Abstract:
Introduction: In patients undergoing surgery for mitral valve replacement (MVR) for valvular heart disease, pulmonary
artery hypertension (PAH) has been considered a major risk factor. In this prospective study, we have studied the
early hemodynamic changes and post-operative outcomes of MVR among patients with severe PAH. Methods: 68 consecutive
patients who underwent mitral valve replacement for severe rheumatic mitral valve disease with severe PAH
(pulmonary artery pressure (PAP) > 50 mmHg) were studied prospectively for immediate postoperative hemodynamics
and outcomes. The mean age of the patients was 32.1 years. 32 (47.05%) patients had mitral stenosis, 13 (19.11%) had
mitral regurgitation and 23 (33.82%) had mixed lesions. Patients were divided into two groups based on preoperative
pulmonary artery pressures. In 56 patients (82.35%, group I) PAP was sub-systemic or systemic, with a mean of 58.4
mmHg. Twelve patients (17.65%, group II) had supra-systemic PAP with a mean of 82.4 mmHg. Results: After mitral
valve replacement, the PAP and pulmonary vascular resistance (PVR) decreased significantly in group I to near normal
levels. In group II also the PAP and PVR decreased significantly but significant residual PAH remained. Operative
mortality was 3.5% in group I and 16.6% in group II. Conclusions: MVR is safe and effective at the presence of severe
PAH as long as the PAP is below or equal to systemic pressures. With suprasystemic PAP, MVR carries a high risk of
mortality and the patient continues to have severe PAH in the postoperative period
