Faculty Opinions recommendation of Negative impact of atrial fibrillation and pulmonary hypertension after mitral valve surgery in asymptomatic patients with severe mitral regurgitation: a 20-year follow-up.

Objectives. This study sought to evaluate the prevalence of pulmonary hypertension after mitral valve surgery ini patients with chronic organic mitral regurgitation and to determine preoperative and predischarge predictors for persistent pulmonary hypertension after surgeryMethods. This is a cohort retrospective study involving subjects with chronic organic mitral regurgitation with preoperative systolic PA pressure > 50 mmHg undergoing surgery. Demographic and echocardiography datas were collected prior to surgery, predischarge, and follow up datas were evaluated after minimal 6 months duration. Subjects were then devided into groups based on existence of persistent pulmonary hypertension after follow up. Bivariate and multivariate analysis was done to determine contributing factors.Results.There were 92 subjects with dominant mitral regurgitation included in this study with median age 40 (range 17-68) years with slight female predominance (55%). Persistent pulmonary hypertension was observed in 23 subjects (25%) predischarge and in 20 subjects (20.7%) after mean follow up of 11 + 5.5 months. Bivariate analysis revealed preoperative TAPSE, underlying etiology, severity of pulmonary hypertension preoperatively, postoperative atrial fibrilation, mean mitral valve gradient predischarge, and the presence of residual pulmonary hypertension predischarge were related with persistent pulmonary hypertension. From multivariate analysis, post operative atrial fibrillation [OR 7.3 (CI 95% 1.64-33.33, p=0.09)], mean mitral valve gradient predischarge [OR 1.67 (CI 95% 1,3-2.7, p=0.038)], and preoperative TAPSE [OR 0.143 (CI 95% 0.03-0.70, p=0.017)] were independent predictors for persistent pulmonary hypertension after mitral valve surgery.Conclusion. Persistent pulmonary hypertension was observed in 20.7% subjects after mitral valve surgery. Preoperative TAPSE, post operative atrial fibrillation, and predischarge mean mitral valve gradient were independent predictors.

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Immediate Results of Mitral Valve Surgery in Asymptomatic Patients With Severe Mitral Regurgitation Due to Degenerative Mitral Valve Disease

Kardiologiia ◽

10.18565/cardio.2015.11.53-60 ◽

2015 ◽

Vol 11_2015 ◽

pp. 53-60

Author(s):

V.M. Nazarov Nazarov ◽

A.V. Afanasyev Afanasyev ◽

S.I. Zheleznev Zheleznev ◽

A.V. Bogachev-Prokophiev Bogachev-Prokophiev ◽

I.I. Demin Demin ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Disease ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Valve Disease ◽

Severe Mitral Regurgitation ◽

Asymptomatic Patients

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Increased Mortality in Patients With Preoperative and Persistent Postoperative Pulmonary Hypertension Undergoing Mitral Valve Surgery for Mitral Regurgitation: A Cohort Study

Journal of the American Heart Association ◽

10.1161/jaha.120.018394 ◽

2021 ◽

Vol 10 (5) ◽

Author(s):

Michael V. Genuardi ◽

Daniel Shpilsky ◽

Adam Handen ◽

Gabrielle VanSpeybroeck ◽

Ann Canterbury ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Pulmonary Artery ◽

Systolic Pressure ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Pulmonary Artery Systolic Pressure ◽

Severe Mitral Regurgitation ◽

Risk Of Death

Background Preoperative pulmonary hypertension (PH) is associated with excess mortality among patients with severe mitral regurgitation undergoing mitral valve surgery (MVS). However, the links between PH phenotype, pulmonary vascular remodeling, and persistent postoperative PH are not well understood. We aimed to describe the associations between components of pulmonary hemodynamics as well as postoperative residual PH with longitudinal mortality in patients with severe mitral regurgitation who received MVS. Methods and Results Patients undergoing MVS for severe mitral regurgitation from 2011 to 2016 were retrospectively identified within our health system (n=488). Mean pulmonary artery pressure and other hemodynamic variables were determined by presurgical right‐heart catheterization. Postoperative pulmonary artery systolic pressure was assessed on echocardiogram 42 to 365 days post‐MVS. Longitudinal survival over a mean 3.9 years of follow‐up was evaluated using Cox proportional hazards modeling to compare survival after adjustment for demographics, surgical characteristics, and comorbidities. Pre‐MVS prevalence of PH was high at 85%. After adjustment, each 10‐mm Hg increase in preoperative mean pulmonary artery pressure was associated with a 1.38‐fold increase in risk of death (95% CI, 1.13–1.68). Elevated preoperative pulmonary vascular resistance, transpulmonary gradient, and right atrial pressure were similarly associated with increased mortality. Among 231 patients with postoperative echocardiogram, evidence of PH on echocardiogram (pulmonary artery systolic pressure ≥35 mm Hg) was associated with increased risk of death (hazard ratio [HR], 2.02 [95% CI, 1.17–3.47]); however, this was no longer statistically significant after adjustment (HR, 1.55 [95% CI, 0.85–2.85]). Conclusions In patients undergoing MVS for mitral regurgitation, preoperative PH, and postoperative PH were associated with increased mortality.

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