Evaluation of early outcomes after mitral replacement in rheumatic heart patients with pulmonary hypertension

Objectives To evaluate and compare the early hemodynamic results and echocardiographic data after rheumatic mitral valve replacement (MVR) in patients with mild and severe pulmonary hypertension (PH). Background Development of PH in association with valvular dysfunction is a marker of advanced disease. Some authors have reported no greater risk in patients with severe PH compared with those with a mild degree of PH, whereas others reported that severe PH is associated with a greater operative risk and a poorer long-term prognosis. It is desirable to reassess the outcome in these patients with newer anesthetic agents, improved valve prostheses, myocardial protection, and postoperative care. Patients and methods Between September 2013 and May 2015, this multicenter prospective observational study included 40 patients who presented with rheumatic mitral stenosis indicated for elective MVR divided into two equal groups: group A, with a mean pulmonary artery pressure (mPAP) equal to 26-40 mmHg, and group B, with mPAP more than 55 mmHg. All patients underwent conventional surgical MVR using cardiopulmonary bypass. Early hemodynamic improvement was observed with follow-up transthoracic echo performed 1 week and 3 months postoperatively Results Our study included 17 male and 23 female patients with a mean age of 32.40 years; all of them underwent conventional MVR with cardiopulmonary bypass. Throughout our study, we detected a statistically significant difference between both groups regarding the duration of postoperative mechanical ventilation and improvement in mPAP in both groups. There was a single case of morbidity in group B with no cases of mortality for 3 months postoperatively in both groups. Conclusion MVR is safe and effective even in patients with severe PH.