Value of pulmonary artery pressure in predicting in-hospital and one-year mortality after valve replacement surgery in middle-aged and aged patients with rheumatic mitral disease: an observational study

OBJECTIVES: To investigate the role of pulmonary artery pressure (PAP) in predicting in-hospital death after valve replacement surgery in middle-aged and aged patients with rheumatic mitral disease. DESIGN: An observational study. SETTING: Guangdong General Hospital, China. PARTICIPANTS: 1639middle-aged and aged patients (mean age 57±6 years) diagnosed with rheumatic mitral disease, undergoing valve replacement surgery and receiving coronary angiography and transthoracic echocardiography before operation, were enrolled. INTERVENTIONS: All participants underwent valve replacement surgery and received coronary angiography before operation. PRIMARY AND SECONDARY OUTCOME MEASURES: In-hospital death and 1-year mortality after operation. METHODS: Included patients were divided into four groups based on the preoperative PAP obtained by echocardiography: group A (PAP≤30 mm Hg); group B (>30 mm Hg<PAP≤50 mm Hg), group C (>50 mm Hg<PAP≤70 mm Hg) and group D (PAP>70 mm Hg). The relationship between PAP and in-hospital death and cumulative rate of 1-year mortality was evaluated. RESULTS: In-hospital mortality rate increased gradually but significantly as the PAP level increased, with 1.9% in group A (n=268), 2.3% in group B (n=771), 4.7% in group C (n=384) and 10.2% in group D (n=216) (p<0.001). Multivariate analysis showed that PAP>70 mm Hg was an independent predictor of in-hospital death (OR=2.93, 95% CI 1.61 to 5.32, p<0.001). PAP>52.5 mm Hg had a sensitivity of 60.3% and specificity of 67.7% in predicting in-hospital death (area under the curve=0.672, 95% CI 0.602 to 0.743, p<0.001). Kaplan–Meier analysis showed that patients with PAP>52.5 mm Hg had higher 1-year mortality after operation than those without (log-rank=21.51, p<0.001). CONCLUSIONS: PAP could serve as a predictor of postoperative in-hospital and 1-year mortality after valve replacement surgery in middle-aged and aged patients with rheumatic mitral disease.