EFFECTS OF PULMONARY HYPERTENSION ON EARLY OUTCOMES AFTER MITRAL VALVE REPLACEMENT

Abstract

Objectives: The objective of this study was to determine the safety of Mitral valvereplacement surgery in the presence of severe pulmonary hypertension.

Methodology: This was a randomized control trial in Chudhary Pervaiz ElahiInstitute of Cardiology. Patients of Mitral stenosis undergoing Elective Mitral valveReplacement were included in this study. In Group I, there were patients withmoderate pulmonary hypertension (30-60 mm of Hg) and in Group II patientswith severe pulmonary hypertension (>60 mm of Hg) were included.

Results: Patients included in the study were 30, with 15 in each group. There wasno significant difference in age, gender, and other risk factors i.e. smoking,diabetes, and obesity in both groups. However pre-operative CVP wassignificantly high in Group II patients (p = 0.05). CPB times, need of inotropesand nitrates, and number of patients with prolonged ventilation time weresignificantly high in Group II (p >0.0001, 0.02, 0.003 and 0.02 respectively).There was significant decrease in Pulmonary Artery Pressures after surgery inGroup I and II (p >0.0001, >0.0001 respectively). Regression analysis showedstrong correlation between pulmonary artery pressures before surgery and aftersurgery (ß=0.708).

Conclusions: Mitral valve replacement should be offered even in the presence ofsevere pulmonary hypertension, however these patients need extra postoperativecare due to increased morbidity.