Preoperative and predischarge predictors for persistent pulmonary hypertension after mitral valve surgery in patients with chronic organic mitral regurgitation
Abstract
Objectives. This study sought to evaluate the prevalence of pulmonary hypertension after mitral valve surgery ini patients with chronic organic mitral regurgitation and to determine preoperative and predischarge predictors for persistent pulmonary hypertension after surgeryMethods. This is a cohort retrospective study involving subjects with chronic organic mitral regurgitation with preoperative systolic PA pressure > 50 mmHg undergoing surgery. Demographic and echocardiography datas were collected prior to surgery, predischarge, and follow up datas were evaluated after minimal 6 months duration. Subjects were then devided into groups based on existence of persistent pulmonary hypertension after follow up. Bivariate and multivariate analysis was done to determine contributing factors.
Results.There were 92 subjects with dominant mitral regurgitation included in this study with median age 40 (range 17-68) years with slight female predominance (55%). Persistent pulmonary hypertension was observed in 23 subjects (25%) predischarge and in 20 subjects (20.7%) after mean follow up of 11 + 5.5 months. Bivariate analysis revealed preoperative TAPSE, underlying etiology, severity of pulmonary hypertension preoperatively, postoperative atrial fibrilation, mean mitral valve gradient predischarge, and the presence of residual pulmonary hypertension predischarge were related with persistent pulmonary hypertension. From multivariate analysis, post operative atrial fibrillation [OR 7.3 (CI 95% 1.64-33.33, p=0.09)], mean mitral valve gradient predischarge [OR 1.67 (CI 95% 1,3-2.7, p=0.038)], and preoperative TAPSE [OR 0.143 (CI 95% 0.03-0.70, p=0.017)] were independent predictors for persistent pulmonary hypertension after mitral valve surgery.
Conclusion. Persistent pulmonary hypertension was observed in 20.7% subjects after mitral valve surgery. Preoperative TAPSE, post operative atrial fibrillation, and predischarge mean mitral valve gradient were independent predictors.
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References
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18. Ghio S, Klersy C, Magrini G, D’Armini AM, Scelsi L, Raineri C, et al. Prognostic relevance of the echocardiographic assessment of right ventricular function in patients with idiopathic pulmonary arterial hypertension. Int J Cardiol. 2010; 140(3):272-8.
19. Forfia PR, Fisher MR, Mathai SC, Housten-Harris T, Hemnes AR, Borlaug BA, et al. Tricuspid annular displacement predicts survival in pulmonary hypertension. Am J Respir Crit Care Med. 2006; 174(9): 1034-41.
20. Kabukcu M, Yanik E, Demircioglu F, Gölbasi I, Ersel F. Effects of Late Regain of Sinus Rhythm on Pulmonary Artery Pressure and Functional Status in Patients with Mitral Valve Replacement Surgery and Atrial Fibrillation. J Heart Valve Dis. 2004; 13: 937-41.
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22. Hung L, Rahimtoola SH. Reverse remodeling after heart valve replacement and repair. In: Greenberg B, editor. Cardiac remodeling mechanisms and treatment. New York: Taylor & Francis; 2006. p. 417-40.
2. Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet. 2006; 368(9540): 1005-11.
3. Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Jr., Faxon DP, Freed MD, et al. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2008; 118(15): e523-661.
4. Thenappan T, Shah SJ, Rich S, Tian L, Archer SL, Gomberg-Maitland M. Survival in pulmonary arterial hypertension: a reappraisal of the NIH risk stratification equation. Eur Respir J. 2010; 35(5): 1079-87.
5. Galie N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA, et al. Guidelines for the diagnosis and treatment of pulmonary hypertension: The Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J. 2009; 30(20): 2493-537.
6. McLaughlin VV, Archer SL, Badesch DB, Barst RJ, Farber HW, Lindner JR, et al. ACCF/AHA 2009 expert consensus document on pulmonary hypertension: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association: developed in collaboration with the American College of Chest Physicians, American Thoracic Society, Inc., and the Pulmonary Hypertension Association. Circulation. 2009; 119(16): 2250-94.
7. Mubeen M, Singh AK, Agarwal SK, Pillai J, Kapoor S, Srivastava AK. Mitral valve replacement in severe pulmonary arterial hypertension. Asian Cardiovasc Thorac Ann. 2008; 16(1): 37-42.
8. Haddad F, Kudelko K, Mercier O, Vrtovec B, Zamanian RT, de Jesus Perez V. Pulmonary hypertension associated with left heart disease: characteristics, emerging concepts, and treatment strategies. Prog Cardiovasc Dis. 2011; 54(2): 154-67.
9. Porter TR, Taylor DO, Cycan A, Fields J, Bagley CW, Pandian NG, et al. Endothelium-dependent pulmonary artery responses in chronic heart failure: influence of pulmonary hypertension. J Am Coll Cardiol. 1993; 22(5): 1418-24.
10. Deuchar GA, Docherty A, MacLean MR, Hicks MN. Pulmonary hypertension secondary to left ventricular dysfunction: the role of nitric oxide and endothelin-1 in the control of pulmonary vascular tone. Br J Pharmacol. 2002; 135(4): 1060-8.
11. Tempe DK, Hasija S, Datt V, Tomar AS, Virmani S, Banerjee A, et al. Evaluation and Comparison of Early Hemodynamic Changes After Elective Mitral Valve Replacement in Patients With Severe and Mild Pulmonary Arterial Hypertension. J Cardiothorac Vasc Anesth. 2009; 23(3): 298-305
12. Barbieri A, Bursi F, Grigioni F, Tribouilloy C, Avierinos JF, Michelena HI, et al. Prognostic and therapeutic implications of pulmonary hypertension complicating degenerative mitral regurgitation due to flail leaflet: A Multicenter Long-term International Study. Eur Heart J. 2011; 32: 751-9
13. Goldstone AB, Chikwe J, Pinney SP, Anyanwu AC, Funt SA, Polanco A, et al. Incidence, Epidemiology, and Prognosis of Residual Pulmonary Hypertension After Mitral Valve Repair for Degenerative Mitral Regurgitation. Am J Cardiol 2011; 107: 755–60.
14. Walls MC, Cimino N, Bolling SF, Bach DS. Persistent pulmonary hypertension after mitral valve surgery: does surgical procedure affect outcome? J Heart Valve Dis. 2008; 17(1): 1-9.
15. Lam BK, Chan V, Hendry P, Ruel M, Masters R, Bedard P, et al. The impact of patient-prosthesis mismatch on late outcomes after mitral valve replacement. J Thorac Cardiovasc Surg. 2007; 133(6): 1464-73.
16. Li M, Dumesnil JG, Mathieu P, Pibarot P. Impact of valve prosthesis-patient mismatch on pulmonary arterial pressure after mitral valve replacement. J Am Coll Cardiol. 2005; 45(7): 1034-40.
17. Zielinski T, Pogorzelska H, Rajecka A, Biedermavn A, Sliwinski M, Korewicki J. Pulmonary hemodynamics at rest and effort, 6 and 12 months after mitral valve replacement: a slow regression of effort pulmonary hypertension. Int J Cardiol. 1993; 42(1): 57-62.
18. Ghio S, Klersy C, Magrini G, D’Armini AM, Scelsi L, Raineri C, et al. Prognostic relevance of the echocardiographic assessment of right ventricular function in patients with idiopathic pulmonary arterial hypertension. Int J Cardiol. 2010; 140(3):272-8.
19. Forfia PR, Fisher MR, Mathai SC, Housten-Harris T, Hemnes AR, Borlaug BA, et al. Tricuspid annular displacement predicts survival in pulmonary hypertension. Am J Respir Crit Care Med. 2006; 174(9): 1034-41.
20. Kabukcu M, Yanik E, Demircioglu F, Gölbasi I, Ersel F. Effects of Late Regain of Sinus Rhythm on Pulmonary Artery Pressure and Functional Status in Patients with Mitral Valve Replacement Surgery and Atrial Fibrillation. J Heart Valve Dis. 2004; 13: 937-41.
21. Rottlaender D, Motloch LJ, Schmidt D, Reda S, Larbig R, Wolny M, et al. Clinical impact of atrial fibrillation in patients with pulmonary hypertension. PLoS One. 2012; 7(3): e33902.
22. Hung L, Rahimtoola SH. Reverse remodeling after heart valve replacement and repair. In: Greenberg B, editor. Cardiac remodeling mechanisms and treatment. New York: Taylor & Francis; 2006. p. 417-40.
Published
2015-05-08
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How to Cite
Ariani, R., Sakidjan, I., & Setianto, B. (2015). Preoperative and predischarge predictors for persistent pulmonary hypertension after mitral valve surgery in patients with chronic organic mitral regurgitation. Indonesian Journal of Cardiology, 35(2), 70-9. https://doi.org/10.30701/ijc.v35i2.394
Section
Clinical Research
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