Clinical Analysis Of Mitral Valve Replacement For Mitral Stenosis With Pulmonary Artery Hypertension

BackgroundPulmonary arterial hypertension(PAH)is a common complication of mitral stenosis(MS),and its incidence rate is up to 56%.Surgical treatment of mitral stenosis with pulmonary arterial hypertension is the main method.Pulmonary arterial hypertension has been considered as a risk factor for poor prognosis after mitral valve replacement,and the degree of pulmonary arterial hypertension is positively correlated with the incidence of surgical risk.In recent years,with the continuous improvement of surgical techniques and perioperative management,surgical mortality has decreased significantly.Current guidelines do not report pulmonary arterial hypertension as an indication for surgical treatment for mitral stenosis.Further studies are needed to investigate the effect of pulmonary arterial hypertension on the prognosis of patients undergoing mitral valve replacement for mitral stenosis.ObjectiveTo analyze the clinical results of mitral valve replacement in patients with mitral stenosis combined with pulmonary arterial hypertension,and to explore the effect and prognosis of surgical treatment of patients with mitral stenosis with different degrees of pulmonary arterial hypertension.MethodsRetrospective analyze the clinical data of 152 patients with mitral stenosis complicated with pulmonary arterial hypertension undergoing mitral valve replacement who were admitted to the cardiac surgery department of Seventh People's Hospital of Zhengzhou from January 2013 to December 2016,including 64 males and 88 females,aged32~70(53.0±8.2).The results of pulmonary artery systolic pressure estimated by echocardiography were divided into 3 groups: mild pulmonary arterial hypertension group(30~49mmHg,n=52),moderate pulmonary arterial hypertension group(50~69mmHg,n=55),severe pulmonary arterial hypertension group(?70mmHg,n=45).The general data,surgial related data,perioperative complications,and early and mid-term follow-up results of the three groups were compared by ?2 and t-test.ResultsAll patients died in the perioperative period in 2 cases(1.3%),including 0 cases in the mild pulmonary arterial hypertension group,1 case in the moderate arterial pulmonary hypertension group,and 1 cases in the severe pulmonary arterial hypertension group.There was no significant difference among the 3 groups(?2=0.663,P=0.718).There was no statistically significant difference in extracorporeal circulation time and aortic occlusion time between the three groups(P<0.05).The postoperative mechanical ventilation time and ICU retention time in the severe pulmonary arterial hypertension group were longer than those in the mild(t=10.105,7.356,P<0.001)and moderate pulmonary arterial hypertension groups(t=8.177,7.727,P<0.001).There were 47 cases(30.9%)of perioperative complications in the whole group,including 8 cases(13.5%)in the mild pulmonary arterial hypertension group,12 cases(21.8%)in the moderate pulmonary arterial hypertension group,and 27 cases(60.0%)in the severe pulmonary arterial hypertension group.The incidence of severe pulmonary arterial hypertension group was higher than that of mild and moderate pulmonary arterial hypertension group(?2=18.931,13.604,P<0.001),and there were significant differences among the three groups(?2=25.088,P<0.001).The mean follow-up time(14.4±6.1)months,the follow-up rate was 100 %(147cases).The results of transthoracic echocardiography showed that left atrial diameter,right ventricular diameter,pulmonary systolic pressure were significantly improved compared with preoperative(P<0.05),however,there was no difference in left ventricular ejection fraction(LVEF)compared with preoperative(P>0.05).The NYHA cardiac function classification wasrestored to 59 cases of grade I,78 cases of grade II,and 10 cases of grade III,which was increased by I or II before operation(P<0.05).Conclusions1.Mitral valve replacement can reduce the pulmonary artery systolic pressure in patients with mitral stenosis combined with pulmonary hypertension,improve the cardiac function and quality of life of patients.The preoperative preparation should be improved actively,and the perioperative cardiopulmonary protection and the control of pulmonary hypertension should be done well.2.Mitral valve replacement for patients with mitral stenosis combined with pulmonary arterial hypertension,severe pulmonary arterial hypertension can extended postoperative mechanical ventilation time and ICU retention time,increase the risk of perioperative complications,but the surgical results are accurate.