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Predictors of persistent pulmonary hypertension after mitral valve replacement

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Abstract

Persistent pulmonary hypertension (P-PH) after mitral valve replacement (MVR) leads to an increased risk of morbidity and mortality. We sought to determine which factors were involved in its occurrence. Patients undergoing MVR for a 3-year period were collected in a retrospective way. We excluded those with an available follow-up shorter than 3 months. Sample size was 111 patients. PH was diagnosed if systolic pulmonary artery pressure (sPAP) estimated by Doppler echocardiography was >40 mmHg. Clinical, echocardiographic, and surgical factors were analyzed. P-PH was present in 42.3 % of patients after 12.6 months of mean follow-up. P-PH was more frequently observed in elderly and female patients, in those with severe degrees of PH before surgery, and significant tricuspid regurgitation (TR). On multivariable analysis, significant TR (OR 1.739; p = 0.01) and more severe degrees of PH before surgery (OR 1.761; p = 0.03) were significantly associated with the presence of P-PH after MVR. Surgical factors related to P-PH were prosthesis size and tricuspid annuloplasty: no need for the performing of tricuspid annuloplasty (OR 0.345; p = 0.025) and the implantation of a smaller prosthesis (OR 0.656; p = 0.004) were related to higher rates of P-PH after MVR. MVR was associated with high prevalence of P-PH after mid-term follow-up. Both PH and significant TR before surgery were associated with P-PH. Our data point out that MVR should be planned before the development of PH and greater TR. Smaller prosthetic size is also a risk factor for P-PH and bigger prostheses are desirable when possible.

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None of the authors declare any potential conflict of interest.

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Authors and Affiliations

  1. Cardiology Department, Infanta Leonor, María de Guzmán 38, 3ºE, 28003, Madrid, Spain

    Sem Briongos Figuero

  2. Cardiology Department, Hospital Ramón y Cajal, Madrid, Spain

    José Luis Moya Mur, Luisa Salido, Ana García Martín & José Luis Zamorano

  3. Cardiology Department, Hospital Príncipe de Asturias, Alcalá De Henares (Madrid), Spain

    Alberto García-Lledó

  4. Cardiac Surgery Department, Hospital Ramón y Cajal, Madrid, Spain

    Tomasa Centella, Ignacio García-Andrade & Enrique Oliva

  5. Cardiology Department, Hospital Fundación Jiménez Díaz, Madrid, Spain

    Álvaro Aceña Navarro

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  1. Sem Briongos Figuero
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  2. José Luis Moya Mur
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Correspondence to Sem Briongos Figuero.

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Briongos Figuero, S., Moya Mur, J.L., García-Lledó, A. et al. Predictors of persistent pulmonary hypertension after mitral valve replacement. Heart Vessels 31, 1091–1099 (2016). https://doi.org/10.1007/s00380-015-0700-2

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  • DOI: https://doi.org/10.1007/s00380-015-0700-2

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