Long-term Outcome of Cardiac Surgery in Patients With Mitral Stenosis and Severe Pulmonary Hypertension

Jj, Vincens; Temizer, D; Lh, Edmunds; Herrmann, HC

doi:10.1161/01.cir.92.9.137

Cited by 100 publications

(72 citation statements)

References 16 publications

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“…1,2) Recent studies have confirmed improved outcomes and lower mortality rate (2.3%-10.0%) as a result of better myocardial preservation and improved postoperative care. 11,12,21,22) In our study, the overall mortality rate was 0.0%, and this is counted a great outcome in comparison to the previous works. The myocardial preservation, anesthetic technique and postoperative managements can have considerable impacts on improving the outcome of MVR in patients with severe PAH.…”

Section: Figsupporting

confidence: 39%

Early Hemodynamic Changes after Mitral Valve Replacement in Patients with Severe and Mild Pulmonary Artery Hypertension

Bayat¹,

Aghdaii

Farivar³

et al. 2013

ATCS

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Purpose: to assess the early hemodynamic changes after elective mitral valve replacement (MVR) in patients with severe and mild pulmonary arterial hypertension (PAH). Methods: a total of 45 consecutive patients, who were candidate for elective MVR, were enrolled in this prospective observational study. Patients were divided into two groups based on the absence (group A, 20 patients) or presence (group B, 25 patients) of severe pulmonary artery hypertension (PAH) defined as systolic pulmonary artery pressure ≥50 mmHg measuring by catheterization. MVR was performed using standard cardiopulmonary bypass (CBD) technique. The hemodynamic and arterial blood gas assessments were carried out at baseline before the induction of general anesthesia, in the operating room immediately after MVR, and then continued after stabilization of hemodynamic status with 2 hr interval up to 24 hours. Results: The mean CPB and aortic cross-clamp times were similar in two groups (95.3 ± 49.5 and 61.8 ± 36.3 minutes in group A and 103.1 ± 34.7and 61.9 ± 20.0 minutes in group B). In group A, the mean PAP showed an increase immediately after the operation (from 40.4 ± 7.3 to 43.10 ± 6.2 mmHg) and then decreased significantly to 32.5 ± 3.9 mmHg (P <0.05). In group B, the mean PAP showed no significant reduction immediately after MVR, but it decreased significantly below the range of severe PAP over the first 24 hours. Conclusion: MVR is safe and effective even in patients with severe PAH. The anesthetic technique and postoperative cares can be useful in improving the outcome in such patients.

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Section: Figsupporting

confidence: 39%

Early Hemodynamic Changes after Mitral Valve Replacement in Patients with Severe and Mild Pulmonary Artery Hypertension

Bayat¹,

Aghdaii

Farivar³

et al. 2013

ATCS

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“…[12][13][14] Ghoreishi, et al also reported that operative mortality after mitral valve operation for mitral regurgitation was correlated with the degree of preoperative PH. 8) In this study, we focused on the impact of preoperative PH after mitral valve repair for degenerative mitral regurgitation.…”

Section: Discussionmentioning

confidence: 96%

The Impact of Preoperative and Postoperative Pulmonary Hypertension on Long-Term Surgical Outcome after Mitral Valve Repair for Degenerative Mitral Regurgitation

Murashita

Okada

Kanemitsu

et al. 2015

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Purpose: The aim of this study is to elucidate the impact of preoperative and postoperative pulmonary hypertension (PH) on long-term clinical outcomes after mitral valve repair for degenerative mitral regurgitation. Methods: A total of 654 patients who underwent mitral valve repair for degenerative mitral regurgitation between 1991 and 2010 were retrospectively reviewed. Patients were divided into PH(+) group (137 patients) and PH(-) group (517 patients). Follow-up was complete in 99.0%. The median follow-up duration was 7.5 years. Results: Patients in PH(+) group were older, more symptomatic and had higher tricuspid regurgitation grade. Thirty-day mortality was not different between 2 groups (p = 0.975). Long-term survival rate was lower in PH(+) group; 10-year survival rate after the operation was 85.2% ± 4.0% in PH(+) group and 89.7% ± 1.8% in PH(-) group (Log-rank, p = 0.019). The incidence of late cardiac events were not different between groups, however, the recurrence of PH was more frequent in PH(+) group. The recurrence of PH had an adverse impact on survival rate, late cardiac events and symptoms. Univariate analysis showed age and preoperative tricuspid regurgitation grade were the predictors of PH recurrence. Conclusion: Early surgical indication should be advocated for degenerative mitral regurgitation before the progression of pulmonary hypertension and tricuspid regurgitation.

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“…27 Thus, it seems reasonable to provide mechanical relief once more than mild symptoms are present. Furthermore, as shown in Figure 4, when pulmonary hypertension has developed, surgical risk is excessive 28 (12% versus the usual 3% to 8% reported in most studies). Thus, it appears unwise to permit pulmonary hypertension to go uncorrected regardless of symptomatic status.…”

Section: Timing Of Mechanical Interventionmentioning

confidence: 96%

Modern Management of Mitral Stenosis

2005

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Long-term Outcome of Cardiac Surgery in Patients With Mitral Stenosis and Severe Pulmonary Hypertension

Cited by 100 publications

References 16 publications

Early Hemodynamic Changes after Mitral Valve Replacement in Patients with Severe and Mild Pulmonary Artery Hypertension

Early Hemodynamic Changes after Mitral Valve Replacement in Patients with Severe and Mild Pulmonary Artery Hypertension

The Impact of Preoperative and Postoperative Pulmonary Hypertension on Long-Term Surgical Outcome after Mitral Valve Repair for Degenerative Mitral Regurgitation

Modern Management of Mitral Stenosis

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