Persistent Pulmonary Hypertension following Aortic or Mitral Valve Surgery: its Prevalence, Predictors, Prognostic Impact, and Clinical Outcomes

Background: this study was aimed to determine the prevalence and factors associated with persistent PH following aortic or mitral valve surgery and its relationship with clinical outcomes. Methods: this retrospective study performed on 204 consecutive patients with sPAP> 40 mmHg who underwent aortic or mitral valve surgery from March 2017 through March 2022 in our center. Clinical and echocardiographic parameters at baseline, early after surgery, and 6 -12 months post-operation collected. Result: overall, 87 (42.6%) had sPAP>40 mm Hg (residual PH) and 117 (57.4%) had sPAP≤40 mm Hg (improved PH) based on the post-operative TTE. The atrial fibrillation/flutter (OR: 1.94 CI 95% 1.23-2.34; P=0.003), moderate & severe MR (OR: 2.03 CI 95% 1.18-2.96; P=0.006), moderate & severe TR (OR: 3.39 CI 95% 2.66-7.94; P=0.002), moderate & severe AI (OR: 2.10 CI 95% 1.12-3.08; P=0.040), tricuspid annuloplasty (OR:2.12 CI 95% 1.32-3.87; P=0.007), and sPAP (OR: 2.05 CI 95% 1.21-2.99; P=0.032) were independent predictors of persistent PH. The presence of residual PH including mild PH, moderate PH, and severe PH was associated with a 1.92, 2.83, 3.36-fold increased risk of re-hospitalization, a 1.62, 1.75, 2.11-fold increased risk of re-operation, and a 1.66, 1.93, 2.98-fold increased risk of post-operative AF. Average length of stay of mild PH (12.32±2.31; adjusted B, 1.53; 95% CI, 1.15-2.04), moderate PH (14.48±3.25; adjusted B, 1.76; 95% CI, 1.35-2.16), and severe PH (16.79±3.87; adjusted B, 2.02; 95% CI, 1.46-2.47) was higher than patients with no PH. Conclusion: Post-operative persistent PH is common and strongly associated with clinical outcomes.

Persistent Pulmonary Hypertension following Aortic or Mitral Valve Surgery: its Prevalence, Predictors, Prognostic Impact, and Clinical Outcomes Keywords:

Pulmonary hypertension , outcome , mitral valve , aortic valve , surgery , prognosis.