The Bluhm Cardiovascular Institute Northwestern Memorial Hospital A Contemporary Analysis of Pulmonary Hypertension in Patients Undergoing Mitral Valve Surgery: Is this a Risk Factor? Daniel H. Enter M.D. , Anthony Zaki B.S., Brett Duncan M.D., Jane Kruse R.N. B.S.N., Andrei Adin-Cristian Ph.D., Zhi Li, M.S., S. Chris Malaisrie M.D., James D. Thomas M.D., Patrick McCarthy M.D.
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The Bluhm Cardiovascular Institute Northwestern Memorial Hospital A Contemporary Analysis of Pulmonary Hypertension in Patients Undergoing Mitral Valve.
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The Bluhm Cardiovascular Institute
Northwestern Memorial Hospital
A Contemporary Analysis of Pulmonary Hypertension in Patients Undergoing Mitral
Valve Surgery: Is this a Risk Factor?
A Contemporary Analysis of Pulmonary Hypertension in Patients Undergoing Mitral
Valve Surgery: Is this a Risk Factor?
Daniel H. Enter M.D., Anthony Zaki B.S., Brett Duncan M.D., Jane Kruse R.N. B.S.N., Andrei
Adin-Cristian Ph.D., Zhi Li, M.S., S. Chris Malaisrie M.D., James D. Thomas M.D.,
Patrick McCarthy M.D.
Daniel H. Enter M.D., Anthony Zaki B.S., Brett Duncan M.D., Jane Kruse R.N. B.S.N., Andrei
Adin-Cristian Ph.D., Zhi Li, M.S., S. Chris Malaisrie M.D., James D. Thomas M.D.,
Patrick McCarthy M.D.
The Bluhm Cardiovascular Institute
Northwestern Memorial Hospital
Pulmonary HypertensionPulmonary Hypertension
1. Pulmonary hypertension (pHTN) is elevated arterial pressures in the pulmonary circulation, specifically systolic pulmonary arterial pressure (PASP) greater than 35 mm Hg.
2. Severe pulmonary hypertension has been identified in the Euroscore data as a factor for 30 day mortality1.
3. However, contemporary surgery may reduce that risk.
1. Pulmonary hypertension (pHTN) is elevated arterial pressures in the pulmonary circulation, specifically systolic pulmonary arterial pressure (PASP) greater than 35 mm Hg.
2. Severe pulmonary hypertension has been identified in the Euroscore data as a factor for 30 day mortality1.
3. However, contemporary surgery may reduce that risk.
1Group, E.S. EuroSCORE II Calculator. European System for Cardiac Operative Risk Evaluation, http://www.euroscore.org/calc.html.
The Bluhm Cardiovascular Institute
Northwestern Memorial Hospital
2014 AHA/ACC Guidelines for the Management of Patients With Valvular
Heart Disease
2014 AHA/ACC Guidelines for the Management of Patients With Valvular
Heart Disease
• Severe pHTN (PASP >50 mm Hg) is considered a class IIa indication for surgery in chronic severe MR1
• Level of Evidence B
• Severe pHTN (PASP >50 mm Hg) is considered a class IIa indication for surgery in chronic severe MR1
• Level of Evidence B
1Nishimura, R.A., et al. J Thorac Cardiovasc Surg, 2014. 148(1): p. e1-e132.
The Bluhm Cardiovascular Institute
Northwestern Memorial Hospital
N= 3342, Multivariate analysis 92.4% Isolated CABG or AVR 6.3% MV surgery, not reported separatelyJ Thorac Cardiovasc Surg, 2013. 146(3): p. 631-7.
The Bluhm Cardiovascular Institute
Northwestern Memorial Hospital
N=873Mitral regurgitationMultivariate analysis
J Thorac Cardiovasc Surg, 2011. 142(6): p. 1439-52.
The Bluhm Cardiovascular Institute
Northwestern Memorial Hospital
HypothesesHypotheses
1. Pulmonary HTN itself does not increase perioperative or long-term mortality in MV surgery patients.
2. Addition of TV surgery does not increase mortality.
1. Pulmonary HTN itself does not increase perioperative or long-term mortality in MV surgery patients.
2. Addition of TV surgery does not increase mortality.