title: The impact of concomitant pulmonary hypertension on early and late outcomes following surgery for mitral stenosis.
abstract: To provide initial evidence on the management of mitral stenosis and pulmonary hypertension (PH) based on short-term and long-term outcomes following mitral valve surgery.
  
  
  
  Consecutive patients with mitral stenosis (n = 317) who had undergone mitral valve surgery between 1992 and 2014 with recorded pulmonary artery pressure (PAP) data were reviewed. PH severity, based on systolic PAP, was categorized as mild (35 to 44 mm Hg), moderate (45 to 59 mm Hg), or severe (>60 mm Hg). Primary outcomes were 30-day mortality and long-term survival.
  
  
  
  There were no significant between-group differences in age or preoperative comorbidities. Mitral valve surgery included mitral valve replacement (78%) and repair (22%). The severe PH group had more mitral valve replacement (81%; P = .04), severe tricuspid valve regurgitation (31%; P = .003), right heart failure (17%; P = .02), and concomitant tricuspid valve procedures (46%; P < .001). For severe PH, 30-day mortality was 9%, with no significant group differences. Ten- and 12-year survival were significantly worse in the moderate-severe PH group (58% and 51%, respectively) compared with the normal PAP-mild PH group (83% and 79%, respectively) with a hazard ratio of 2.98 (95% confidence interval, 1.55-5.75; P = .001). Ten-year survival after mitral valve surgery for mitral stenosis was inversely associated with preoperative PAP.
  
  
  
  Mitral valve surgery can be performed with acceptable 30-day mortality for patients with mitral stenosis and moderate to severe PH, but long-term survival is impaired by moderate to severe PH. Patients with mitral stenosis and mild PH (systolic PAP 35-44 mm Hg) should be considered for mitral valve surgery.
authors.affiliation: Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, Mich. Electronic address: boya@med.umich.edu.
authors.forename: Bo
authors.initials: B
authors.lastname: Yang
authors.affiliation: University of Michigan Medical School, Ann Arbor, Mich.
authors.forename: Christina
authors.initials: C
authors.lastname: DeBenedictus
authors.affiliation: Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, Mich.
authors.forename: Tessa
authors.initials: T
authors.lastname: Watt
authors.affiliation: College of Human Medicine, Michigan State University, East Lansing, Mich.
authors.forename: Sean
authors.initials: S
authors.lastname: Farley
authors.affiliation: College of Osteopathic Medicine, Michigan State University, East Lansing, Mich.
authors.forename: Alona
authors.initials: A
authors.lastname: Salita
authors.affiliation: Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich.
authors.forename: Whitney
authors.initials: W
authors.lastname: Hornsby
authors.affiliation: Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, Mich.
authors.forename: Xiaoting
authors.initials: X
authors.lastname: Wu
authors.affiliation: Southwest Data Consultants, Dallas, Tex.
authors.forename: Morley
authors.initials: M
authors.lastname: Herbert
authors.affiliation: Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, Mich.
authors.forename: Donald S
authors.initials: DS
authors.lastname: Likosky
authors.affiliation: Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, Mich.
authors.forename: Steven F
authors.initials: SF
authors.lastname: Bolling
mesh_terms: D000328:Adult; D000368:Aged; D062186:Arterial Pressure; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016016:Proportional Hazards Models; D011651:Pulmonary Artery / Q000503:physiopathology*; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: mitral stenosis; pulmonary hypertension; survival