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 ۲۰۴ consecutive patients with sPAP> ۴۰ mmHg who underwent aortic or mitral valve surgery from March ۲۰۱۷ through March ۲۰۲۲ in our center. Clinical and echocardiographic parameters at baseline, early after surgery, and ۶ -۱۲ months post-operation collected. Result: overall, ۸۷ (۴۲.۶%) had sPAP>۴۰ mm Hg (residual PH) and ۱۱۷ (۵۷.۴%) had sPAP≤۴۰ mm Hg (improved PH) based on the post-operative TTE. The atrial fibrillation/flutter (OR: ۱.۹۴ CI ۹۵% ۱.۲۳-۲.۳۴; P=۰.۰۰۳), moderate & severe MR (OR: ۲.۰۳ CI ۹۵% ۱.۱۸-۲.۹۶; P=۰.۰۰۶), moderate & severe TR (OR: ۳.۳۹ CI ۹۵% ۲.۶۶-۷.۹۴; P=۰.۰۰۲), moderate & severe AI (OR: ۲.۱۰ CI ۹۵% ۱.۱۲-۳.۰۸; P=۰.۰۴۰), tricuspid annuloplasty (OR:۲.۱۲ CI ۹۵% ۱.۳۲-۳.۸۷; P=۰.۰۰۷), and sPAP (OR: ۲.۰۵ CI ۹۵% ۱.۲۱-۲.۹۹; P=۰.۰۳۲) were independent predictors of persistent PH. The presence of residual PH including mild PH, moderate PH, and severe PH was associated with a ۱.۹۲, ۲.۸۳, ۳.۳۶-fold increased risk of re-hospitalization, a ۱.۶۲, ۱.۷۵, ۲.۱۱-fold increased risk of re-operation, and a ۱.۶۶, ۱.۹۳, ۲.۹۸-fold increased risk of post-operative AF. Average length of stay of mild PH (۱۲.۳۲±۲.۳۱; adjusted B, ۱.۵۳; ۹۵% CI, ۱.۱۵-۲.۰۴), moderate PH (۱۴.۴۸±۳.۲۵; adjusted B, ۱.۷۶; ۹۵% CI, ۱.۳۵-۲.۱۶), and severe PH (۱۶.۷۹±۳.۸۷; adjusted B, ۲.۰۲; ۹۵% CI, ۱.۴۶-۲.۴۷) was higher than patients with no PH. Conclusion: Post-operative persistent PH is common and strongly associated with clinical outcomes.

Keywords:

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