Mitral Valve Replacement in Severe Pulmonary Artery Hypertension — a Single Center Single Surgeon Experience

ABSTRACT

Background:Pulmonary artery hypertension (PAH) is a major risk factor in patients presenting in our hospital for mitral valve replacement (MVR) surgery. In this prospective study, we have focused on hemodynamic changes and post-operative results of MVR in patients with severe PAH. Methods: 136 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 from December 2013 to January 2016. The mean age of the patients was 34.3 years. 74 (54.41%) patients had mitral stenosis, 30 (22.05%) had mitral regurgitation and 32 (23.52%) had mixed lesions. Patients were randomly given two groups based on preoperative pulmonary artery pressures. In 120 patients (88.23%, group I) PAP was sub-systemic or systemic, with a mean of 59.6 mmHg. Sixteen patients (11.76%, group II) had supra-systemic PAP with a mean of 84.2 mmHg Results: After mitral valve replacement, the PAP and pulmonary vascular resistance (PVR) decreased significantly in group I to near normal levels. However, in group II, despite reduction in the PAP and PVR, significant residual PAH remained. Operative mortality was 1.6% in group I and 12.5% in group II. Conclusion: In patients with mitral valve disease undergoing mitral valve replacement, PAH is a significant risk factor. In cases with sub-systemic or systemic PAH, results are very good but significant PAH persists even after MVR is cases of supra-systemic PAH causing continuation of symptoms.