September 15, 2021Cardiovascular JournalOpen Access

In Hospital Outcome of Mitral Valve Replacement with Severe Pulmonary Hypertension

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Rheumatic mitral valve disease with pulmonary hypertension (n=60). Intervention: Mitral valve replacement in severe pulmonary hypertension (PASP ≥ 60 mm Hg) vs. Mitral valve replacement in mild to moderate pulmonary hypertension (PASP 40-59 mm Hg). Primary outcome: In-hospital mortality (p=0.150).

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Key result

Severe pulmonary hypertension shows no significant association with higher in-hospital mortality after mitral valve replacement.

P=0.150
n=60

Why the study?

Pulmonary artery hypertension has been considered a major risk factor in patients undergoing mitral valve replacement, prompting evaluation of early hemodynamic changes and postoperative outcomes in Bangladesh.

Does mitral valve replacement improve pulmonary artery systolic pressure and survival in patients with severe pulmonary hypertension compared to those with mild-to-moderate pulmonary hypertension?

Population

60 patients undergoing MVR for MR or mixed lesion with MS and PAH in Bangladesh

Comparison

Mild to moderate pulmonary hypertension (PASP 40-59 mm of Hg) vs severe pulmonary hypertension (PASP >= 60 mm of Hg)

Design

Prospective study

Follow-up

Immediate postoperative

Authors

RTRubaiya Reza TumpaSt. Mark's Hospital AHAl Masum Ziaul HaqueNational Institute of Cardiovascular Diseases MHMd Kamrul HasanChattagram Maa-O-Shishu Hospital Medical College

Discussion

Member takes

Implication

Higher mortality with severe PH warrants preoperative risk stratification; leaves open whether MVR improves long-term outcomes.

Study Design

Type

Cohort (n=60)

Multicenter

Structured PICO

Does mitral valve replacement improve pulmonary artery systolic pressure and survival in patients with severe pulmonary hypertension compared to those with mild-to-moderate pulmonary hypertension?

Population

60 patients undergoing mitral valve replacement for predominantly mitral regurgitation (n=13, 21.66%) and mixed lesion with mitral stenosis (n=47, 78.33%) with mild to severe pulmonary artery hypertension, mean age 36.23±9.18 years, in Bangladesh.

Intervention

Mitral valve replacement in patients with severe pulmonary hypertension (PASP ≥ 60 mm Hg)

Comparator

Mitral valve replacement in patients with mild to moderate pulmonary hypertension (PASP 40-59 mm Hg)

Outcome

Immediate postoperative hemodynamic changes (pulmonary arterial systolic pressure) and operative mortalityhard clinical

Main Result

Absolute Event Rate: 6.7% vs 0%

p-value: p=0.150

Mitral valve replacement is safe and effective in patients with PASP ≤60 mm Hg, but carries higher mortality and persistent severe PAH in those with PASP >60 mm Hg.

Limitations

Small sample size and short follow up interval
Most patients were young and had less associated co-morbidities, so results may not be applicable to elderly populations

Cite This Study

Tumpa et al. (2021) conducted a cohort in Rheumatic mitral valve disease with pulmonary hypertension (n=60). Mitral valve replacement in severe pulmonary hypertension (PASP ≥ 60 mm Hg) vs. Mitral valve replacement in mild to moderate pulmonary hypertension (PASP 40-59 mm Hg) was evaluated on In-hospital mortality (p=0.150). Mitral valve replacement in patients with severe pulmonary hypertension (PASP ≥ 60 mm Hg) resulted in a 6.7% in-hospital mortality rate compared to 0% in patients with mild to moderate pulmonary hypertension.

synapsesocial.com/papers/6a08f6682757fd3263d38d8f https://doi.org/10.3329/cardio.v14i1.55371

Topics

Mitral valve intervention

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In Hospital Outcome of Mitral Valve Replacement with Severe Pulmonary Hypertension

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

In Hospital Outcome of Mitral Valve Replacement with Severe Pulmonary Hypertension

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider