Outcomes Of Surgical Aortic Valve Replacement With Pulmonary Hypertension: A Systematic Review And Meta-analysis
Rodolfo V. Rocha, Jan O. Friedrich, Kathryn Hong, Jessica Lee, Subodh Verma, Asim Cheema, Akshay Bagai, Bobby Yanagawa.
St Michaels Hospital, University of Toronto, Toronto, ON, Canada.
OBJECTIVE: Pulmonary hypertension (PHT) is frequently associated with aortic stenosis and can complicate the outcome of surgical aortic valve replacement (SAVR). We sought to evaluate the prognostic impact of PHT on the outcomes of SAVR.
METHODS: We searched MEDLINE and EMBASE databases for studies reporting the results of patients with PHT undergoing SAVR. We identified 13 observational studies. Data were subjected to a meta-analysis using a random-effects model.
RESULTS: Compared to patients with mild-moderate PHT, patients with severe PHT undergoing SAVR were older [MD 2.31 years (95% CI:1.38, 3.23), p<0.01, I2=71%] with reduced left ventricle ejection fraction [MD -9.48 years (95% CI:-13.09, -5.88), p<0.01, I2=64%]. Patients with severe PHT, compared to patients with mild-moderate PHT, have higher in-hospital mortality (5.0 vs 2.6%) [RR 2.29 (95% CI:1.52-3.46), p<0.01, I2=0%] (Figure 1) as well as acute renal failure (12.6 vs 6.4%) [RR 2.05 (95% CI:1.57-2.67), p<0.01, I2=0%], prolonged ventilation (15.8 vs 9.0%) [RR 1.91 (95% CI:1.50-2.45), p<0.01, I2=0%], and longer hospital length of stay [MD 1.93 days (95% CI:0.12, 3.74), p=0.04, I2=96%].
CONCLUSIONS: Patients with severe PHT are were older with greater comorbidities and are at higher risk of mortality and adverse outcomes following SAVR. Such patients may benefit from less invasive transcatheter aortic valve replacement.
FIGURE LEGEND: Forest plot comparing perioperative mortality following SAVR in patients with PHT. CI=confidence interval; PHT: Pulmonary Hypertension; SAVR: Surgical aortic valve replacement.
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