Pulmonary Hypertension Increases Mortality Risk in Patients Undergoing Mitral Valve Surgery

Mitral valve repair in mitral valve regurgitation with coronary artery disease
The researchers’ goals included determining how postoperative residual pulmonary hypertension was related to longitudinal mortality in patients with severe mitral regurgitation who had mitral valve surgery.

A new study again links preoperative and postoperative pulmonary hypertension to an increased risk of mortality in patients with severe mitral regurgitation undergoing mitral valve surgery (MVS). Findings from this study were published in a recent edition of the Journal of the American Heart Association.

Researchers retrospectively identified 488 patients who underwent MVS for severe mitral regurgitation at the University of Pittsburgh Medical Center from 2011 to 2016. These patients underwent presurgical right-heart catheterization to collect hemodynamic variables such as mean pulmonary artery pressure (PAP) and pulmonary capillary wedge pressures. In addition, an echocardiogram was performed 42 to 365 days following MVS to assess postoperative pulmonary artery systolic pressure.

The primary outcome was all-cause mortality after MVS, while the primary exposure was pre- and post-MVS pulmonary hypertension. A total of 134 patients had died after a mean 3.9-year follow-up period. The prevalence of pulmonary hypertension before MVS was 85%.

In an adjusted analysis, the researchers found that there was a 1.38-fold (38%) increase in risk of death for each 10-mm Hg increase in preoperative mean PAP (95% CI, 1.13-1.68; P =.001). Other variables associated with decreased 3-year postoperative survival included elevated mean PAP (P <.0001), preoperative pulmonary vascular resistance (P =.002), transpulmonary gradient (P =.001), and right atrial pressure (P =.005).

Limitations of this study include its observational and retrospective design as well as the lack of reliable data on quality of life, heart failure hospitalizations, and functional assessments.

The investigators concluded that future research “evaluating clinical and echocardiographic risk factors for the development of [pulmonary hypertension in mitral regurgitation] may help optimize surgical timing and improve clinically meaningful outcomes.”

Disclosure: Some study authors declared affiliations with industry. Please see the original reference for a full list of authors’ disclosures.


Genuardi MV, Shpilsky D, Handen A, et al. Increased mortality in patients with preoperative and persistent postoperative pulmonary hypertension undergoing mitral valve surgery for mitral regurgitation: a cohort study. J Am Heart Assoc. 2021;10(5):e018394. doi:10.1161/JAHA.120.018394