Impact of pulmonary hypertension hemodynamic presentation on perioperative outcomes in patients undergoing elective cardiac surgery: An observational study

Abstract

Abstract Background Pulmonary hypertension (PH) is classified by hemodynamic presentation into precapillary, isolated postcapillary, and combined postcapillary and precapillary PH. Whether PH type influences risk stratification in cardiac surgery remains undetermined. We aimed to evaluate the incidence of perioperative (≤30 days) morbidity and mortality in different PH population. Methods This was a retrospective observational study. All patients who underwent right heart catheterization between August 2015 and July 2020 were divided into the noncapillary, precapillary, isolated postcapillary, and combined postcapillary and pre capillary PH groups based on their mean pulmonary arterial pressure, pulmonary artery wedge pressure, and diastolic pressure difference preoperatively. Results Of the 500 patients who underwent elective cardiac surgeries, 487 were analyzed. Overall, 236 patients (48.7%) had PH, and isolated postcapillary PH was the most common presentation. Mild PH proportion was highest in the precapillary PH type (70.8%), followed by isolated postcapillary PH (46.2%), and finally combined postcapillary and precapillary PH (10.7%). Patients with PH had a greater frequency of renal insufficiency and wound infection within 30 days postoperatively. Mean pulmonary arterial pressure >25 mm Hg after cardiopulmonary bypass (CPB) was a risk factor for short-term complications. New York Heart Association Functional Class ≥II, long CPB duration, and isolated postcapillary PH or combined postcapillary and precapillary PH type are independent risk factors for short-term morbidity and mortality after elective cardiac surgery. Conclusions Isolated postcapillary PH and combined postcapillary and precapillary PH patients had a higher complication rate 30 days postoperatively among elective cardiac surgery patients. After CPB, mean pulmonary arterial pressure >25 mm Hg was associated with greater complication frequency.