69. Does pulmonary hypertension affect outcome after mitral valve surgery

Abstract

Pulmonary hypertension (PH) due to left heart disease (LHD) is the most common form of pulmonary hypertension. We know from previous studies that PH in patients with LHD is associated with poor prognosis. Regarding incidence and prevalence of PH associated with mitral valve disease we have different data depending of study population. The purpose of this study was to evaluate effects of pulmonary hypertension on short and long term survival following mitral valve surgery at KFSH&RC. Methods: Retrospective study of all patients who have undergone mitral valve (MV) surgery since January 2010 until December 2011 with follow up to December 2013. Pulmonary artery pressure was assessed by Doppler echocardiography pre- and postoperatively. The impact of pulmonary hypertension (PASp ⩾ 50 mm Hg) on early (30 days) and late outcomes and duration of hospital stay was analyzed. Results: During the period of 2 years 233 patients (63% female) with mean age 45 ± 14 (range 19–83 years) underwent MV surgery. Mean follow up was 2.8 ± 0.97 years. Main indication for MV surgery was rheumatic valve disease (83%). Isolated MV surgery has been performed in 130 patients and combine valve surgery in 103 patients. Mortality was significantly higher after combine valve surgery (p = 0.028). Primary valve surgery has been done in 162 cases and re-do surgery in 71 cases. Interesting, there were no difference in survival between these two groups (p = 0.88). There were no significant difference in survival after MV replacement (n = 195) and MV repair (n = 38; p = 0.18). Pulmonary hypertension was present in 115 (51%) patients. Duration of hospitalization stay after valve surgery was almost twofold longer in patients with PH (24 ± 48 vs.13 ± 14 days, p = 0.02). Patients died within 30 days had a significantly higher PASp (64 ± 30 vs. 48 ± 17 mmHg; p = 0.003). We found a clear tendency to higher mortality in patients with pulmonary hypertension. Conclusions: Pulmonary hypertension clearly affects early and late survival after MV surgery. Better survival and shorter duration of hospital stay in patients without PH supports early admission for MV surgery before occurrence of PH.