Efficacy of valve replacement surgery in patients with severe pulmonary hypertension

Objectives: 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 > 60 mmhg) on patients operated for valve replacement at tabba heart institute, karachi. method: 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. results: 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. conclusion: cardiac surgery can be successfully performed with an acceptable morbidity and very low mortality in patients with long standing valvular disease and sph.