Does the Society of Thoracic Surgeons risk score accurately predict operative mortality for patients with pulmonary hypertension?

Jamie L.W. Kennedy, Damien J. Lapar, John A. Kern, Irving L. Kron, James D. Bergin, Sandeep Kamath, Gorav Ailawadi

Research output: Contribution to journalArticlepeer-review

26 Scopus citations


Objective: This study assessed the impact of pulmonary hypertension (PH) on morbidity and mortality after the most common cardiac operations and evaluated the accuracy of the Society of Thoracic Surgeons (STS) risk model for patients with PH. Methods: At a single center between 1994 and 2010, all adult cardiac operations performed with recorded preoperative mean pulmonary arterial pressure (MPAP) and STS predicted mortality were reviewed. MPAP was defined as normal (<25 mm Hg) or as mild (25-34 mm Hg), moderate (35-44 mm Hg), or severe (≥45 mm Hg) PH. Multivariate analysis was performed to elucidate the contribution of PH to morbidity and mortality. Results: In all, 3343 patient records were reviewed. Coronary artery bypass grafting (CABG) was the most common procedure (67.5%), followed by aortic valve replacement (24.9%) and mitral valve procedures (6.3%). Postoperative complications and mortality increased with increasing MPAP. Multivariable analysis found that both moderate (odds ratio, 7.17; P <.001) and severe (odds ratio, 13.73; P <.001) PH were significantly associated with increased mortality, even after accounting for STS risk. A subset analysis of isolated CABG cases revealed markedly increased mortality for all categories of PH (mild odds ratio, 1.99; moderate odds ratio, 11.5; severe odds ratio, 38.9; P <.001). Conclusions: Morbidity and mortality were independently associated with PH. Observed mortality was significantly higher than predicted by the STS model for patients with moderate and severe PH, particularly in isolated CABG. Addition of PH to the STS risk model should be considered, or alternative tools should be used to assess risk in these patients.

Original languageEnglish (US)
Pages (from-to)631-637
Number of pages7
JournalJournal of Thoracic and Cardiovascular Surgery
Issue number3
StatePublished - Sep 2013


  • AVR
  • CABG
  • CI
  • MPAP
  • OR
  • PASP
  • PH
  • PROM
  • PVR
  • STS
  • Society of Thoracic Surgeons
  • aortic valve replacement
  • confidence interval
  • coronary artery bypass grafting
  • mean pulmonary arterial pressure
  • odds ratio
  • predicted risk of mortality
  • pulmonary arterial systolic pressure
  • pulmonary hypertension
  • pulmonary vascular resistance

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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