Prognostic Implication of Pulmonary Arterial Pressure in Surgical Repair of Predominantly Congenital Mitral Value Regurgitation-based Intracardiac Abnormalities

Background Knowledge is limited regarding the significance of pulmonary arterial pressure (PAP) in predominantly congenital mitral value regurgitation (MR)-based intracardiac abnormalities. Methods From a prospective cohort, we included 200 patients with congenital mitral value regurgitation regardless of other associated intracardiac abnormalities (mean age 60.4 months, 67% female, systolic PAP [sPAP] 54.2 mm Hg) surgically repaired in 2012-2019 and followed up to 2020 (median 30.0 months). Significant pulmonary hypertension (PH) was defined as sPAP > 50 mm Hg at rest or mean PAP > 25 mmHg on right heart catheterization. By perioperative sPAP changes, patients were stratified as Group I (pre-normotension-to-post-normotension), Group II (pre-hypertension-to- post-normotension), or Group III (pre-hypertension-to- post-hypertension). Primary outcomes were the recurrence of MR (defined as the regurgitation grade of moderate or greater) and the progression of MR (defined as any increase in magnitude of regurgitation grade after surgery). Cox proportional hazard and Kaplan-Meier curve was performed. Results There was no association between preoperative PH and the recurrent MR (adjusted hazard ratios [aHR] 1.146 [95% CI 0.453-2.899]) and progressive MR (aHR 1.753 [95% CI 0.807-3.804]), respectively. There were no significant differences among Group I, Group II and Group III in the recurrent MR but in the progressive MR. A dose dependency was identified for preoperative sPAP with the recurrent MR (aHR 1.050 [95% CI 1.029-1.071]) and progressive MR risks (aHR 1.037 [95% CI 1.019-1.055]), respectively. Conclusions Preoperative higher sPAP are associated with worse outcomes, warranting heightened attention to the identification of perioperative sPAP.