{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T08:34:07Z","timestamp":1740126847655,"version":"3.37.3"},"reference-count":29,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thorac Cardiovasc Surg"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Severe pulmonary hypertension (PH) and left ventricular diastolic dysfunction (LVDD) are independently associated with poor outcomes in cardiac surgery. We evaluated the relationship of several measures of LVDD, PH, and hemodynamic subtypes of PH including precapillary pulmonary hypertension(pcPH) and isolated post-capillary pulmonary hypertension(ipcPH) and combined pre and post capillary pulmonary hypertension(cpcPH) capillary PH to postoperative outcomes in a cohort of patients who underwent elective isolated-AVR.<\/jats:p><jats:p>\n          Methods\u2003We evaluated (n\u2009=\u2009206) patients in our local STS database who underwent elective isolated-AVR between 2014 and 2018, with transthoracic echocardiogram (n\u2009=\u2009177) or right heart catheterization (n\u2009=\u2009183) within 1 year of operation (or both, n\u2009=\u2009161). The primary outcome was a composite end point of death, prolonged ventilation, ICU readmission, and hospital stay &gt;14 days.<\/jats:p><jats:p>\n          Results\u2003Severe PH was associated with worse outcomes (moderate: OR, 1.1, p\u2009=\u20090.09; severe: OR, 1.28, p\u2009=\u20090.01), but degree of LVDD was not associated with worse outcomes. Across hemodynamic subtypes of PH, odds of composite outcome were similar (p\u2009=\u20090.89), however, patients with cpcPH had more postoperative complications (67 vs. 36%, p\u2009=\u20090.06) and patients with ipcPH had greater all-cause mortality at 1 (8 vs. 1%, p\u2009=\u20090.03) and 3 years (27 vs. 4%, p\u2009=\u20090.008).<\/jats:p><jats:p>\n          Conclusion\u2003Severe PH conferred modestly greater risk of adverse events, and both LVDD grade and the combination of severe PH and LVDD were not associated with worse outcomes. However, hemodynamic stratification of PH revealed higher postoperative complications and worse long-term outcomes for those with cpcPH and ipcPH. Preoperative stratification of PH by hemodynamic subtype in valve replacement surgery may improve our risk stratification in this heterogenous condition. Further evaluation of the significance of LVDD and PH in other cardiac operations is warranted.<\/jats:p>","DOI":"10.1055\/s-0041-1727138","type":"journal-article","created":{"date-parts":[[2021,4,16]],"date-time":"2021-04-16T23:32:45Z","timestamp":1618615965000},"page":"398-406","source":"Crossref","is-referenced-by-count":0,"title":["Left Ventricular Diastolic Dysfunction and Pulmonary Hypertension: Outcomes in SAVR"],"prefix":"10.1055","volume":"71","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2351-236X","authenticated-orcid":false,"given":"Tom X.","family":"Liu","sequence":"additional","affiliation":[{"name":"School of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States"},{"name":"Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mira T.","family":"Tanenbaum","sequence":"additional","affiliation":[{"name":"School of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claire H.","family":"Seo","sequence":"additional","affiliation":[{"name":"School of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dan","family":"Park","sequence":"additional","affiliation":[{"name":"School of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John C.","family":"Lystash","sequence":"additional","affiliation":[{"name":"Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Joseph","sequence":"additional","affiliation":[{"name":"Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William S.","family":"Arnold","sequence":"additional","affiliation":[{"name":"Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2021,4,16]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"2005","DOI":"10.1053\/j.jvca.2017.09.035","article-title":"Pulmonary hypertension in patients for transcatheter and surgical aortic valve replacement: a focus on outcomes and perioperative management","volume":"32","author":"S T Morozowich","year":"2018","journal-title":"J Cardiothorac Vasc Anesth"},{"issue":"02","key":"ref2","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1161\/CIRCHEARTFAILURE.112.000095","article-title":"Left ventricular dysfunction with pulmonary hypertension: part 1: epidemiology, pathophysiology, and definitions","volume":"6","author":"V V Georgiopoulou","year":"2013","journal-title":"Circ Heart Fail"},{"issue":"21","key":"ref3","doi-asserted-by":"crossref","first-page":"2155","DOI":"10.1016\/j.jcin.2019.08.031","article-title":"Impact of pulmonary hypertension hemodynamic status on long-term outcome after transcatheter aortic valve replacement","volume":"12","author":"J Schewel","year":"2019","journal-title":"JACC Cardiovasc Interv"},{"issue":"09","key":"ref4","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1161\/CIRCULATIONAHA.119.040295","article-title":"Differentiating precapillary from postcapillary pulmonary hypertension","volume":"140","author":"R Naeije","year":"2019","journal-title":"Circulation"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1016\/S0140-6736(09)60211-7","article-title":"Aortic stenosis","volume":"373","author":"B A Carabello","year":"2009","journal-title":"Lancet"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1111\/echo.12285","article-title":"Presence of preoperative diastolic dysfunction predicts postoperative pulmonary edema and cardiovascular complications in patients undergoing noncardiac surgery","volume":"31","author":"D H Cho","year":"2014","journal-title":"Echocardiography"},{"issue":"03","key":"ref7","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1161\/CIRCULATIONAHA.112.127639","article-title":"Incremental value of the preoperative echocardiogram to predict mortality and major morbidity in coronary artery bypass surgery","volume":"127","author":"J Afilalo","year":"2013","journal-title":"Circulation"},{"issue":"04","key":"ref8","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1016\/S0735-1097(02)02002-8","article-title":"Severe pulmonary hypertension in patients with severe aortic valve stenosis: clinical profile and prognostic implications","volume":"40","author":"J F Malouf","year":"2002","journal-title":"J Am Coll Cardiol"},{"issue":"01","key":"ref9","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.athoracsur.2018.10.004","article-title":"The society of thoracic surgeons adult cardiac surgery database: 2019 update; outcomes and quality","volume":"107","author":"R S D'Agostino","year":"2019","journal-title":"Ann Thorac Surg"},{"issue":"11","key":"ref10","doi-asserted-by":"crossref","first-page":"e450","DOI":"10.1177\/000313481708301112","article-title":"An evaluation of risk stratification in general surgery patients","volume":"83","author":"S L Fogel","year":"2017","journal-title":"Am Surg"},{"issue":"19","key":"ref11","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1136\/heartjnl-2017-311506","article-title":"The role and clinical implications of diastolic dysfunction in aortic stenosis","volume":"103","author":"P N Kampaktsis","year":"2017","journal-title":"Heart"},{"issue":"03","key":"ref12","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1016\/j.jtcvs.2012.07.055","article-title":"Does the Society of Thoracic Surgeons risk score accurately predict operative mortality for patients with pulmonary hypertension?","volume":"146","author":"J LW Kennedy","year":"2013","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"07","key":"ref13","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1016\/j.amjcard.2010.11.031","article-title":"Clinical profile, prognostic implication, and response to treatment of pulmonary hypertension in patients with severe aortic stenosis","volume":"107","author":"I Ben-Dor","year":"2011","journal-title":"Am J Cardiol"},{"issue":"01","key":"ref14","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1186\/s13019-018-0744-3","article-title":"Diastolic dysfunction is common and predicts outcome after cardiac surgery","volume":"13","author":"T S Metkus","year":"2018","journal-title":"J Cardiothorac Surg"},{"issue":"06","key":"ref15","doi-asserted-by":"crossref","first-page":"1424","DOI":"10.1016\/j.jtcvs.2011.02.028","article-title":"Impact of pulmonary hypertension on outcomes after aortic valve replacement for aortic valve stenosis","volume":"141","author":"S J Melby","year":"2011","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"01","key":"ref16","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1053\/euje.2000.0051","article-title":"Coronary artery bypass grafting in patients with severe left ventricular dysfunction: predictive significance of left ventricular diastolic filling pattern","volume":"2","author":"J Vaskelyte","year":"2001","journal-title":"Eur J Echocardiogr"},{"issue":"06","key":"ref17","doi-asserted-by":"crossref","first-page":"e002253","DOI":"10.1161\/CIRCINTERVENTIONS.114.002253","article-title":"Pulmonary hypertension in patients undergoing transcatheter aortic valve replacement: discussion of the current evidence","volume":"8","author":"M G\u00f6ssl","year":"2015","journal-title":"Circ Cardiovasc Interv"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1186\/1749-8090-4-67","article-title":"Left ventricular diastolic dysfunction of the cardiac surgery patient; a point of view for the cardiac surgeon and cardio-anesthesiologist","volume":"4","author":"E E Apostolakis","year":"2009","journal-title":"J Cardiothorac Surg"},{"issue":"07","key":"ref19","doi-asserted-by":"crossref","first-page":"e002358","DOI":"10.1161\/CIRCINTERVENTIONS.114.002358","article-title":"Effect of pulmonary hypertension hemodynamic presentation on clinical outcomes in patients with severe symptomatic aortic valve stenosis undergoing transcatheter aortic valve implantation: insights from the new proposed pulmonary hypertension classification","volume":"8","author":"C J O'Sullivan","year":"2015","journal-title":"Circ Cardiovasc Interv"},{"issue":"S 01","key":"ref20","doi-asserted-by":"crossref","first-page":"S2","DOI":"10.1016\/j.athoracsur.2009.05.053","article-title":"The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 1\u2014coronary artery bypass grafting surgery","volume":"88","author":"D M Shahian","year":"2009","journal-title":"Ann Thorac Surg"},{"issue":"04","key":"ref21","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1093\/ejcts\/ezs043","article-title":"EuroSCORE II","volume":"41","author":"S A Nashef","year":"2012","journal-title":"Eur J Cardiothorac Surg"},{"issue":"01","key":"ref22","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1093\/eurheartj\/ehv317","article-title":"2015 ESC\/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: The joint task force for the diagnosis and treatment of pulmonary hypertension of the European Society Of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT)","volume":"37","author":"N Gali\u00e8","year":"2016","journal-title":"Eur Heart J"},{"issue":"07","key":"ref23","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1093\/eurheartj\/ehi720","article-title":"Comparison of 19 pre-operative risk stratification models in open-heart surgery","volume":"27","author":"J Nilsson","year":"2006","journal-title":"Eur Heart J"},{"issue":"04","key":"ref24","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.echo.2016.01.011","article-title":"Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"29","author":"S F Nagueh","year":"2016","journal-title":"J Am Soc Echocardiogr"},{"issue":"06","key":"ref25","doi-asserted-by":"crossref","first-page":"1844","DOI":"10.1016\/j.athoracsur.2011.02.008","article-title":"Utility of a simple algorithm to grade diastolic dysfunction and predict outcome after coronary artery bypass graft surgery","volume":"91","author":"M Swaminathan","year":"2011","journal-title":"Ann Thorac Surg"},{"key":"ref26","first-page":"356982","article-title":"Perioperative anesthesiological management of patients with pulmonary hypertension","volume":"2012","author":"J Gille","year":"2012","journal-title":"Anesthesiol Res Pract"},{"issue":"06","key":"ref27","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.1213\/01.ANE.0000062523.67426.0B","article-title":"Management of pulmonary hypertension: physiological and pharmacological considerations for anesthesiologists","volume":"96","author":"L G Fischer","year":"2003","journal-title":"Anesth Analg"},{"issue":"01","key":"ref28","doi-asserted-by":"crossref","first-page":"e004255","DOI":"10.1161\/CIRCHEARTFAILURE.117.004255","article-title":"Intersection of pulmonary hypertension and right ventricular dysfunction in patients on left ventricular assist device support","volume":"11","author":"C T Sparrow","year":"2018","journal-title":"Circ Heart Fail"},{"issue":"10","key":"ref29","doi-asserted-by":"crossref","first-page":"1562","DOI":"10.1016\/j.amjcard.2014.08.019","article-title":"Prognostic impact of pulmonary artery systolic pressure in patients undergoing transcatheter aortic valve replacement for aortic stenosis","volume":"114","author":"K Bishu","year":"2014","journal-title":"Am J Cardiol"}],"container-title":["The Thoracic and Cardiovascular Surgeon"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0041-1727138.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,8]],"date-time":"2023-08-08T23:15:12Z","timestamp":1691536512000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0041-1727138"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,16]]},"references-count":29,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2023,8,8]]},"published-print":{"date-parts":[[2023,8]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0041-1727138","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0171-6425","1439-1902"],"issn-type":[{"type":"print","value":"0171-6425"},{"type":"electronic","value":"1439-1902"}],"subject":[],"published":{"date-parts":[[2021,4,16]]}}}