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

Murashita, Takashi; Okada, Yukikatsu; Kanemitsu, Hideo; Fukunaga, Naoto; Konishi, Yasunobu; Nakamura, Ken; Koyama, Tadaaki

doi:10.5761/atcs.oa.13-00364

Cited by 23 publications

(17 citation statements)

References 14 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Chen

Liu

Chan

et al. 2016

JAHA

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BackgroundTricuspid annuloplasty is increasingly performed during left heart valve surgery, but the long‐term clinical outcome postoperatively is not satisfactory. The aim of this study was to determine whether residual pulmonary hypertension (PHT) contributes to the adverse outcome.Methods and ResultsOne‐hundred thirty‐seven patients (age 61±11 years; men, 30%) who underwent tricuspid annuloplasty during left‐side valve surgery were enrolled. The mean pulmonary artery systolic pressure before surgery was 49±13 mm Hg and 32±15 mm Hg following surgery. Patients were divided into 3 groups according to postoperative pulmonary artery systolic pressure: no residual PHT (n=78, 57%), mild residual PHT (n=43, 31%), or significant residual PHT (n=16, 12%). A preoperative larger right ventricular (RV) geometry and tricuspid valve tethering area were associated with mild or significant residual PHT. A total of 24 adverse events (20 heart failures and 4 cardiovascular deaths) occurred during a median follow‐up of 25 months. Kaplan–Meier survival curve demonstrated that patients with significant residual PHT had the highest percentage of adverse events followed by those with mild residual PHT. Patients with no residual PHT had a very low risk of adverse events. Multivariable Cox regression analysis revealed that both mild (hazard ratio=4.94; 95% CI =1.34–18.16; P=0.02) and significant residual PHT (hazard ratio=8.67; 95% CI =2.43–30.98; P<0.01) were independent factors associated with adverse events.ConclusionsThe present study demonstrated that 43% of patients who underwent tricuspid annuloplasty had residual PHT. The presence of mild or significant residual PHT was associated with adverse events in these patients.

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Section: Discussionmentioning

confidence: 99%

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

Chen

Liu

Chan

et al. 2016

JAHA

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“… 7 Furthermore, PH sometimes develops lately in patients who did not show PH before valve surgery. 8 Once established, PH in corrected VHD is an untreatable risk-factor of mortality and disability in the long-term. 6 , 8–10 …”

Section: Introductionmentioning

confidence: 99%

“… 8 Once established, PH in corrected VHD is an untreatable risk-factor of mortality and disability in the long-term. 6 , 8–10 …”

Section: Introductionmentioning

confidence: 99%

Sildenafil for improving outcomes in patients with corrected valvular heart disease and persistent pulmonary hypertension: a multicenter, double-blind, randomized clinical trial

Bermejo

Yotti

García‐Orta

et al. 2017

European Heart Journal

186

132

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AimsWe aimed to determine whether treatment with sildenafil improves outcomes of patients with persistent pulmonary hypertension (PH) after correction of valvular heart disease (VHD).Methods and resultsThe sildenafil for improving outcomes after valvular correction (SIOVAC) study was a multricentric, randomized, parallel, and placebo-controlled trial that enrolled stable adults with mean pulmonary artery pressure ≥ 30 mmHg who had undergone a successful valve replacement or repair procedure at least 1 year before inclusion. We assigned 200 patients to receive sildenafil (40 mg three times daily, n = 104) or placebo (n = 96) for 6 months. The primary endpoint was the composite clinical score combining death, hospital admission for heart failure (HF), change in functional class, and patient global self-assessment. Only 27 patients receiving sildenafil improved their composite clinical score, as compared with 44 patients receiving placebo; in contrast 33 patients in the sildenafil group worsened their composite score, as compared with 14 in the placebo group [odds ratio 0.39; 95% confidence interval (CI) 0.22–0.67; P < 0.001]. The Kaplan–Meier estimates for survival without admission due to HF were 0.76 and 0.86 in the sildenafil and placebo groups, respectively (hazard ratio 2.0, 95% CI = 1.0–4.0; log-rank P = 0.044). Changes in 6-min walk test distance, natriuretic peptides, and Doppler-derived systolic pulmonary pressure were similar in both groups.ConclusionTreatment with sildenafil in patients with persistent PH after successfully corrected VHD is associated to worse clinical outcomes than placebo. Off-label usage of sildenafil for treating this source of left heart disease PH should be avoided.The trial is registered with ClinicalTrials.gov, number NCT00862043.

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“…20) Atrial fibrillation was the most common complication in the early postoperative period in our study.…”

Section: Discussionmentioning

confidence: 91%

Coronary Bypass Surgery in Patients with Pulmonary Hypertension: Assessment of Early and Long Term Results

Akça

Erdil

Disli

et al. 2015

ATCS

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IntroductionPulmonary hypertension (PH) is one of the main causes of increased mortality and morbidity rates in open heart surgery. Left heart disease is probably the most frequent cause of PH. 1) Left-sided ventricular or valvular diseases may lead to an increase in left atrial pressure, and the passive backward transmission of this pressure may result in increased pulmonary arterial pressure (PAP). 2) Despite intensive postoperative medical treatment, an increase is observed in mortality and morbidity rates following coronary bypass surgery in patients with PH and right heart failure. 3,4) PH has a significant effect on right ventricular afterload. Various studies have shown that patients with right ventricle dysfunction display higher rates of early perioperative mortality and poor long term survival. 5,6) In this study, we investigated the effect of preoperative PH on the early-and long term results of patients who underwent isolated coronary artery bypass surgery, as well as its effect on the quality of life and the changes in The late mortality of cases was 5.79%. In our study, during 33.9 ± 17 (9-100) months follow up period, life expectancy was calculated as 94.7 months. Conclusion: Preoperative evaluation of these patients for appropriate medical treatment at peroperative and postoperative period, coronary bypass can be performed with low morbidity and mortality rates. In the late period after surgical revascularization PH showed no significant change and had no adverse effect on quality of life.

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

Cited by 23 publications

References 14 publications

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

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

Sildenafil for improving outcomes in patients with corrected valvular heart disease and persistent pulmonary hypertension: a multicenter, double-blind, randomized clinical trial

Coronary Bypass Surgery in Patients with Pulmonary Hypertension: Assessment of Early and Long Term Results

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