Abstract
AimMitral valve pathology in rheumatic heart disease patients is a common cause of secondary pulmonary hypertension (PH). Our aim was to evaluate pulmonary hypertension severity as a predictor of in-hospital mortality and early complications following mitral valve replacement.MethodsA retrospective review of rheumatic heart disease patients who underwent mitral valve replacement between January 2017 and August 2020 was performed. Systolic pulmonary artery pressure (sPAP) was used to classify patients as no PH (<35 mmHg), mild PH (35-44 mmHg), moderate PH (45-59 mmHg) or severe PH (>60 mmHg). Patients subjected to additional cardiac procedures (such as aortic valve replacement and coronary artery bypass grafting) were excluded from the study sample.ResultsThe study group was composed of 159 patients (mean age: 40; 73 male, 86 female) categorized as no PH (n = 32; 20.1%), mild PH (n = 14; 8.8%), moderate PH (n = 65, 40.9%) and severe PH (n = 48, 30.2%) groups. Patient demographic data and preoperative comorbidities were comparable among the four groups. Use of intraoperative and postoperative blood products was similar in all the groups. Severe PH patients had similar in-hospital mortality (4.2%; p = 0.74) as in groups with lesser degrees of pulmonary hypertension. Likewise, increasing severity of pulmonary hypertension did not confer any significant increase in early postoperative complications, namely prolonged ICU stay (10.4%; p = 0.41), prolonged ventilation (2.1%; p = 0.70), reintubation (4.2%; p = 0.90), reopening for bleeding tamponade (6.3%; p = 0.39), new-onset renal failure (6.3%; p = 0.91), postoperative stroke (4.2%; p = 0.52) or prolonged length of stay (mean: 5.6 + 2.8 days; p = 0.49).ConclusionsIncreasing severity of pulmonary hypertension does not appear to have a significant impact on in-hospital mortality or early postoperative outcomes of patients undergoing mitral valve replacement.
Highlights
Rheumatic heart disease is a substantial burden in developing countries where it is responsible for significant cardiovascular morbidity and mortality [1]
Mitral valve pathology in rheumatic heart disease patients is a common cause of secondary pulmonary hypertension (PH)
The study group was composed of 159 patients categorized as no PH (n = 32; 20.1%), mild PH (n = 14; 8.8%), moderate PH (n = 65, 40.9%) and severe PH (n = 48, 30.2%) groups
Summary
Rheumatic heart disease is a substantial burden in developing countries where it is responsible for significant cardiovascular morbidity and mortality [1]. The leading cardiovascular consequence is mitral valve pathology, with pulmonary hypertension frequently observed secondary to left-sided valve disease [2]. The mechanism is retrograde transmission of the increased left atrial pressure, which in turn leads to pulmonary vascular remodeling and subsequently pulmonary hypertension [3]. The development of pulmonary hypertension in mitral valve disease indicates poor overall prognosis and is considered an indication for early surgical intervention [3]. Increasing severity of pulmonary hypertension in mitral valve disease patients may be an indicator of advanced disease and poor long-term outcomes [5], the effect of pulmonary hypertension severity on early surgical outcomes of mitral valve replacement remains an interesting debate.
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