title: Outcomes of repeat mitral valve surgery in patients with pulmonary hypertension.
abstract: OBJECTIVE
  We sought to study the outcomes of redo-mitral valve surgery in patients with pulmonary hypertension.
  
  
  METHODS
  We reviewed data on redo mitral valve surgery in patients with pulmonary hypertension measured by Swan-Ganz catheter (mean pulmonary artery pressure ≥ 25 mm Hg or systolic pulmonary artery pressure ≥ 40 mm Hg).
  
  
  RESULTS
  Between 1996 and 2010, 637 patients underwent 658 redo mitral valve operations; 138 of them had pulmonary hypertension. The mean patient age was 61.3 (13.9) years, with mean left ventricular ejection fraction of 47.6% (13.2%). The mean systolic pulmonary artery pressure was 61.5 (16.8) mm Hg, and mean pulmonary artery pressure was 40.8 (11.6) mm Hg. Patients had one (71%, 98/138), two (23.9%, 33/138), and three (5.1%, 7/138) previous mitral valve operations. Thirty-day mortality was 10.1% (14/138). Multivariate predictors of 30-day mortality were chronic renal failure [odds ratio (OR), 8.041; P = 0.022], peripheral vascular disease (OR, 5.976; P = 0.025), previous mitral valve replacement (OR, 9.034; P = 0.014), and increasing age (OR, 1.077; P = 0.013). The severity of pulmonary hypertension did not impact 30-day (P = 0.314) or late mortality (P = 0.860). Kaplan-Meier survival rates at 1, 3, and 5 years were 76.6% (n = 99), 65.7% (n = 62), and 55.9% (n = 41), respectively.
  
  
  CONCLUSIONS
  Patients with pulmonary hypertension that undergo redo mitral valve surgery have a 55.9% 5-year survival rate. Increasing age, chronic renal insufficiency, peripheral vascular disease, and preexisting mitral valve prosthesis are associated with early mortality. The severity of pulmonary hypertension does not affect operative mortality rates, but it may decrease 1-, 3-, and 5-year survival.
authors: From the *Department of Surgery, Medical University of South Carolina, Charleston, SC USA; and †Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO USA.
authors: Mario
authors: M
authors: Castillo-Sang
authors: Tracey J
authors: TJ
authors: Guthrie
authors: Marc R
authors: MR
authors: Moon
authors: Jennifer S
authors: JS
authors: Lawton
authors: Hersh S
authors: HS
authors: Maniar
authors: Ralph J
authors: RJ
authors: Damiano
authors: Scott C
authors: SC
authors: Silvestry
mesh_terms: D000368:Aged; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology / Q000601:surgery*; D015999:Multivariate Analysis; D012086:Reoperation / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome