The effect of pulmonary hypertension and right ventricular dysfunction on early mortality and morbidity in patients undergoing mitral valve replacement

BMC Cardiovasc Disord. 2024 Oct 17;24(1):568. doi: 10.1186/s12872-024-04238-7.

Abstract

Introduction: The indications for concominant tricuspid valve surgery in patients undergoing mitral valve surgery for rheumatic reasons are limited. The aim of our study was to investigate the effects of severe pulmonary hypertension and low TAPSE values on early-term mortality and morbidity in patients undergoing mitral valve replacement.

Methods: The data of all patients who underwent mitral valve replacement between January 2013 and August 2020 were examined retrospectively. Patients were divided into 2 groups according to pulmonary artery pressure (PAP ≥ 50 and PAP < 50). The group with PAP > 50 was then divided into 2 subgroups according to TAPSE (1.5 ≥ or < 1.5) values. The early-term mortality and morbidity rates of these groups were compared.

Results: Seventy-nine patients who underwent mitral valve replacement were included in the study. Fifty-four (68%) of them were female, and 25 (32%) were male. During the preoperative period, the TAPSE was 16.8 ± 3.0 mm, and the PAP was 52.1 ± 14.1 mmHg. There were 53 patients with PAP > 50 and 26 patients with PAP < 50. In the PAP > 50 group, the rates of tricuspid regurgitation (p < 0.001), blood transfusion (p < 0.001), intensive care unit stay (p < 0.001), need for CPAP (p = 0.043), reintubation (p = 0.048), acute renal failure (p = 0.028), and mortality (p = 0.026) were found to be significantly different.

Conclusion: In conclusion, we believe that in patients with mitral valve pathology, early referral for surgical intervention, before the pulmonary pressures significantly increase and right ventricular function deteriorates, can enhance survival outcomes.

Keywords: Mitral valve replacement; Mitral valve surgery; Pulmonary hypertension; Right ventricular dysfunction.

MeSH terms

  • Adult
  • Aged
  • Arterial Pressure
  • Female
  • Heart Valve Prosthesis Implantation* / adverse effects
  • Heart Valve Prosthesis Implantation* / mortality
  • Humans
  • Hypertension, Pulmonary / diagnosis
  • Hypertension, Pulmonary / mortality
  • Hypertension, Pulmonary / physiopathology
  • Hypertension, Pulmonary / surgery
  • Male
  • Middle Aged
  • Mitral Valve Insufficiency / diagnostic imaging
  • Mitral Valve Insufficiency / mortality
  • Mitral Valve Insufficiency / physiopathology
  • Mitral Valve Insufficiency / surgery
  • Mitral Valve* / diagnostic imaging
  • Mitral Valve* / physiopathology
  • Mitral Valve* / surgery
  • Postoperative Complications / etiology
  • Postoperative Complications / mortality
  • Pulmonary Artery / physiopathology
  • Pulmonary Artery / surgery
  • Retrospective Studies
  • Rheumatic Heart Disease / complications
  • Rheumatic Heart Disease / diagnosis
  • Rheumatic Heart Disease / mortality
  • Rheumatic Heart Disease / physiopathology
  • Rheumatic Heart Disease / surgery
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Ventricular Dysfunction, Right* / etiology
  • Ventricular Dysfunction, Right* / mortality
  • Ventricular Dysfunction, Right* / physiopathology
  • Ventricular Function, Right*