The development of pulmonary arterial hypertension (PAH) has been long considered a risk factor for poor outcome in patients undergoing mitral valve replacement (MVR).
This prospective study was conducted to assess the operative mortality, immediate postoperative hemodynamics and short term (6 months) survival in patients who underwent MVR in the presence of severe PAH
Patients and methods
This study was conducted between May 2007 and September 2011 at the departments of cardiac surgery in Sohag Heart center and Sohag university hospital. 83 patients (25 men, 58 women) with rheumatic mitral valve disease (61 patients with predominant mitral stenosis, 13 with mitral regurgitation and 9 combined lesions), and severe pulmonary hypertension (ranging from 70 to 135 mmHg) were included in the study. Patients age range from 17–60years (mean = 34years). We followed the patients for 6 months postoperatively. We divided the patients into 2 groups, group I, 35 patients with pulmonary artery systolic pressure (PASP) <90 mmHg, group II, 48 patients with PASP > 90 mmHg.
3 patients from group II died, and only 1 patient in group I. constituting an overall mortality rate of 4%. In group I, the mean PASP fell by 44% from a mean preoperative of 76.6 mmHg to 33.16 within a week after surgery, which is highly statistically significant (p < 0.01), and it deceased to a mean of 27 mmHg during follow up after 6 month. In group II, PASP fell by 64% from a mean preoperative level of 109.7 mmHg to 45mmHg (p < 0.01), which is highly significant, and it decreased to a mean of 35 mmHg at 6 months. The follow up period of 6 months was completed in 65 patients (78%). There were no late deaths. New York Heart Association (NYHA) class was also improved in all our patients.
Mitral Valve replacement in the presence of severe pulmonary hypertension has a low operative mortality, with the evidence of decreased PASP and excellent short term survival.