title: Predictors of persistent pulmonary hypertension after mitral valve replacement.
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.
authors.affiliation: Cardiology Department, Infanta Leonor, María de Guzmán 38, 3ºE, 28003, Madrid, Spain. semdoc@hotmail.com.
authors.forename: Sem
authors.initials: S
authors.lastname: Briongos Figuero
authors.affiliation: Cardiology Department, Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Moya Mur
authors.affiliation: Cardiology Department, Hospital Príncipe de Asturias, Alcalá De Henares (Madrid), Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: García-Lledó
authors.affiliation: Cardiac Surgery Department, Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: Tomasa
authors.initials: T
authors.lastname: Centella
authors.affiliation: Cardiology Department, Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: Luisa
authors.initials: L
authors.lastname: Salido
authors.affiliation: Cardiology Department, Hospital Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Aceña Navarro
authors.affiliation: Cardiology Department, Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: García Martín
authors.affiliation: Cardiac Surgery Department, Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: García-Andrade
authors.affiliation: Cardiac Surgery Department, Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Oliva
authors.affiliation: Cardiology Department, Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Zamorano
mesh_terms: D000367:Age Factors; D000368:Aged; D062186:Arterial Pressure; D058385:Cardiac Valve Annuloplasty / Q000009:adverse effects / Q000295:instrumentation; D016009:Chi-Square Distribution; D015150:Echocardiography, Doppler; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D015999:Multivariate Analysis; D016017:Odds Ratio; D011474:Prosthesis Design; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000503:physiopathology / Q000601:surgery
keywords: Mitral valve replacement; Persistent pulmonary hypertension; Prosthetics size; Tricuspid regurgitation