the release of inflammatory mediators from pulmonary endothelium, exacerbating any previous predilection to hypoxia [6]. The TR also routinely encountered in such patients is often a result of RV dilation, secondary to pHTN, which in turn is a result of MV stenosis.…”