From January 2005 to July 2010, 422 consecutive patients with severe AS underwent isolated AVR. According to systolic pulmonary artery pressure (sPAP), PH was classified as none (sPAPS < 35 mmHg, N = 224), mild-moderate (35 ¡Ü sPAP < 50 mmHg, N = 159) and severe (sPAP ¡Ý 50 mmHg, N = 39).
Overall in-hospital mortality was 2.8 % . Unadjusted mortality was 0.9 % , 3.8 % and 10.2 % for patients with normal, mild-moderate and severe PH (p = 0.003). In multivariable analysis, severe PH (OR 4.1, 95 CI 1.1-15.3, p = 0.04) and New York Heart Association class III-IV (OR 14.9, 95 % CI 1.8-117.8, p = 0.01) were independent risk factors of in-hospital mortality. Multivariable predictors of five-year survival were extracardiac arteriopathy (HR 2.8, 95 % CI 1.6-4.9, p < 0.0001), severe PH (HR 2.4, 95 % CI 1.2-4.6 p = 0.01), NHYA III-IV class (HR 2.3, 95 % CI 1.3-4, p = 0.003), preoperative serum creatinine (HR 2.2, 95 % CI, 1.6-3.1,p < 0.0001) and age (HR 1.08, 95 % CI 1.03 - 1.13, p = 0.01). Five-year survival was 86 % ¡À 3 % with normal sPAP, 81 % ¡À 4 % with mild-moderate PH and 63 ¡À 10 % with severe PH (p < 0.001).
In patients undergoing isolated AVR with severe AS, severe PH is an independent predictor of in-hospital mortality and five-year survival