Key result
Mitral valve replacement significantly reduced systolic pulmonary artery pressure by 56.92% at 3 months in patients with severe preoperative pulmonary hypertension.
Why the study?
The authors sought to assess changes in pulmonary artery pressure after mitral valve replacement and closed mitral commissurotomy, and correlate pre- and postoperative pulmonary artery pressure with surgical outcomes.
Does mitral valve surgery reduce pulmonary artery pressure in patients with rheumatic mitral valve disease?
Observational (n=81)
No
Does mitral valve surgery reduce pulmonary artery pressure in patients with rheumatic mitral valve disease?
Mitral valve replacement significantly reduces pulmonary artery pressure in patients with rheumatic mitral valve disease, with reductions occurring immediately and continuing up to 3 months postoperatively.
MVR was associated with SPAP reduction in severe PH; hypothesis-generating and should not yet change practice in rheumatic mitral disease.
Background: In this study we have studied the change of pulmonary artery pressure after mitral valve replacement and closed mitral commissurotomy. We have also correlated pulmonary artery pressure before and after operation with postoperative outcome.Methods: This study was conducted at Department of CTVS of NRS Medical College and Hospitals from August 2019 to September 2021. All 81 patients had rheumatic mitral valve disease. Among these 73 patients underwent mitral valve replacement (MVR) and 8 patients underwent closed mitral commissurotomy (CMC). Group 1 (n=35) consisted of patients who underwent MVR having preoperative systolic PAP measured by TTE was less than 50 mmHg. Group 2 patients (n=38) had preoperative systolic PAP more than or equal to 50 mmHg measured by TTE. Group 3 patients (n=8), consists of patients who underwent CMC. Compared the results between group 1 and 2 and documented the results of group 3 separately.Results: Our results showed a significant decrease in SPAP after MVR, and further fall of SPAP in the immediate and late postoperative period.Conclusions: In conclusion, PAP returns to near-normal values after MVR in patients with severe preoperative PAH and to normal values in patients with mild preoperative PAH. Reductions in PAP in patients with preoperative PAH occur immediately after MVR. Postoperative period of patients with severe PAH may be hectic. CMC may be a valid option in isolated MS in selected patients and is very much cost-effective. There were no differences noted among the types of valves used.
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Mukhopadhyay et al. (2022) conducted an observational in Rheumatic mitral valve disease (n=81). Mitral valve replacement (MVR) vs. Preoperative baseline was evaluated on Systolic pulmonary artery pressure (SPAP) at 3 months post-MVR in patients with severe preoperative PAH (≥50 mmHg) (56.92% decrease). Mitral valve replacement significantly reduced systolic pulmonary artery pressure by 56.92% at 3 months in patients with severe preoperative pulmonary hypertension.
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