Efficacy of valve replacement surgery in patients with severe pulmonary hypertension

To evaluate the safety of valve replacement surgery in rheumatic heart disease patients with severe pulmonary hypertension (SPH); defined as pulmonary artery systolic pressure (PASP > or = 60 mmHg) on patients operated for valve replacement at Tabba Heart Institute, Karachi.

From July 2005 to September 2007, total of 112 patients underwent valve replacement (AVR, MVR, AVR+MVR) at our institution. We retrospectively examined the patients with SPH.

The male:female ratio was 8:16, age range 18 to 70 years. Data was entered in SPSS version 16. Student t test was used for analyzing the qualitative data and chi-square for the quantitative data. Each case was reviewed on its merit and patient safety maintained by the cardiology and anaesthesia team. Twenty four patients had SPH (range; 60 to 120 mmHg, mean 77.38). Fifteen underwent MVR; AVR one and 7 had AVR+MVR and one MVR + CABG. Three bioprosthetic and 21 mechanical prostheses were implanted. LVEF ranged from 47% to 75 %. Left atrium size ranged from 35 mm to 160mm. Out of 24 patients 10 patients had giant left atria (>6.5 cm). Four patients had dilated RV (range; 17mm to 31 mm). We observed no operative mortality, one patient developed post-operative pulmonary hypertensive crisis and one developed acute renal failure. The incidence of post-op atrial fibrillation was 12.5%. All patients were NYHA class IV pre-operatively and NYHA class I or II post-operatively. There were no neurological or pulmonary complications in our series and none of the patients had re-exploration for bleeding.

Cardiac surgery can be successfully performed with an acceptable morbidity and very low mortality in patients with long standing valvular disease and SPH.