Pulmonary-Systemic Pressure Ratio Correlates with Morbidity in Cardiac Valve Surgery

Schubert, Sarah; Mehaffey, J. Hunter; Booth, Alexander; Yarboro, Leora T.; Kern, John A.; Kennedy, Jamie L.W.; Ailawadi, Gorav; Mazimba, Sula

doi:10.1053/j.jvca.2018.08.190

Cited by 12 publications

(9 citation statements)

References 17 publications

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“…21 Unfavorable ventricular-ventricular interactions as reflected by a high mean arterial pressure to mPAP ratio have also been associated with increased morbidity and mortality among patients undergoing valvular heart surgery. 8 Specifically, right ventricular function has been shown to be an important prognostic indicator for patients with various cardiac conditions including those undergoing surgery. 22,23 CVP, a proxy for right ventricular function, reflects the right ventricular preload and by extension marks the right ventricular contractile response to afterload imposed on it.…”

Section: Discussionmentioning

confidence: 99%

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A systemic congestive index (systemic pulse pressure to central venous pressure ratio) predicts adverse outcomes in patients undergoing valvular heart surgery

Knio

Morales

Shah

et al. 2022

Journal of Cardiac Surgery

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Background and Aims: Invasive hemodynamics may provide a more nuanced assessment of cardiac function and risk phenotyping in patients undergoing cardiac surgery. The systemic pulse pressure (SPP) to central venous pressure (CVP) ratio represents an integrated index of right and left ventricular function and thus may demonstrate an association with valvular heart surgery outcomes. This study hypothesized that a low SPP/CVP ratio would be associated with mortality in valvular surgery patients. Methods: This retrospective cohort study examined adult valvular surgery patients with preoperative right heart catheterization from 2007 through 2016 at a single tertiary medical center (n = 215). Associations between the SPP/CVP ratio and mortality were investigated with univariate and multivariate analyses.Results: Among 215 patients (age 69.7 ± 12.4 years; 55.8% male), 61 died (28.4%) over a median follow-up of 5.9 years. A SPP/CVP ratio <7.6 was associated with increased mortality (relative risk 1.70, 95% confidence interval[CI] 1.08-2.67, p = .019) and increased length of stay (11.56 ± 13.73 days vs. 7.93 ± 4.92 days, p = .016). It remained an independent predictor of mortality (adjusted odds ratio 3.99, 95% CI 1.47-11.45, p = .008) after adjusting for CVP, mean pulmonary artery pressure, aortic stenosis, tricuspid regurgitation, smoking status, diabetes mellitus, dialysis, and cross-clamp time.

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Section: Discussionmentioning

confidence: 99%

“…At the authors' institution, an estimated 11.6% of all valvular surgery patients undergo preoperative right heart catheterization. 8…”

Section: Measurements and Data Handlingmentioning

confidence: 99%

A systemic congestive index (systemic pulse pressure to central venous pressure ratio) predicts adverse outcomes in patients undergoing valvular heart surgery

Knio

Morales

Shah

et al. 2022

Journal of Cardiac Surgery

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“…In recent years, NO inhalation therapy has been used in adults who have undergone cardiac surgery [4][5][6]. Some patients who undergo cardiac valve surgery develop PH postoperatively [7]; therefore, as postoperative PH portends worse outcomes, research and use of NO inhalation therapy in adult patients have attracted attention. However, evidence of improved outcomes with the use of NO in adults with PH after mitral valve surgery is insu cient.…”

Section: Introductionmentioning

confidence: 99%

Nitric Oxide Inhalationtherapy for Pulmonary Hypertension After Mitral Valve Surgery Does Not Shorten the Intubation Period and Length of Stay in the Intensive Care Unit: A Retrospective Study

Sasaki

Kowatari

Kondo

et al. 2022

Preprint

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Background Inhaled nitric oxide (NO) is often used postoperatively for pediatric pulmonary hypertension (PH). Although the use of postoperative inhaled NO for adult cases has become prevalent, the Asian data of such cases are limited. This study aimed to evaluate the safety and effectiveness of NO inhalation therapy for PH in adult patients after mitral valve surgery. Methods In this retrospective study, we enrolled 24 adult patients with a mean pulmonary artery pressure (mPAP) > 25 mmHg after mitral valve surgery at our institution from January 2017 to September 2020. Among these patients, NO was used postoperatively (NO group) in 13, whereas NO was not used in 11 (non-NO group). We compared the clinical data, such as age, preoperative echocardiogram, cardiac catheterization results, perioperative information, postoperative Swan-Ganz catheter data, tracheal intubation time, and length of stay in the intensive care unit (ICU). Results The NO group had higher tricuspid regurgitation pressure gradient, right atrial pressure, and pulmonary artery wedge pressure, as well as more surgically complex cases, than the non-NO group. There were no differences in operative and aortic cross-clamp time, tracheal intubation duration, or length of ICU stay. In the NO group, the mPAP decreased and the cardiac index increased after postoperative NO inhalation. However, there were no significant differences in the mPAP and cardiac index between the NO and non-NO groups. Conclusions Our results suggest that NO inhalation therapy was not associated with shorter postoperative intubation and ICU stay in adult patients with PH after mitral valve surgery. These findings support those of studies from other countries, yet they do not clarify the usefulness of inhaled NO in these cases. Optimal NO therapeutic strategies should be reconsidered with the goal of reducing intubation time and length of stay in the ICU.

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“…Thus, the complexity of PH in left heart disease is apparent and different mechanisms may be contributing to its occurrence, which are determined largely by the nature of lesion, for example, primary mitral valve disease (stenosis or regurgitation), secondary MR, AS, and heart failure with preserved ejection fraction. The results of Schubert and colleagues' study 7 must be interpreted in light of this and offer the following learning points.…”

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confidence: 99%

“…5,6 In this issue of the Journal of Cardiothoracic and Vascular Anesthesia, Schubert and colleagues have published a report on 314 patients with PH undergoing valve surgery with or without coronary artery bypass grafting. 7 The authors have used a pulmonary-systemic ratio (mean pulmonary artery pressure [MPAP]/mean systemic artery pressure [MAP] to predict the worse outcome after surgery. In this group of patients predominantly composed of those undergoing aortic valve surgery, the authors found that patients with the highest pulmonary-systemic ratio had the highest rates of morbidity and mortality.…”

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The Complexity of Pulmonary Hypertension and Its Prognostic Importance in Patients With Valvular Heart Disease

Tempe

2019

Journal of Cardiothoracic and Vascular Anesthesia

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Pulmonary-Systemic Pressure Ratio Correlates with Morbidity in Cardiac Valve Surgery

Abstract: The 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.

Cited by 12 publications

References 17 publications

A systemic congestive index (systemic pulse pressure to central venous pressure ratio) predicts adverse outcomes in patients undergoing valvular heart surgery

A systemic congestive index (systemic pulse pressure to central venous pressure ratio) predicts adverse outcomes in patients undergoing valvular heart surgery

Nitric Oxide Inhalationtherapy for Pulmonary Hypertension After Mitral Valve Surgery Does Not Shorten the Intubation Period and Length of Stay in the Intensive Care Unit: A Retrospective Study

The Complexity of Pulmonary Hypertension and Its Prognostic Importance in Patients With Valvular Heart Disease

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