Clinical Effect of Iloprost on Pulmonary Artery Hypertension After Mitral Valve Surgery

Abstract Purpose Recent investigations of pulmonary artery (PA) ablation into the treatment of idiopathic pulmonary artery hypertension (PAH) have suggested improvement of functional capacity, and hemodynamics. We investigated the impact of PA ablation in patients with PAH due to left heart disease (Dana Point, 2008) scheduled for open-heart mitral valve surgery. Methods Fifty patients aged 52±10 with mitral valve disease complicated severe PAH (mean PAP >40mm Hg) were randomly assigned to mitral valve surgery with or without PA ablation procedure. Eligible criteria: positive reactive test with nitric oxide inhalation (decrease of mean PAP more than 10 mm Hg without decrease of cardiac output). There were no between group differences in preoperative characteristics. Surgical procedure After bypass is establishedthe fibrous fold of pericardiumand the ligamentum arteriosum are dissected out, and the branches of the right and left pulmonary artery are mobilized well out into the hilum of the lungs bilaterally. PA ablation was performed epicardially at the bifurcation of the main PA, and 10 mm distal to the right and left PA's using AtriCure Isolator®multifunctional pen. Serial assessment of echocardiography, right heart catheterization (catheter Swan-Ganz), and 6-min walk test (6MWT) were performed during hospital stay. The primary endpoints were the change of meanpulmonary artery pressure (PAP)and 6MWT. The secondary endpoints were hospital mortality, freedom from PADN-related complication: PA perforation, PA dissection, and PA thrombosis (MDCT assessment). Results There were no early deaths. No procedure-related complications were observed. On first day after surgery patients from ablation group showed significant reduction of mean PAP (from 50.6±5.3to 34.6±9.9 mm Hg, p<0.001), and significant improvement of 6MWT at discharge (from 229±34 m to 475±21 m, p<0.001). On first day after surgery patients from control group also showed significant reduction of mean PAP (from 51.3±6.3to 47.2±8.5 mm Hg, p=0.011), and significant improvement of 6MWT at discharge (from 249±32 m to 335±18 m, p<0.001). Nevertheless, there was significant between group difference in mean PAP on first day after surgery (34.6±9.9 mm Hg, vs 47.2±8.5 mm Hg, p=0.005). Moreover there was significant differences in 6MWT at discharge (475±21 m vs 335±18 m, p=0.002) with benefit to ablation group. Epicardial pulmonary artery ablation Conclusions We report for the first time the effect and superiority of PA ablation on functional capacity and hemodynamics in patients with mitral valve disease complicated PAH. Epicardial PA ablation for the treatment PAH can be effectively and safely performed during open heart surgery. Acknowledgement/Funding None

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Epicardial pacemaker cable located in pulmonary artery after mitral valve surgery. Incidental finding

Revista Española de Anestesiología y Reanimación (English Edition) ◽

10.1016/j.redare.2019.07.008 ◽

2019 ◽

Vol 66 (10) ◽

pp. 564-565

Author(s):

L. Rodríguez Martín ◽

S. Fossati Puertas ◽

C. Aguilar Lloret ◽

L. Santé Serna

Keyword(s):

Mitral Valve ◽

Pulmonary Artery ◽

Incidental Finding ◽

Mitral Valve Surgery ◽

Valve Surgery

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Simple and Short-term Inspiration Training Accelerates Recovery from Residual Pulmonary Hypertension after Mitral Valve Surgery: A randomized control trial

Indonesian Journal of Cardiology ◽

10.30701/ijc.1096 ◽

2021 ◽

Author(s):

Basuni Radi Radi ◽

Bima Suryaatmaja ◽

Ario Suryo Kuncoro ◽

Amiliana M Soesanto

Keyword(s):

Pulmonary Hypertension ◽

Mitral Valve ◽

Pulmonary Artery ◽

Pulmonary Artery Pressure ◽

Intervention Group ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Control Group ◽

Muscle Training ◽

Residual Pulmonary Hypertension

Background: Residual pulmonary hypertension after mitral valve surgery predicts a worse prognosis. This study aimed to explore the effect of inspiratory muscle training on functional capacity and pulmonary artery pressure in patients with residual pulmonary hypertension after mitral valve surgery. Methods: Forty-three patients with residual pulmonary hypertension soon after mitral valve repair or replacement surgery were consecutively enrolled in this randomised controlled trial. They were randomly allocated to either an intervention group (n=22) or a control group (n=21). Both groups participated in usual 10-12 sessions of supervised aerobic exercise training, with low to moderate intensity. The subjects in the intervention group participated in additional inspiratory muscle training using an incentive spirometer with a series of 10-12 inspiration repetitions of 50% of maximum inspiratory volume in each aerobic session. Echocardiography and the 6-minute walking test were performed before and after the programme. Results: The patients were 70% female, mean age 43.5+/-13 years. Both groups had similar baseline characteristics. The systolic pulmonary artery pressure declined from 51(43-68) mmHg to 35 (29-39) mmHg, p<0.001 in intervention group, and from 46(43-55) mmHg to 43(40-51)mmHg, p<0.01 in control group. The reduction was higher in the intervention group than in the control group, 16 (12-30) vs 3.5 (2-4) mmHg respectively, p<0.001, and in patients with higher baseline systolic pulmonary artery pressure. The 6-minute walk test distance increased from 308(242-353) meters to 407(377-433) meter, p<0.01 in intervention group, and from 353(334-381) meter to 391(376-429) meter, p<0.01 in control group. The improvement was higher in the intervention group than in control group, 101 (93-131) vs 48 (35-53) meter respectively, p<0.001. Conclusion: Adding inspiratory muscle training to a usual exercise programme resulted in faster recovery from residual pulmonary hypertension and higher increase in functional capacity.

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Outcomes of Repeat Mitral Valve Surgery in Patients with Pulmonary Hypertension

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000139 ◽

2015 ◽

Vol 10 (2) ◽

pp. 120-124 ◽

Cited By ~ 5

Author(s):

Mario Castillo-Sang ◽

Tracey J. Guthrie ◽

Marc R. Moon ◽

Jennifer S. Lawton ◽

Hersh S. Maniar ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Mitral Valve ◽

Pulmonary Artery ◽

Pulmonary Artery Pressure ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Systolic Pulmonary Artery Pressure ◽

Peripheral Vascular ◽

Artery Pressure ◽

The Mean

Objective We sought to study the outcomes of redo-mitral valve surgery in patients with pulmonary hypertension. Methods We reviewed data on redo mitral valve surgery in patients with pulmonary hypertension measured by Swan-Ganz catheter (mean pulmonary artery pressure ≥ 25 mm Hg or systolic pulmonary artery pressure ≥ 40 mm Hg). Results Between 1996 and 2010, 637 patients underwent 658 redo mitral valve operations; 138 of them had pulmonary hypertension. The mean patient age was 61.3 (13.9) years, with mean left ventricular ejection fraction of 47.6% (13.2%). The mean systolic pulmonary artery pressure was 61.5 (16.8) mm Hg, and mean pulmonary artery pressure was 40.8 (11.6) mm Hg. Patients had one (71%, 98/138), two (23.9%, 33/138), and three (5.1%, 7/138) previous mitral valve operations. Thirty-day mortality was 10.1% (14/138). Multivariate predictors of 30-day mortality were chronic renal failure [odds ratio (OR), 8.041; P = 0.022], peripheral vascular disease (OR, 5.976; P = 0.025), previous mitral valve replacement (OR, 9.034; P = 0.014), and increasing age (OR, 1.077; P = 0.013). The severity of pulmonary hypertension did not impact 30-day ( P = 0.314) or late mortality ( P = 0.860). Kaplan-Meier survival rates at 1, 3, and 5 years were 76.6% (n = 99), 65.7% (n = 62), and 55.9% (n = 41), respectively. Conclusions Patients with pulmonary hypertension that undergo redo mitral valve surgery have a 55.9% 5-year survival rate. Increasing age, chronic renal insufficiency, peripheral vascular disease, and preexisting mitral valve prosthesis are associated with early mortality. The severity of pulmonary hypertension does not affect operative mortality rates, but it may decrease 1-, 3-, and 5-year survival.

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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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