PULMONARY HYPERTENSION SEVERITY IS NOT A LIMIT FOR MINIMALLY INVASIVE MITRAL VALVE SURGERY: RESULTS OF A MULTICENTRIC OBSERVATIONAL STUDY

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.