Objectives
Pulmonary hypertension (PH) is frequently encountered in patients undergoing left-sided valve surgery and may influence clinical outcomes. While studies of transcatheter therapies have identified PH as a relevant prognostic factor for postprocedural outcome, data on surgical cohorts undergoing concomitant tricuspid valve repair (TVR) remain limited. This study aimed to investigate the impact of PH on early outcomes in patients undergoing fully endoscopic mitral valve surgery (MVS) with concomitant TVR.
Methods
This retrospective single-center analysis included 97 patients who underwent fully endoscopic MVS with concomitant TVR between 2012 and 2023. PH was defined as an estimated systolic pulmonary artery pressure (sPAP) ≥35 mmHg on transthoracic echocardiography, and patients were stratified accordingly into two groups. Perioperative outcomes, including TR reduction, right heart failure, and 30-day all-cause mortality, were analyzed.
Results
Patients without PH (n=47) had a median sPAP of 28 (IQR 22.5–32.0) mmHg, whereas those with PH (n=50) presented with a median sPAP of 47 (40.0–53.0) mmHg. Patients with PH exhibited higher NT-proBNP levels (1565 [668–3158] vs. 1375 [331–2098] pg/mL; p=0.035), more severe TR (≥3+ in 54.3% vs. 40.8%; p=0.023), and larger LVEDD (57 [49–61] vs. 46 [42–54] mm; p<0.007). Preoperative right ventricular function, measured by TAPSE, was comparable between groups (21 [17–27] vs. 20 [18–26] mm; p=0.665). Procedural strategies, including type of annuloplasty ring, were similar, with Cosgrove ring use in 89.4% vs. 86.0% of patients (p=0.569). Early postoperative outcomes did not differ significantly. Rates of right heart failure were 6.4% vs. 4.0% (p=0.600), median ICU stay was 2 (1–3) vs. 3 (2–4) days (p=0.075), and total in-hospital length of stay was 10 (7–12) vs. 10 (7–15) days (p=0.239). TR was successfully reduced to ≤1+ in 91.5% vs. 98.0% (p=0.887), and median TAPSE at discharge was comparable (12 [10–14] vs. 12 [9–13] mm; p=0.333). Thirty-day mortality was 0.0% in both groups.
Conclusion
In this cohort of patients undergoing concomitant TVR during fully endoscopic MVS, PH was associated with more advanced baseline heart failure but did not significantly affect early postoperative clinical outcomes. Given the retrospective design and limited sample size, these findings should be interpreted with caution and require confirmation in larger prospective studies.
