Results Of Mitral Valve Replacement In64Mitral Stenosis Patientswith Pulmonary Arterial Hypertension

Aim:To evaluate the clinical results of mitral valve replacement (MVR) on mitral stenosis (MS) patients with pulmonary arterial hypertension (PAH).Clinical material and Method:64MS patients with PAH who received MVR were analyzed by statistics methods. Patients were divided into three groups depending on systolic pulmonary arterial pressure (SPAP) acquired through echocardiography. Group A (Mild PAH:30mmHg≤SPAP≤49mmHg); Group B (Modest PAH:50mmHg≤SPAP≤69mmHg); Group C (Severe PAH:SPAP≥70mmHg).Results:There was no significant difference on age, length of history, left ventricular ejection fraction (LVEF), mitral valve area (MVA), cardiopulmonary bypass (CPB) and aorta cross-clamping time among three groups (P>0.05); There was significant difference on preoperative New York Heart Association (NYHA) cardiac function class among three groups:Group C was significantly worse than group B and group A (P<0.01); Transmitral pressure gradient (PGmax) of group C was significantly higher than group B (P<0.01), and PGmax of group B was significantly higher than group A (P<0.05); Preoperative SPAP was in notable linear correlation with PGmax (P=0.000); Perioperative mortality was6.25%in total, and2.9%,6.3%,14.3%with that of group A, B and C respectively; Postoperative SPAP in group B and group C was significantly lower than preoperative SPAP (P<0.01), and PGmax of the three groups was also significantly lower than preoperative PGmax (P<0.01); Mean postoperative follow-up time was34.9±3.9months.73.7%of the survivors had cardiac function improved by at least one NYHA class, and75.0%,70.0%,75.0%with that of group A, B and C respectively.Conclusion:MVR in MS patients with pulmonary arterial hypertension especially in severe PAH cases are of certain but acceptable risks, with a good long-term results, and preoperative PAH are likely to regress after operation.