Background and Aim: Pulmonary hypertension (PH) is diagnosed in 40-70% of patients undergoing mitral valve (MV) surgery. Little is known regarding the outcomes of MV patients with PH receiving minimally invasive surgery. This study compares characteristics and in- hospital outcomes of patients undergoing minimally invasive MV surgery, stratified by systolic pulmonary artery pressure (PAPs). Methods: This multi-centre retrospective-prospective observational study included adults undergoing MV operations through right mini-thoracotomy with/without tricuspid valve (TV) surgery and atrial fibrillation (AF) ablation between 2020 and 2024. Comparison were performed between patients with PAPs< 31 mmHg, PAPs 31-55 mmHg, and PAPs>55mmHg based on EuroSCORE II cut-offs for PAPs categories. Results: This analysis included 1121 patients (females: 47.5%; median age: 69 years, interquartile range, IQR [59-77]). The median PAPs was 38 mmHg (IQR [30-50]; PAPs<31: n=307, 27.4%; PAPs 31-55: n=152, 55.3%; PAPs>55: n=194, 17.3%). Patients with higher PAPs were older, mainly female, and characterized by more comorbidities including atrial fibrillation and renal disease. A critical perioperative state was diagnosed in 12% of patients with PAPs > 55 mmHg (p<0.001). Patients with higher PAPs underwent more frequently mitral valve replacement and tricuspid annuloplasty and experienced more postoperative dialysis and pacemaker implantation but comparable rates of respiratory and bleeding complications, and in-hospital mortality (PAPs<31: n=3, 1%; PAPs 31-55: n=6, 1%; PAPs>55: n=5, 2.6%; p=0.222) compared to patients with lower PAPs. Conclusions: Despite a higher pre-operative complexity, patients with PH could be considered for minimally invasive MV surgery with no increased risks of major intra- or post-operative complications regardless of their PAPs values.
The diagnosis and surgical treatment of patients with Marfan syndrome remain controversial. It is of utmost importance to identify patients at risk for acute aortic events to establish the correct surgical timing and the appropriate surgical treatment.From May 2008 to December 2012, 500 patients were screened at the Marfan Presidium of the Tor Vergata University Hospital of Rome (Italy). Patients were evaluated by a cardiac surgeon, including echocardiographic, orthopedic, ophthalmologic and dental examinations. All patients received genetic counseling, and genetic sampling was performed if appropriate.The diagnosis of Marfan syndrome was confirmed in 146 patients (29.2%). Fifty-four patients (37%) underwent cardiac surgery on the aortic root, 4 patients had surgery on the mitral valve, 13 patients had combined surgery; 11 cases were emergent surgery for acute aortic dissection. Twenty-eight patients (52%) were operated on at our Division: 13 underwent valve-sparing aortic root replacement (David procedure), 1 underwent Yacoub remodeling procedure and 14 underwent Bentall procedure. Following the establishment of the Marfan Center, the David aortic valve-sparing operation was the most frequently performed procedure compared to the previous period of surgical activity (63 vs 22%, p<0.0001).Regular follow-up twice a year may allow to identify patients at risk for acute aortic syndromes. Early surgical treatment is recommended in these patients to achieve optimal results of valve-sparing procedures and life-saving management, especially for patients who live far away from a cardiac surgery center.
