Arterial hypertension in immediate postoperative period after valve replacement.

Abstract

suMMARY Paroxysmal hypertension occurred during the first 8 hours after cardiac valve replacement in 15 of 186 consecutive patients. The clinical characteristics of this hypertension were similar to those of hypertension after myocardial revascularisation, except that this complication occurred much less frequently after valve replacement (8-1%) than after myocardial revascularisation (33%) (P < 0.001).Hypertension resulting from hypoxia, hypercapnia, shivering, or arousal from anaesthesia was excluded from consideration.The (Estafanous et al., 1973;Estafanous, 1975;Chaptal et al., 1975). It occurs after both coronary bypass surgery (Estafanous et al., 1973;Estafanous, 1975;Chaptal et al., 1975) and cardiac valve replacement (Cleland et al., 1969; BraimbridgeandBranthwaite, 1972;McQueen et al., 1972), but has been said to be much less frequent in the latter situation (Estafanous et al., 1973). However, our initial report dealt with fewer cases of valve replacement (38) than of coronary bypass (76). Other reports were concerned only with hypertension after valve replacement and did not include coronary bypass cases (Cleland et al., 1969;Braimbridge and Branthwaite, 1972;McQueen et al., 1972). Further, the numbers involved in the latter series were also relatively small and the criteria for hypertension and the time of its occurrence differed in these reports. It still is not clear, therefore, whether postoperative hypertension is more frequent after myocardial revascularisation than after other Received for publication 12 September 1977 types of open heart surgery. More important, it has yet to be established whether the clinical picture and associated haemodynamic changes were the same in both circumstances. To that end a clinical study by the same group of investigators applying the same criteria was appropriate.We have, therefore, investigated 186 patients who have had valve replacement operations; the results were compared with our experience in over 5000 myocardial revascularisation procedures (Estafanous et al., 1972(Estafanous et al., , 1973Estafanous, 1975). MethodsThe postoperative records of 186 consecutive patients who had had an operation for cardiac valve replacement were reviewed. Of these, 85 patients had had mitral valve replacement, 83 aortic valve replacement, and 18 patients had had both valves replaced.Premedication consisted of Pantopon (0 3 mg/kg body weight) intramuscularly and promethazine hydrochloride (0-25 mg/kg body weight). Anaesthesia was induced with sodium thiopentone (3 to 5 mg/kg body weight), and a muscle relaxant was 718 on 7 June 2019 by guest. Protected by copyright.http://heart.bmj.com/ Br Heart J: first published as 10.1136/hrt.40.7.718 on 1 July 1978. Downloaded from

Arterial Pulse Wave Dynamics After Percutaneous Aortic Valve Replacement

“…Although this finding seems surprising in view of the reduced ventricular load and could indicate an adverse effect of PAVR, a similar blood pressure response has been reported after open-chest aortic valve replacement, [27][28][29] which is thought to be due to modulation of baroreflexes rather than modulation of ventricular afterload per se.…”

Hypertension in aortic valve disease and its response to valve replacement

“…Left ventricular contractility is impaired in aortic valve disease with heart failure and following AVR this often returns to normal so that subsequent improved ventricular ejection could then explain rises in systolic pressure." [5][6][7][8][9][10][11][12][13][14][15][16][17] Hypertension immediately following cardiac surgery appears to be mediated via cardiac reflexes and sympathetic nervous system, although the renin-angiotensin system and circulating vasopressin levels have been implicated. '820 Hypertension following repair of aortic coarctation is associated with reduced arterial compliance, abnormalities of baroreceptor function and abnormal vascular reactivity consistent with a myogenic abnormality.2-23 It is not known if these mechanisms are responsible for the long-term elevations in blood pressure seen in AVD.…”

Short-term effects of transcatheter aortic valve replacement on blood pressure and cardiac function in elderly patients with severe aortic stenosis

“…Preprocedural HT is a risk factor and predictor of increased mortality after surgical aortic valve replacement (AVR) [1]. The disappearance of the pressure gradient across the aortic valve after surgical AVR often leads to dramatic hemodynamic changes and increased HT [2], which can challenge perioperative care and may further affect patients in the chronic phase. The use of antihypertensive medications after surgery has been shown to improve left ventricular (LV) remodeling and mortality [3].…”