Early Results of Mitral Valve Replacement in Severe Pulmonary Artery Hypertension—An Institutional Prospective Study
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Date
2013-06
Journal Title
Journal ISSN
Volume Title
Publisher
Scientific Research
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
Description
Keywords
Pulmonary Artery Hypertension, Mitral Valve Replacement
Citation
World Journal of Cardiovascular Surgery, 2013, 3, 63-69