The effects of pulmonary hypertension severity on the outcomes of mitral valve replacement for rheumatic mitral stenosis

Background

We performed this study to evaluate the effects of pulmonary hypertension (PH) severity on the hemodynamic and echocardiographic outcomes of mitral valve replacement (MVR) for rheumatic mitral stenosis (MS).

Methods

Patients with rheumatic MS were divided into two groups: Group-A with mean pulmonary arterial pressure (mPAP) equal to 26–40 mmHg and group-B with mPAP > 55 mmHg. We compared the hemodynamic and arterial blood gases (ABG) data between both groups.

Results

Our analysis showed no significant difference between mild and severe PH groups in terms of all analyzed baseline and pre-operative data (p < 0.05), except for NYHA class distribution and O₂ saturation on room-air, which were better in the mild PH group. Moreover, post-induction ABG data and heart rate were similar between both groups; however, post-induction central venous pressure (p = 0.01) and systolic blood pressure (p < 0.001) were significantly higher in the severe PH group, compared to the mild PH. All analyzed hemodynamic and ABG data in the 24 post-operative hours were comparable between both groups. The hospital stay duration was significantly longer (p = 0.01) in the severe PH group than the mild PH group. Concerning the echocardiographic data at three-months of follow-up, the left atrial size was comparable (p = 0.4) between both groups; however, the left ventricular end-systolic (p = 0.009) and end-diastolic (p = 0.01) dimensions were significantly higher in the severe PH group, compared to the mild PH group.

Conclusions

Our study showed that both mild and severe PH groups were comparable in most operative and post-operative hemodynamic and ABG outcomes of MVR surgery.