Risk Factors for Mitral Valve Surgery: Atrial Fibrillation and Pulmonary Hypertension

Lombard, Frederick W.; Liang, Yafen

doi:10.1177/1089253218821694

Cited by 8 publications

(9 citation statements)

References 93 publications

(175 reference statements)

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“…LV dysfunction, atrial fibrillation and pulmonary hypertension are identified risk factors for peri-operative morbidity and mor-tality. (30) In our study, arrythmias and pulmonary arterial pressures >30mmHg were commonly documented. A limitation of our study is that pulmonary artery pressures were only documented prior to surgery in most patients, making it difficult to assess whether increasing pressures had a direct correlation with the risk of mortality.…”

Section: Discussionmentioning

confidence: 56%

Peri-operative outcomes of mitral valve surgery at Charlotte Maxeke Johannesburg Academic Hospital

Tabane¹,

Leonard²,

Kleyenstuber³

2021

SAHJ

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Distribution and determinants of heart disease vary greatly between high-income countries and sub-Saharan Africa where rheumatic heart disease (RHD) is a major public health challenge. (1) RHD is the predominant cause of valve disease in Africa, (2) resulting in Africa having the highest prevalence of cardiac disease in children and young adults .(1) Cumulative effects of poverty, social instability and lack of infrastructure, resources and awareness contribute to the underestimated impact of RHD. (1,2) Studies from Africa confirm that RHD is the main cause of cardiac morbidity and mortality from heart surgery. (1)(2)(3) Mitral valve disease, in the form of mitral stenosis and mitral regurgitation, is the commonest form of valve disease and its treatment usually involves surgical repair or replacement. These surgical procedures are highly invasive and not without risk of complications. (3) In South Africa, data on the management and outcomes of mitral valve surgery are limited. (4) Operative mortality in mitral valve replacement surgery is 5% -6% and 1% -2% in mitral valve repair. (5) Complications associated with mitral valve surgery are commonly related to cardiopulmonary

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Section: Discussionmentioning

confidence: 56%

Peri-operative outcomes of mitral valve surgery at Charlotte Maxeke Johannesburg Academic Hospital

Tabane¹,

Leonard²,

Kleyenstuber³

2021

SAHJ

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“…Both mitral stenosis and mitral regurgitation can result in increased left atrial (LA) pressure and LA enlargement (LAE) [11][12][13][14] . Several studies report that age, LA diameter changes due to mitral regurgitation, severity of mitral stenosis, and reduced left ventricular function are associated with atrial fibrillation [15][16][17][18][19][20][21] . Vulnerability to atrial fibrillation at increased atrial pressure has been demonstrated in animal models [22] and in patients with mitral stenosis [23] .…”

Section: Etiologymentioning

confidence: 99%

Incidence, etiology, and outcomes of pre- and post-operative atrial fibrillation in mitral valve procedures: a review

Dokko¹,

Novotny²,

Santore³

et al. 2022

Vessel Plus

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Although pre-procedural and post-procedural atrial fibrillation occur commonly in mitral valve (MV) patients, the impact on patient outcomes and resource utilization has not been well documented. A comprehensive PubMed review was performed using a combination of MeSH terms related to atrial fibrillation, MV disease, MV and atrial fibrillation procedures, and medical management. Additional publications were selected from the reference lists of studies identified in the literature search. This review found that several studies conflict with the short-term outcomes associated with pre- and post-operative atrial fibrillation in MV patients. In general, both pre- and post-operative atrial fibrillation have clear negative long-term impacts on MV patients’ mortality and risk of stroke, major bleeding and other thromboembolic events. Surgical ablation for pre-operative atrial fibrillation and transcatheter ablation for medically resistant post-operative atrial fibrillation appears to be safe and effective procedure; these percutaneous and surgical interventions have been documented to mitigate MV-related thromboembolic risk. For MV patients, evidence suggests that the first step should be to optimize the current medical therapy; for persistent symptoms not addressed medically, ablation procedures should be considered. To optimize MV patients’ quality of care, however, additional research appears warranted to prevent long-term adverse outcomes.

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“…The leading cardiovascular consequence is mitral valve pathology, with pulmonary hypertension frequently observed secondary to left-sided valve disease [ 2 ]. The mechanism is retrograde transmission of the increased left atrial pressure, which in turn leads to pulmonary vascular remodeling and subsequently pulmonary hypertension [ 3 ]. Globally, the prevalence of pulmonary hypertension is 1%; almost 80% of those affected reside in developing countries [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…The development of pulmonary hypertension in mitral valve disease indicates poor overall prognosis and is therefore considered an indication for early surgical intervention [ 3 ]. Although increasing severity of pulmonary hypertension in mitral valve disease patients may be an indicator of advanced disease and thus poor long-term outcomes [ 5 ], the effect of pulmonary hypertension severity on early surgical outcomes of mitral valve replacement remains an interesting debate.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary Hypertension as a Predictor of Early Outcomes of Mitral Valve Replacement: A Study in Rheumatic Heart Disease Patients

Farooq¹,

Jan²,

Ghani³

et al. 2021

Cureus

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Mitral valve pathology in rheumatic heart disease patients is a common cause of secondary pulmonary hypertension (PH). Our aim was to evaluate pulmonary hypertension severity as a predictor of in-hospital mortality and early complications following mitral valve replacement. MethodsA retrospective review of rheumatic heart disease patients who underwent mitral valve replacement between January 2017 and August 2020 was performed. Systolic pulmonary artery pressure (sPAP) was used to classify patients as no PH (<35 mmHg), mild PH (35-44 mmHg), moderate PH (45-59 mmHg) or severe PH (>60 mmHg). Patients subjected to additional cardiac procedures (such as aortic valve replacement and coronary artery bypass grafting) were excluded from the study sample. ResultsThe study group was composed of 159 patients (mean age: 40; 73 male, 86 female) categorized as no PH (n = 32; 20.1%), mild PH (n = 14; 8.8%), moderate PH (n = 65, 40.9%) and severe PH (n = 48, 30.2%) groups. Patient demographic data and preoperative comorbidities were comparable among the four groups. Use of intraoperative and postoperative blood products was similar in all the groups. Severe PH patients had similar in-hospital mortality (4.2%; p = 0.74) as in groups with lesser degrees of pulmonary hypertension. Likewise, increasing severity of pulmonary hypertension did not confer any significant increase in early postoperative complications, namely prolonged ICU stay (10.4%; p = 0.41), prolonged ventilation (2.1%; p = 0.70), reintubation (4.2%; p = 0.90), reopening for bleeding tamponade (6.3%; p = 0.39), new-onset renal failure (6.3%; p = 0.91), postoperative stroke (4.2%; p = 0.52) or prolonged length of stay (mean: 5.6 + 2.8 days; p = 0.49). ConclusionsIncreasing severity of pulmonary hypertension does not appear to have a significant impact on in-hospital mortality or early postoperative outcomes of patients undergoing mitral valve replacement.

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Risk Factors for Mitral Valve Surgery: Atrial Fibrillation and Pulmonary Hypertension

Cited by 8 publications

References 93 publications

Peri-operative outcomes of mitral valve surgery at Charlotte Maxeke Johannesburg Academic Hospital

Peri-operative outcomes of mitral valve surgery at Charlotte Maxeke Johannesburg Academic Hospital

Incidence, etiology, and outcomes of pre- and post-operative atrial fibrillation in mitral valve procedures: a review

Pulmonary Hypertension as a Predictor of Early Outcomes of Mitral Valve Replacement: A Study in Rheumatic Heart Disease Patients

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