Predictors of persistent pulmonary hypertension after mitral valve replacement

Abstract

Persistent pulmonary hypertension (P-PH) after mitral valve replacement (MVR) leads to an increased risk of morbidity and mortality. We sought to determine which factors were involved in its occurrence. Patients undergoing MVR for a 3-year period were collected in a retrospective way. We excluded those with an available follow-up shorter than 3 months. Sample size was 111 patients. PH was diagnosed if systolic pulmonary artery pressure (sPAP) estimated by Doppler echocardiography was >40 mmHg. Clinical, echocardiographic, and surgical factors were analyzed. P-PH was present in 42.3 % of patients after 12.6 months of mean follow-up. P-PH was more frequently observed in elderly and female patients, in those with severe degrees of PH before surgery, and significant tricuspid regurgitation (TR). On multivariable analysis, significant TR (OR 1.739; p = 0.01) and more severe degrees of PH before surgery (OR 1.761; p = 0.03) were significantly associated with the presence of P-PH after MVR. Surgical factors related to P-PH were prosthesis size and tricuspid annuloplasty: no need for the performing of tricuspid annuloplasty (OR 0.345; p = 0.025) and the implantation of a smaller prosthesis (OR 0.656; p = 0.004) were related to higher rates of P-PH after MVR. MVR was associated with high prevalence of P-PH after mid-term follow-up. Both PH and significant TR before surgery were associated with P-PH. Our data point out that MVR should be planned before the development of PH and greater TR. Smaller prosthetic size is also a risk factor for P-PH and bigger prostheses are desirable when possible.

Clinical outcomes of tricuspid valve repair accompanying left-sided heart disease

“…From our standpoint, the explanation may reside in the fact that significant tricuspid regurgitation following a left-sided heart disease is an independent risk factor encompassing several other factors such as pulmonary arterial hypertension and dyspnea. Such finding has been reported in several studies of other diseases with regard to aortic and mitral valve diseases which also corroborate the present data embodying multiple diseases at once[ 23 - 25 ].…”

Prevalence, Predictors and Clinical Outcome of Residual Pulmonary Hypertension Following Tricuspid Annuloplasty

“…This high prevalence of preoperative PHT was expected, as the presence of significant TR may increase PASP irrespective of the left heart valve status. In the same context, prior reports have shown that the prevalence of postoperative residual PHT varies according to different types of valve surgery: 5% to 13% in patients who undergo mitral valve repair19, 20 and over 40% in those who undergo mitral valve replacement 21. Nonetheless, the prevalence of residual PHT in patients undergoing TA has not been studied.…”

Circular Sympathetic Pulmonary Artery Denervation in Cardiac Surgery Patients With Mitral Valve Defect, Atrial Fibrillation and High Pulmonary Hypertension

“…Целесообразность хирургической денервации симпатических сплетений в легочных артериях также продемонстрирована в работе S. Briongos Figuero и соавт. [29], которые показали, что высокая степень вторичной ЛГ в дооперационном периоде тесно коррелирует с высокой стойкой ЛГ в послеоперационном периоде даже после коррекции порока митрального клапана (отношение шансов 1,761; p=0,03). Методики хирургического лечения ЛГ применяются также в условиях искусственного кровообращения при одномоментной коррекции клапанной патологии сердца, которые заключаются в эпикардиальной абляции передней стенки ствола и устьев легочных артерий с применением монополярного электрода-ручки [30], а также методики циркулярной абляции ствола и устьев легочных артерий с применением биполярного деструктора [13,31].…”