Early Results of Mitral Valve Replacement in Severe Pulmonary Artery Hypertension—An Institutional Prospective Study

Abstract

Introduction:In patients undergoing surgery for mitral valve replacement (MVR) for valvular heart disease, pulmonary artery hypertension (PAH) has been considered a major risk factor. In this prospective study, we have studied the early hemodynamic changes and post-operative outcomes of MVR among patients with severe PAH. Methods: 68 consecutive patients who underwent mitral valve replacement for severe rheumatic mitral valve disease with severe PAH (pulmonary artery pressure (PAP) > 50 mmHg) were studied prospectively for immediate postoperative hemodynamics and outcomes. The mean age of the patients was 32.1 years. 32 (47.05%) patients had mitral stenosis, 13 (19.11%) had mitral regurgitation and 23 (33.82%) had mixed lesions. Patients were divided into two groups based on preoperative pulmonary artery pressures. In 56 patients (82.35%, group I) PAP was sub-systemic or systemic, with a mean of 58.4 mmHg. Twelve patients (17.65%, group II) had supra-systemic PAP with a mean of 82.4 mmHg. Results: After mitral valve replacement, the PAP and pulmonary vascular resistance (PVR) decreased significantly in group I to near normal levels. In group II also the PAP and PVR decreased significantly but significant residual PAH remained. Operative mortality was 3.5% in group I and 16.6% in group II. Conclusions: MVR is safe and effective at the presence of severe PAH as long as the PAP is below or equal to systemic pressures. With suprasystemic PAP, MVR carries a high risk of mortality and the patient continues to have severe PAH in the postoperative period.

In Hospital Outcome of Mitral Valve Replacement with Severe Pulmonary Hypertension

“…23 Incidence of post-operative low cardiac output syndrome can be reducing as well. 22 In this study there was statistically significant incidence of low output syndrome in Group B (33.3%) than Group A (10%) with a p value of 0.029. However, prolong duration of inotrope support was needed for Group B patients which was statistically significant.…”

“…Operatively both groups did not have significant difference concerning total bypass time, cross clamp time, total operative duration, which is similar to the study done by Mohammad 21 and his colleagues and also in India by Kumar and his colleagues. 22 In all cases MVR was done with St Jude Bileaflet Mechanical valve. Since 1979, St Jude Medical double -leaflet valve is used preferentially, which is associated with better haemodynamic and is therefore considered the gold Standard.…”

Kết quả sớm phẫu thuật thay van tim ở bệnh nhân có bệnh van tim nặng tại bệnh viện hữu nghị Việt Đức giai đoạn 2014-2016

“…[13] Các tác giả trong và ngoài nước khi nghiên cứu về ALĐMP tâm thu sau mổ đều có chung một nhận định rằng ALĐMP sẽ giảm ngay sau mổ. Áp lực ĐMP tâm thu giảm trung bình trong nghiên cứu của chúng tôi từ mức 74,03± 13 [9]. Như vậy, ngay sau phẫu thuật thay tim, ALĐMP giảm nhiều và có ý nghĩa, làm giảm hẳn tình trạng khó thở, phù, gan to trên lâm sàng.…”

Impact of preoperative pulmonary arterial hypertension on early and late outcomes in patients undergoing valve surgery for rheumatic heart disease

“…Large body of literature is available on impact of PAH on outcomes in valve surgeries. These studies have studied various patient populations and used different methods for assessment of PAH with variable cut-offs and variable follow-up[ 3 4 5 13 14 15 16 17 18 19 20 21 22 23 24 25 ] [ Table 6 ]. Present study assessed impact of PAH as measured by Doppler echocardiography on patients undergoing cardiac surgery exclusively for RHD as per EuroSCORE II cut-offs.…”