Predictors of persistent pulmonary hypertension after mitral valve replacement

• Published in: Heart and vessels Vol. 31; no. 7; pp. 1091 - 1099
• Main Authors: Briongos Figuero, Sem, Moya Mur, José Luis, García-Lledó, Alberto, Centella, Tomasa, Salido, Luisa, Aceña Navarro, Álvaro, García Martín, Ana, García-Andrade, Ignacio, Oliva, Enrique, Zamorano, José Luis
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.07.2016; Springer Nature B.V
• Subjects: Age Factors; Aged; Arterial Pressure; Biomedical Engineering and Bioengineering; Cardiac Surgery; Cardiac Valve Annuloplasty - adverse effects; Cardiac Valve Annuloplasty - instrumentation; Cardiology; Cardiovascular disease; Chi-Square Distribution; Echocardiography, Doppler; Female; Heart surgery; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - instrumentation; Humans; Hypertension; Hypertension, Pulmonary - diagnostic imaging; Hypertension, Pulmonary - etiology; Hypertension, Pulmonary - physiopathology; Logistic Models; Lung diseases; Male; Medicine; Medicine & Public Health; Middle Aged; Mitral Valve - diagnostic imaging; Mitral Valve - physiopathology; Mitral Valve - surgery; Mitral Valve Stenosis - complications; Mitral Valve Stenosis - diagnostic imaging; Mitral Valve Stenosis - physiopathology; Mitral Valve Stenosis - surgery; Multivariate Analysis; Odds Ratio; Original Article; Prosthesis Design; Pulmonary Artery - diagnostic imaging; Pulmonary Artery - physiopathology; Retrospective Studies; Risk Factors; Severity of Illness Index; Sex Factors; Surgical outcomes; Time Factors; Treatment Outcome; Tricuspid Valve Insufficiency - complications; Tricuspid Valve Insufficiency - physiopathology; Tricuspid Valve Insufficiency - surgery; Vascular Surgery; Persistent pulmonary hypertension; Tricuspid regurgitation; Mitral valve replacement; Prosthetics size
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-015-0700-2

Persistent pulmonary hypertension (P-PH) after mitral valve replacement (MVR) leads to an increased risk of morbidity and mortality. We sought to determine which factors were involved in its occurrence. Patients undergoing MVR for a 3-year period were collected in a retrospective way. We excluded those with an available follow-up shorter than 3 months. Sample size was 111 patients. PH was diagnosed if systolic pulmonary artery pressure (sPAP) estimated by Doppler echocardiography was >40 mmHg. Clinical, echocardiographic, and surgical factors were analyzed. P-PH was present in 42.3 % of patients after 12.6 months of mean follow-up. P-PH was more frequently observed in elderly and female patients, in those with severe degrees of PH before surgery, and significant tricuspid regurgitation (TR). On multivariable analysis, significant TR (OR 1.739; p  = 0.01) and more severe degrees of PH before surgery (OR 1.761; p  = 0.03) were significantly associated with the presence of P-PH after MVR. Surgical factors related to P-PH were prosthesis size and tricuspid annuloplasty: no need for the performing of tricuspid annuloplasty (OR 0.345; p  = 0.025) and the implantation of a smaller prosthesis (OR 0.656; p  = 0.004) were related to higher rates of P-PH after MVR. MVR was associated with high prevalence of P-PH after mid-term follow-up. Both PH and significant TR before surgery were associated with P-PH. Our data point out that MVR should be planned before the development of PH and greater TR. Smaller prosthetic size is also a risk factor for P-PH and bigger prostheses are desirable when possible.