DOES PREOPERATIVE PULMONARY ARTERY HYPERTENSION AFFECT LONG-TERM SURVIVAL AFTER OFF-PUMP CORONARY ARTERY BYPASS SURGERY?
CCC ePoster Gallery. Khalaf D. 10/26/19; 280553; 318
Dori Khalaf
Dori Khalaf
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Abstract
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BACKGROUND: Preoperative pulmonary hypertension (HTAP) increases perioperative morbidity and mortality after coronary surgery. How it is affected by revascularization and how it impacts on long-term survival remain questionable. Off-pump coronary artery bypass (OPCAB) patients offer a unique model to specifically study the effect of preoperative HTAP because no extra-corporal circulation is used. The purpose of our study is to evaluate long-term effect of preoperative HTAP after OPCAB surgery.

METHODS AND RESULTS: Data on 1500 consecutive patients who underwent isolated 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. HTAP was defined by a systolic pulmonary hypertension above 40 mm Hg at the time of surgery. Patients were prospectively followed and data collected in a dedicated database. 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 was not identified as a significant risk factor for long-term survival (p=0.91). Absolute and pulmonary to systemic ratio dropped after revascularisation but resumed almost preoperative value after 24 hours (Fig. 1a-b).

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. Coronary revascularisation does not impact on short term preoperative HTAP.
BACKGROUND: Preoperative pulmonary hypertension (HTAP) increases perioperative morbidity and mortality after coronary surgery. How it is affected by revascularization and how it impacts on long-term survival remain questionable. Off-pump coronary artery bypass (OPCAB) patients offer a unique model to specifically study the effect of preoperative HTAP because no extra-corporal circulation is used. The purpose of our study is to evaluate long-term effect of preoperative HTAP after OPCAB surgery.

METHODS AND RESULTS: Data on 1500 consecutive patients who underwent isolated 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. HTAP was defined by a systolic pulmonary hypertension above 40 mm Hg at the time of surgery. Patients were prospectively followed and data collected in a dedicated database. 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 was not identified as a significant risk factor for long-term survival (p=0.91). Absolute and pulmonary to systemic ratio dropped after revascularisation but resumed almost preoperative value after 24 hours (Fig. 1a-b).

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. Coronary revascularisation does not impact on short term preoperative HTAP.
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