Key result
Preoperative sPAP ≥50 mmHg shows no association with 3-year survival after mitral valve replacement.
Why the study?
High pulmonary artery pressure is a critical survival parameter in severe mitral stenosis, prompting investigation into how changes in PAP impact survival after mitral valve replacement.
Does preoperative systolic pulmonary artery pressure elevation affect survival in patients undergoing mitral valve replacement for severe mitral stenosis?
Cohort (n=42)
No
Does preoperative systolic pulmonary artery pressure elevation affect survival in patients undergoing mitral valve replacement for severe mitral stenosis?
Absolute Event Rate: 75.8% vs 85.2%
p-value: p=0.510
Patients with severe mitral stenosis and high preoperative systolic pulmonary artery pressure can undergo mitral valve replacement with acceptable midterm survival, as elevated sPAP (≥50 mmHg) did not significantly reduce 3-year survival.
Supports mitral valve replacement despite elevated preoperative sPAP in severe mitral stenosis; leaves open prospective validation before changing practice.
Introduction: High pulmonary artery pressure (PAP) is a critical survival parameter in patients with severe mitral stenosis.We investigated changes in PAP and their impact on survival in patients undergoing mitral valve replacement for severe mitral stenosis.Methods: We retrospectively analyzed 42 patients who underwent mitral valve replacement for severe mitral stenosis between January 2020 and January 2022.Changes in systolic pulmonary artery pressure (sPAP) assessed by echocardiography and survival outcomes were analyzed. Results:The mean age of the patients was 56.0514.21years.Among the patients, 71.4% were female and 28.6% were male.The median postoperative sPAP was 29 mmHg, which was significantly lower than the preoperative value (p<0.001).In the subgroup analysis according to preoperative sPAP value, the postoperative sPAP change was 17.87% in <50 mmHg group and 41.61% in 50 mmHg group, which indicated a statistically significant difference (p=0.003).In the patient group with preoperative sPAP <50 mmHg, the expected 3-year survival rate was 85.2% compared with 75.8% in the patient group with sPAP 50 mmHg, and the differences were insignificant (p=0.510). Conclusion:Patients with severe mitral stenosis and high sPAP can undergo surgery with acceptable survival expectancy.However, the decrease in pulmonary pressure in the early postoperative period alone cannot adequately predict survival.
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Ayyıldız et al. (2024) conducted a cohort in Severe mitral stenosis (n=42). Mitral valve replacement (preoperative sPAP ≥50 mmHg) vs. Mitral valve replacement (preoperative sPAP <50 mmHg) was evaluated on 3-year survival rate (p=0.510). In patients undergoing mitral valve replacement for severe mitral stenosis, preoperative systolic pulmonary artery pressure ≥50 mmHg did not significantly impact the 3-year survival rate compared to <50 mmHg (75.8% vs 85.2%, p=0.510).
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