Outcome after Mitral Valve Replacement in Patients with Pulmonary Hypertension

Abstract

Background: Mitral valve complications can lead to the serious consequence of pulmonary arterial hypertension (PAH). It has long been  believed that the onset of PAH increases the chance of a poor outcome in individuals having mitral valve replacement surgery (MVR).

Objective: The aim of the present study was to assess and improve the early outcome after MVR in patients with pulmonary  hypertension.

Patients and methods: This study included forty-eight patients undergoing MVR at the Cardiothoracic Surgery Department, Suez Canal  University Hospital. Patients were divided into: group (A) 25 patients: with mild to moderate pulmonary hypertension; and group (B) 23  patients: with severe pulmonary hypertension. Transthoracic Doppler echocardiography, systolic pulmonary arterial pressure (sPAP), left  atrium diameter (LAD), left ventricular enddiastolic dimensions (LVEDD), left ventricular end systolic dimensions (LVESD), fraction  shortening (FS) and left ejection fraction (LEF), were evaluated and compared in all patients.

Results: Mitral valve pathology was non- significantly different between the two groups. However, number of patients who had grade III IV tricuspid regurge was significantly  higher in group B. The ventilation duration in group B was significantly longer than group A. The duration of weaning from inotropic  support was significantly longer in group B. We found no significant difference between the two groups regarding postoperative  complications and mortality with postoperative mortality of 4.3% in group B.

Conclusion: Pulmonary arterial systolic pressure decreased  near normal value in most patients after surgery.