Patients with pulmonary hypertension (PH) have a higher risk of complications when they undergo conventional cardiac surgery, but a new study reports that if they undergo minimally invasive valve surgery, patients with PH can have a reduced risk of complications along with a decreased recovery period and less time spent in the hospital.
The study, “Aortic and/or mitral valve surgery in patients with pulmonary hypertension performed via a minimally invasive approach,” was published in the Interactive CardioVascular and Thoracic Surgery journal.
Pulmonary hypertension is a serious condition characterized by high blood pressure in the arteries that supply blood to the lungs (called pulmonary arteries), with vessels becoming narrowed, blocked or destroyed, and consequently compromising a proper blood flow. As pressure builds, the heart’s right chamber, which is responsible for pumping blood to the lungs, must work harder, causing the heart muscle to weaken and eventually fail. As a result, patients with pulmonary hypertension who undergo heart surgery have a significantly higher risk of operative complications and long-term mortality.
Previous studies suggested that patients who underwent minimally invasive valve surgery exhibited a decreased incidence of perioperative complications, and had faster postoperative recovery and decreased hospital costs when compared to sternotomy, the standard incision for most cardiac operations where a vertical incision is made along the sternum.
Now, a team of researchers at Massachusetts General Hospital and Harvard Medical School, and colleagues at the Columbia University Division of Cardiology and Mount Sinai Heart Institute in New York, analyzed the outcomes of patients with pulmonary hypertension who underwent minimally invasive aortic and/or mitral valve surgery. In total, the team assessed 569 patients, with a mean age of 72.
The researchers observed that the operative mortality after minimally invasive aortic or mitral valve surgery was 3.5 percent, and postoperative strokes occurred in 1.4 percent of the patients. The incidence of major perioperative complications in pulmonary hypertension patients was previously reported to be 14.4 percent, including a 2.4 percent incidence of stroke. Moreover, the mean intensive care unit and hospital length of stay were reduced to 50 hours and seven days, respectively.
According to the results, minimally invasive procedures to aortic or mitral valve surgery in patients with pulmonary hypertension lead to good perioperative outcomes and acceptable hospital lengths of stay. The strategy appears safe and feasible, and represents a possible alternative to median sternotomy.