Minimally invasive mitral surgery in patients with high pulmonary artery pressure: Results of a multicenter observational study.
10 affiliations
- 1Cardiac Surgery Unit, Cardiothoracic and Vascular Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
- 2Cardiovascular Research Institute Maastricht, University of Maastricht, Maastricht, The Netherlands.
- 3Department of Surgical Sciences, University of Turin, Turin, Italy.
- 4Cardiac Surgery Unit, Department of Cardiothoracic and Vascular Surgery, Careggi University Hospital, Florence, Italy.
- 5Department of Cardiac Surgery, Azienda Ospedaliera Ordine Mauriziano di Torino, Turin, Italy.
- 6Division of Cardiac Surgery, University of Trento, ASUIT, Trento, Italy.
- 7Department of Cardiac Surgery, ASST Ovest Milanese, Legnano, Italy.
- 8Cardiac Surgery Department, University Hospital "SS. Antonio e Biagio e C. Arrigo", Alessandria, Italy.
- 9Department of Cardiac Surgery, European Hospital, Unicamillus University, Rome, Italy.
- 10School of Medicine and Surgery, University of Milano - Bicocca, Milan, Italy.
Abstract
Objectives
Pulmonary hypertension is diagnosed in 40% to 75% of patients affected by mitral valve diseases. Little is known regarding outcomes of patients with pulmonary hypertension undergoing mitral valve oeprations through minimally invasive approaches. This study compares the characteristics and in-hospital outcomes of patients undergoing minimally invasive mitral valve surgery, stratified by systolic pulmonary artery pressure.Methods
This multicenter, retrospective, prospective, observational study included adults undergoing mitral valve operations through a right minithoracotomy with or without tricuspid valve surgery and atrial fibrillation ablation between 2020 and 2024. Comparisons were performed between patients with systolic pulmonary artery pressure less than 31 mm Hg, systolic pulmonary artery pressure 31 to 55 mm Hg, and systolic pulmonary artery pressure more than 55 mm Hg based on European System for Cardiac Operative Risk Evaluation II cutoffs for systolic pulmonary artery pressure categories.Results
This analysis included 1121 patients (female, 47.5%; median age, 69 years, interquartile range, 59-77). Median systolic pulmonary artery pressure was 38 mm Hg (interquartile range, 30-50; systolic pulmonary artery pressure <31 mm Hg: n = 307, 27.4%; systolic pulmonary artery pressure 31-55 mm Hg: n = 152, 55.3%; systolic pulmonary artery pressure >55 mm Hg: n = 194, 17.3%). Patients with higher systolic pulmonary artery pressure 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 systolic pulmonary artery pressure more than 55 mm Hg (P < .001). Patients with higher systolic pulmonary artery pressure more frequently underwent mitral valve replacement and tricuspid annuloplasty and experienced more postoperative dialysis and pacemaker implantation but comparable rates of conversions to sternotomy, respiratory and bleeding complications, and in-hospital mortality (systolic pulmonary artery pressure <31 mm Hg: n = 3, 1%; systolic pulmonary artery pressure 31-55 mm Hg: n = 6, 1%; systolic pulmonary artery pressure >55 mm Hg: n = 5, 2.6%; P = .222) compared with patients with lower systolic pulmonary artery pressure.Conclusions
Despite a higher preoperative complexity, patients with high systolic pulmonary artery pressure could be considered for minimally invasive mitral valve surgery with acceptable rates of major intraoperative or postoperative complications regardless of their systolic pulmonary artery pressure values.
Related
- Twelve-month outcomes after fixation-free, 3-dimensional, lightweight SWING-Mesh implantation for minimally-invasive inguinal hernia repair: a multicenter prospective observational study
- Preoperative exercise capacity as a predictor of postoperative pulmonary complications in patients with esophageal cancer: a multicenter observational cohort study
- A case report-prone position ventilation as an ECMO sparing strategy for re-expansion pulmonary edema following minimally invasive cardiac surgery.
- Transaxillary minimally invasive mitral valve surgery: early and mid-term outcomes in 763 patients
- Minimally Invasive Coronary Artery Bypass Grafting in Patients With Prior Myocardial Infarction: A Propensity Score-Matched Retrospective Study
BibTeX
@article{mariani2026minimally,
title = {{Minimally invasive mitral surgery in patients with high pulmonary artery pressure: Results of a multicenter observational study.}},
author = {Silvia Mariani and Cristina Barbero and Valentina Gislao and Cecilia Capozza and Pierluigi Stefano and Paolo Centofanti and Vittoria Lodo and Francesco Onorati and Giorgia Cibin and Germano Di Credico and Andrea Audo and Ruggero De Paulis and Mauro Rinaldi and Giovanni Marchetto and Minimally Invasive Mitral Valve Surgery Registry Investigators},
journal = {JTCVS open},
year = {2026},
month = jul,
doi = {10.1016/j.xjon.2026.101966},
url = {https://europepmc.org/article/MED/42948459},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Minimally invasive mitral surgery in patients with high pulmonary artery pressure: Results of a multicenter observational study.
AU - Silvia Mariani
AU - Cristina Barbero
AU - Valentina Gislao
AU - Cecilia Capozza
AU - Pierluigi Stefano
AU - Paolo Centofanti
AU - Vittoria Lodo
AU - Francesco Onorati
AU - Giorgia Cibin
AU - Germano Di Credico
AU - Andrea Audo
AU - Ruggero De Paulis
AU - Mauro Rinaldi
AU - Giovanni Marchetto
AU - Minimally Invasive Mitral Valve Surgery Registry Investigators
PY - 2026
DA - 2026/07/16
JO - JTCVS open
DO - 10.1016/j.xjon.2026.101966
UR - https://europepmc.org/article/MED/42948459
AB - Objectives Pulmonary hypertension is diagnosed in 40% to 75% of patients affected by mitral valve diseases. Little is known regarding outcomes of patients with pulmonary hypertension undergoing mitral valve oeprations through minimally invasive approaches. This study compares the characteristics and in-hospital outcomes of patients undergoing minimally invasive mitral valve surgery, stratified by systolic pulmonary artery pressure.Methods This multicenter, retrospective, prospective, observational study included adults undergoing mitral valve operations through a right minithoracotomy with or without tricuspid valve surgery and atrial fibrillation ablation between 2020 and 2024. Comparisons were performed between patients with systolic pulmonary artery pressure less than 31 mm Hg, systolic pulmonary artery pressure 31 to 55 mm Hg, and systolic pulmonary artery pressure more than 55 mm Hg based on European System for Cardiac Operative Risk Evaluation II cutoffs for systolic pulmonary artery pressure categories.Results This analysis included 1121 patients (female, 47.5%; median age, 69 years, interquartile range, 59-77). Median systolic pulmonary artery pressure was 38 mm Hg (interquartile range, 30-50; systolic pulmonary artery pressure <31 mm Hg: n = 307, 27.4%; systolic pulmonary artery pressure 31-55 mm Hg: n = 152, 55.3%; systolic pulmonary artery pressure >55 mm Hg: n = 194, 17.3%). Patients with higher systolic pulmonary artery pressure 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 systolic pulmonary artery pressure more than 55 mm Hg (P < .001). Patients with higher systolic pulmonary artery pressure more frequently underwent mitral valve replacement and tricuspid annuloplasty and experienced more postoperative dialysis and pacemaker implantation but comparable rates of conversions to sternotomy, respiratory and bleeding complications, and in-hospital mortality (systolic pulmonary artery pressure <31 mm Hg: n = 3, 1%; systolic pulmonary artery pressure 31-55 mm Hg: n = 6, 1%; systolic pulmonary artery pressure >55 mm Hg: n = 5, 2.6%; P = .222) compared with patients with lower systolic pulmonary artery pressure.Conclusions Despite a higher preoperative complexity, patients with high systolic pulmonary artery pressure could be considered for minimally invasive mitral valve surgery with acceptable rates of major intraoperative or postoperative complications regardless of their systolic pulmonary artery pressure values.
SN - 2666-2736
ER -