Early Mortality Following Mitral Valve Surgery in Patients With Rheumatic Heart Disease and Severe Pulmonary Hypertension

Background: Rheumatic heart disease (RHD) remains highly prevalent in Yemen, often presenting with advanced mitral valve lesions and pulmonary hypertension (PH). However, prospective data on early postoperative outcomes, including 3-month mortality, are limited. Therefore, this study aimed to evaluate the association between preoperative PH severity and 3-month outcomes following mitral valve surgery for RHD in Yemen. Methods: A prospective observational study was performed on 134 adult patients with RHD who were undergoing mitral valve surgery at the Cardiovascular and Kidney Transplantation Center, Taiz, Yemen (January 2022–August 2024). Patients were stratified according to preoperative systolic pulmonary artery pressure (sPAP) into Group I (<60 mmHg) and Group II (≥60 mmHg). All-cause 3-month mortality, readmissions, and major postoperative complications were recorded. Results: The 30-day mortality was low and did not differ significantly between groups (3.9% vs. 3.5%; p = 0.907). The overall 3-month all-cause mortality rate was 10.4%, with no significant difference in mortality within the two groups (12.3% vs. 9.1%; p = 0.551). The early complication rates and hospital readmissions were comparable between groups. Conclusions: Early mitral valve surgery before the development of severe PH and right ventricular dysfunction was shown to improve survival outcomes. Surgery is safe and feasible for RHD patients with severe PH, with low early mortality and an 89.6% 3-month survival rate.