Soumaia Bendjaballah, Farid Aimar, Rabeh Bouharraga, Redha Lakehal, Redhouane Boukerroucha, Rafik Nezzal, Redouane Bellara, Abdelmalek Brahami
Institution : Service de chirurgie cardio-vasculaire, EHS Djeghri-Mokhtar (ex Erriadh), Constantine, Algérie
Objectives : Rheumatic heart diseases (mitral stenosis +++) are redoubtable complication of acute articular rheumatic. Without treatment, pulmonary hypertension and right heart failure may occur. This pulmonary hypertension was admitted as predictor of worse outcome after surgery. The aim of our study is to value the results after mitral surgery in patients with moderate and severe pulmonary hypertension.
Methods : This is an observational descriptive retrospective study between January 2006 and December 2012; a total of 201 patients were operated for mitral or mitro-tricuspid disease with pulmonary arterial hypertension in Djeghri Mokhtar hospital.These patients are divided into two groups according to preoperative pulmonary hypertension (PAH)degree:
- GroupA: 102 patients in moderate PAH, 40≤ sPAP <60 mmHg;
- Group B: 99 patients in severe PAH, sPAP ≥60 mmHg.
In our study, sPAP was measured with Doppler echocardiography. Preoperative, operative and postoperative data collection included age, sex, functional class, type of surgery and cardiopulmonary bypass. Pulmonary arterial systolic pressure, left atrial diameter, left ventricular end-diastolic diameter, and left ventricular ejection fraction were recorded and compared.
Results : The follow up is in mean of 61.73 months (from 30 to 108 months). The functional class was improved in majority of patients. There is a significant decrease in mean sPAP during follow up (48.72 ± 5.85 versus 29.12 ± 8.29 mmHg in group A; 77.90±15.62 versus 28.87±10.61 mmHg in group B). Global hospital mortality is 0.49% (0% in group A, 0.98% in group B). Late mortality is 2.48% (3.92% in group A; 1.01% in group B). Survival at 5 years is 96.5%.
Conclusion : Pulmonary arterial systolic pressure decreased near normal value in most patients after surgery. Severe pulmonary hypertension must not be an absolute contraindication for mitral surgery, the outcome has been improved by developing cardiopulmonary bypass, myocardial protection and anesthetic technique.