Impact of pulmonary hypertension on early outcomes of valve surgery in rheumatic heart disease: The first outcome-based study from Yemen

BackgroundThere is conflicting evidence on the adverse impact of pulmonary hypertension (PH) on outcomes following cardiac surgery for rheumatic heart disease (RHD). This study aimed to evaluate the influence of PH severity on in-hospital mortality and early outcomes after valve surgery in patients with RHD.MethodsIn this prospective observational study, 152 patients with RHD undergoing valve surgery were categorized into three groups based on estimated systolic pulmonary artery pressure on echocardiography: no or mild PH (<45 mmHg), moderate PH (45-59 mmHg), and severe PH (≥60 mmHg). The primary endpoint was in-hospital all-cause mortality and major morbidity; the secondary endpoint was 30-day readmission.ResultsIn-hospital all-cause mortality was 3.3% (<i>n</i> = 5), with no statistically significant difference among severe (4.8%), moderate (3.2%), and no/mild PH (0%) groups (<i>p</i> = 0.518). ICU stay was significantly longer in patients with severe PH (<i>p</i> = 0.042). There was no significant difference in mortality based on predominant valve lesion (mitral stenosis or regurgitation) across PH groups (<i>p</i> = 0.625, <i>p</i> = 0.172). The 30-day readmission rate was 12.5%, with no significant variation across PH categories (<i>p</i> = 0.194).ConclusionThe severity of PH did not significantly impact early postoperative outcomes or in-hospital mortality following valve surgery for RHD. These findings support the feasibility and safety of surgical intervention even in patients with severe PH and provide a critical foundation for future studies in Yemen.