Influence Of Preoperative Pulmonary Artery Hypertension On Long-term Follow-up After Off Pump Coronary Bypass Surgery
Ismail Bouhout, Dori Khalaf, Raymond Cartier.
Montreal heart institute, Montreal, QC, Canada.
Background. Preoperative pulmonary hypertension (HTAP) is an important prognostic factor in cardiac surgery associated with increased morbidity and mortality. Its impact on long-term survival is poorly understood. OCPAB patients offer a unique model to specifically study the effect of preoperative HTAP because no extra-corporal circulation is used. Objectives. The purpose of our study is to evaluate long-term effect of preoperative HTAP after OCPAB surgery. Methods. Data on 1500 consecutive patients who underwent isolated off-pump coronary artery bypass (OPCAB) surgery between September 1996 and December 2008 were prospectively collected over 10 years (mean follow-up 78 months) . One hundred and 133 patients (9%) were diagnosed with preoperative HTAP. Patients were prospectively followed and data collected in a dedicated database. Results. HTAP patients were older (68±9 vs 64±10. P<0.001), had a lower left ventricular function and had a higher prevalence of diabetes, chronic obstructive pulmonary disease, mitral insufficiency, chronic heart failure, peripheral vascular disease, recent myocardial infarction, and chronic renal insufficiency. They were also more frequently operated in emergency. Operative mortality was higher in HTAP patients (3.8% vs 1.5%, p=0.07). Postoperative atrial fibrillation, infection, and delirium were also more frequent. Kaplan Meyer 10-year survival was decreased in HTAP patients (57±75% VS 73±1.8%. P<0.001). After correction for demographics and risk factors HTAP (p=0.91) was not identified as a significant risk factor for long-term survival. Conclusion. Preoperative HTAP is associated with significant comorbidities and is a surrogate for higher operative mortality and decreased long-term survival but is not, per se, a significant risk factor for long-term mortality.
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