ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
The effect of pulmonary hypertension on surgical outcome in patients undergoing coronary artery bypass grafting
Zeki Çatav, Levent Altınay, Soner Yavaş, Ahmet Sarıtaş, Mustafa Paç, S. Fehmi Katırcıoğlu
Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, Ankara
Background: In this retrospective study, the impact of preoperatively existent pulmonary hypertension on hospital mortality and certain clinical indices in patients undergoing coronary artery bypass grafting (CABG) was investigated.

Methods: The patients having pulmonary hypertension detected by preoperative echocardiography among those undergoing isolated CABG in our clinic between January 2000 and May 2006 were retrospectively reviewed. One hundred and seventy-seven cases with no possible etiologies other than ischemic heart disease to explain elevated pulmonary pressures were included in the study. The patients were then divided into three groups. Patients with a pulmonary artery systolic pressure (PASP) below 30 mmHg were assigned to the “normal PASP group” (group 1), those with a PASP between 30-50 mmHg were assigned to the “mild pulmonary hypertension group” (group 2) and those with a PASP above 50 mmHg were assigned to the “severe pulmonary hypertension group” (group 3). These three groups were then compared as to cardiopulmonary bypass (CPB) and aortic cross-clamp durations, mechanical ventilation duration, perioperative inotropic support or intra-aortic baloon pump (IABP) requirement and hospital mortality.

Results: The hospital mortalities were 4.7%, 10%, 18.9% for the groups 1, 2 and 3, respectively. The difference between the hospital mortalities of group 1 and 3 was significant (p=0.02). There was no significant difference between the groups in terms of operation time, CPB and aortic cross-clamp durations. However, the difference between the groups 1 and 3, in regard to perioperative inotropic support and IABP need, was significant (p=0.001 and p=0.01, respectively). In addition, there was a negative correlation between the average left ventricular ejection fraction and pulmonary pressure (Pearson’s correlation coefficient: –0.429; p<0.0001) throughout the study population.

Conclusion: Based on the present results, we observed that the hospital mortality for CABG in patients with severely elevated pulmonary artery pressures was significantly increased and the need for inotropic support and IABP use were also raised.

Keywords : Coronary artery bypass; hypertension; pulmonary
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