Abstract
ObjectiveObserve the efficacy of surgical treatment in patients with severe pulmonary arterial hypertension caused by mitral valve disease.MethodsWe examined the results of surgical treatment in 32 patients with mitral valve disease and severe pulmonary arterial hypertension (pulmonary arterial systolic pressure ≥ 80 mmHg) retrospectively. Operative and postoperative data collection included type of the surgery, cardiopulmonary bypass time, cross-clamp time and the mortality rate. Pulmonary arterial systolic pressure, left atrial diameter, left ventricular end-diastolic diameter, and left ventricular ejection fraction were recorded and compared.ResultsA total number of 32 patients had the operation of mitral valve replacement. Among those subjects, twenty-seven patients were surgically replaced with mechanical prosthesis and five patients with tissue prosthesis. Only one patient died of pneumonia, with a mortality rate of 3.1 %. The statistical results of preoperative and postoperative echocardiographic data showed significant decrease in pulmonary arterial systolic pressure (101.2 ± 20.3 versus 48.1 ± 14.3 mmHg, P < 0.05), left atrial diameter(67.6 ± 15.7 versus 54.4 ± 11.4 mm, P < 0.05) and left ventricular end-diastolic diameter (52.3 ± 9.5 versus 49.2 ± 5.9 mm, P < 0.05). There was no significant change in left ventricular ejection fraction (59.2 ± 6.5 versus 57.9 ± 7.6, P = NS). At the time of follow-up, twenty-eight (96.6 %) patients were classified in New York Heart Association functional class I or II, one(3.4 %) in class III, with the mortality rate is zero percent.ConclusionsMitral valve replacement can be performed successfully in patients with mitral valve disease and severe pulmonary arterial hypertension with an acceptable perioperative risk.
Highlights
Pulmonary arterial hypertension(PAH) increases the risk of complications in patients undergoing mitral valve surgery perioperatively, with a high operative mortality rate ranging from 15 % to 31 % [1, 2]
Thirty-two patients who met the inclusion criteria with severe Pulmonary arterial pressure (PAH) following mitral valve disease in whom pulmonary arterial systolic pressure(PASP) were ≥ 80 mmHg on echocardiographic determination were enrolled in this study
Results were considered statistically significant if P value < 0.05. Perioperative mortality This retrospective analysis of surgically treated patients with severe PAH and mitral valve disease demonstrated a perioperative mortality of 3.1 % and a survival rate of 96.9 % with a mean follow-up period of 26.3 ± 10.7 months
Summary
Pulmonary arterial hypertension(PAH) increases the risk of complications in patients undergoing mitral valve surgery perioperatively, with a high operative mortality rate ranging from 15 % to 31 % [1, 2]. Many cardiac surgeons refused to operate on these high-risk patients. With the enhancement in medical technology and the development of pharmacological treatment, the operative risk in patients undergoing cardiac surgery with severe PAH should be decreased. In this study, we retrospectively examined patients with mitral valve disease and severe PAH treated surgically in our hospital over a 3-year period to assess the perioperative mortality rate, 3-year survival rate and survivors’ cardiac function through New York Heart Association (NYHA) functional class
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