36. Scoliosis surgery normalizes cardiac function in AIS patients

Abstract

BACKGROUND CONTEXT Spinal deformity in adolescent idiopathic scoliosis (AIS) can increase right atrial and ventricular pressures secondary to restrictive lung disease. Pulmonary hypertension leading to cor pulmonale is the most feared outcome; however, mild pulmonary hypertension in AIS patients has been reported in the past. No study has examined these changes including the improvement of right heart function following scoliosis surgery. PURPOSE To determine if AIS patients, compared to healthy patients, will have a higher incidence of pulmonary hypertension that worsens with increasing curve angle and improves following scoliosis surgery. STUDY DESIGN/SETTING Retrospective review. PATIENT SAMPLE A total of 202 healthy AIS patients undergoing posterior spinal fusion from 2009-2013 at a single institution (Group 1), 179 healthy age-matched control patients, who did not undergo spinal deformity correction, at the same institution (Group 2) and 47 AIS patients from with elevated preoperative tricuspid regurgitant jet velocity (TRV) undergoing posterior spinal fusion (PSF). OUTCOME MEASURES Right ventricular systolic pressure (RVSP) value, TRV value, aortic root dimensions, PFT. METHODS Cobb angle, 2D-echo signs of structural heart disease, aortic root dimensions, tricuspid regurgitant jet velocity (TRV), PFTs, ABG, and patient demographics were reviewed. Right ventricular systolic pressure (RVSP) was estimated using Bernoulli's equation [4(TRV)2] and right atrial pressure. RVSP ≥ 36mmHg is a surrogate marker for pulmonary hypertension. Logistic regression was used to assess for differences in TRV between groups. RESULTS Mean preoperative RVSP was significantly elevated in AIS patients (26.9±0.49; p CONCLUSIONS This study found that 21% of patients with AIS had elevated TRV while age-matched controls had no TRV abnormalities. Additionally, RVSP measurements demonstrated mild pulmonary hypertension in AIS patients. These abnormal values normalized postoperatively, indicating the benefits of scoliosis surgery on cardiac function in AIS. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.