Does Pulmonary Hypertension increase Morbidity and Mortality in Mitral and Aortic Valve Surgery?
Eugene V. Yeika ; Charles M. Mvondo ; Anastase T. Dzudie ; Jacques Cabral Tantchou ; Martins H. Abanda ; Alessandro Giamberti
CaHReF 20116, Yaoundé Conges hall, 23 – 26 August 2016 , PL101
Open heart surgery can be associated with high morbidity and mortality when performed on patients with pulmonary hypertension (PH). However, there is little published data on the outcome of patients with PH undergoing mitral and aortic valve surgery (MAVS). Thus, our study aimed at comparing the clinical and operative outcomes of patients with and without PH undergoing MAVS.
This was a retrospective cohort study from January 2010 to December 2015 with a 6 months follow-up. 282 files of patients who underwent MAVS at Shisong Cardiac Centre were reviewed and 26 files excluded due to incomplete data. Socio-demographic, clinical and echocardiographic profiles were collected. Participants were categorized based on presence of PH (pulmonary artery systolic pressure ≥ 35mmHg) or absence of PH measured by transthoracic echocardiography. Data was analyzed using SPSS version 20.
The mean age of participants was 29.9 ± 16.6 years and 52.7% were women. The prevalence of PH amongst patients who underwent MAVS was 83.2% and operative mortality from MAVS was 5.5%. The most common valvular lesions were rheumatic (68.8%), degenerative (18.8%), endocarditis (9.0%), and congenital (2.3%). Compared to patients without PH, patients with PH were more in NYHA-FC III and IV (82.2% versus 41.9%, p < 0.001), had lower systolic function (mean LVEF: 57.2 ± 14.5% versus 62.7 ± 12.5%, p = 0.031), longer ICU stay (mean duration: 72.8 ± 43.4 versus 55.1 ± 26.6 hours, p = 0.010), higher incidence of postoperative events: operative mortality (6.6% versus 0.0%, p = 0.021); bleeding incidence (29.1% versus 20.9%, p = 0.024) , arrhythmias (26.8% versus 9.3%, p = 0.014), and pleural effusion (9.4% versus 4.7%, p = 0.041).
PH was common amongst patients who underwent MAVS with over two-third of patients associated with rheumatic disease. Preoperative PH increased morbidity and mortality following MAVS. This warrants the need for therapeutic strategies to decrease preoperative PH and to consider PH as a cardiovascular risk factor useful in preoperative risk assessment.
Pulmonary hypertension, mitral and aortic valve surgery, rheumatic disease, mortality