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- Title
Aortic valve replacement with pulmonary hypertension: Meta-analysis of 70 676 patients.
- Authors
Rocha, Rodolfo V.; Friedrich, Jan O.; Hong, Kathryn; Lee, Jessica; Cheema, Asim; Bagai, Akshay; Verma, Subodh; Yanagawa, Bobby
- Abstract
<bold>Background and Aim Of the Study: </bold>We compared early and late outcomes of surgical aortic valve replacement (SAVR) in patients with aortic stenosis (AS) and pulmonary hypertension (PHT).<bold>Methods: </bold>We searched MEDLINE and EMBASE databases until July 2018 for studies comparing patients with AS and none, mild-moderate, or severe PHT undergoing SAVR. Random-effects meta-analysis was performed.<bold>Results: </bold>There were 12 observational studies with 70 676 patients with median follow-up 4.0 years (interquartile range, 2.6-4 years). Compared to patients with no PHT, patients with any PHT undergoing SAVR were older (mean difference [MD], 2.31 years; 95% confidence interval [CI], 1.38-3.23 years; P < .01), with greater comorbidities and reduced ejection fraction (MD, -4.36; 95%CI, -5.94 to -2.78; P < .01). Patients with any PHT had higher unadjusted (5.2% vs 2.4%; risk ratio [RR], 2.27; 95%CI, 2.04-2.53; P < .01) and adjusted (RR, 1.65; 95%CI, 1.28-2.14; P < .01) in-hospital mortality compared with no PHT. Severe (RR, 3.53; 95%CI, 1.46-8.54; P < .01) and mild-moderate PHT (RR, 2.13; 95%CI, 1.28-3.55; P < .01) were associated with higher unadjusted in-hospital mortality compared with no PHT. Any PHT was associated with a higher unadjusted risk of stroke (RR, 1.64; 95%CI, 1.42-1.90; P < .01), acute kidney injury (RR, 2.02; 95%CI, 1.50-2.72; P < .01), prolonged ventilation (RR, 1.62; 95%CI, 1.04-2.52; P = .03), and longer hospital stay (MD, 1.76 days; 95%CI, 0.57-2.95; P < .01). Severe (HR, 2.44; 95%CI, 1.60-3.72; P < .01) but not mild-moderate PHT (HR, 2.25; 95%CI, 0.91-5.59; P = .08) was associated with higher adjusted long-term mortality compared with no PHT.<bold>Conclusions: </bold>Patients with severe AS and severe PHT had a significant increase in operative mortality and more than double the risk of long-term mortality following SAVR compared with patients with no PHT. Such patients may benefit from a less invasive transcatheter aortic valve intervention.
- Subjects
AORTIC valve transplantation; PULMONARY hypertension; PULMONARY valve; HOSPITAL mortality; AORTIC stenosis; HEART valve prosthesis implantation; PROSTHETIC heart valves; META-analysis; DISEASE complications
- Publication
Journal of Cardiac Surgery, 2019, Vol 34, Issue 12, p1617
- ISSN
0886-0440
- Publication type
journal article
- DOI
10.1111/jocs.14309