Does pulmonary hypertension affect early-term outcomes of off-pump coronary artery bypass surgery?

Abstract

OBJECTIVE: This study aimed to investigate the effect of preoperative pulmonary hypertension (PHT) on postoperative early mortality and morbidity in patients undergoing off-pump coronary artery bypass grafting (CABG). METHODS: A total of 1107 patients undergoing elective first-time off-pump CABG between January 2011 and April 2022 were included in this retrospective observational cohort study. The patients were categorized into two groups according to their preoperative systolic pulmonary artery pressure (SPAP) values. The PHT group (n=104) consisted of patients with a SPAP value >30 mmHg, while the non-PHT group (n=1003) consisted of patients with a SPAP value ≤30 mmHg. Patients' preoperative demographics and clinical features, operative data, and postoperative outcomes were recorded and then compared between the groups. RESULTS: In the PHT group, the median age was significantly higher (66 vs. 63 years, p=0.001) and the median left ventricular ejection fraction level was significantly lower (45 vs. 50%, p=0.045) as compared to the non-PHT group. Additionally, the PHT group included a significantly greater percentage of patients with chronic obstructive pulmonary disease (22.1 vs. 7.4%, p=0.019). As perioperative early-term outcomes, complications, and mortality were considered, the groups were statistically similar, and there were no significant differences between the groups, except for the development of atrial fibrillation. CONCLUSION: For the first time in the literature, this study revealed that mild PHT (mean SPAP=38.9±8.7 mmHg) did not significantly affect earlyterm outcomes of off-pump CABG.

Preoperative pulmonary artery hypertension as a risk factor: the tip of the iceberg

“…In this study, in which pulmonary hypertension was investigated as a risk factor, we think that the frequency of COPD is a very important parameter. In this study, the frequency of COPD was found to be 22.1% in the PHT group and 7.4% in the non-PHT group, with a p-value of 0.019 1 . Considering the number of patients in the patient groups, we think that the p-value may be inaccurate with the current rates.…”

“…The PHT group (n=104) consisted of patients with an SPAP value >30 mmHg, while the non-PHT group (n=1003) consisted of patients with an SPAP value ≤30 mmHg. The authors concluded that both patient groups had similar postoperative outcomes 1 . Could this be due to the large number of patients with an SPAP value between 30 and 50 mmHg?…”

“…We have read the article by Velioglu et al 1 , entitled “Does pulmonary hypertension affect early-term outcomes of off-pump coronary artery bypass surgery?” with great interest. We congratulate the authors for their valuable contributions and successful off-pump coronary surgeries.…”

Association between intraoperative pulmonary artery pressure and cardiovascular complications after off-pump coronary artery bypass surgery: a single-center observational study

“…A recent study reported no difference in early-term outcomes after OPCAB surgery between pulmonary hypertension and non-hypertension groups [ 36 ]. However, Table 2 suggests that preoperative NYHA, beta blocker use, and emergency surgery are important confounding factors in the development of postoperative MACE.…”