The impact of pulmonary hypertension on outcomes of transcatheter mitral valve replacement in mitral annular calcification

Hector R. Cajigas, Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, Minnesota, USA.
Tatiana Kaptzan, Cardiovascular Research Unit, Mayo Clinic, Rochester, Minnesota, USA.
Bradley Lewis, Division of Biostatistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA.
Abdallah El-Sabbagh, Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, Florida, USA.
Mohammed Al-Hijji, Division of Cardiovascular Diseases, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
Mackram Eleid, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Mohamad Alkhouli, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Dee Dee Wang, Division of Cardiovascular Medicine, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan, USA.
Marvin Eng, Division of Cardiovascular Medicine, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan, USA.
Susheel Kodali, Division of Cardiology, Columbia University Medical Center, New York, New York, USA.
Isaac George, Department of Surgery, Columbia University Medical Center, New York, New York, USA.
Tarun Chakravarty, Division of Cardiology, Cedars Sinai Medical Center, Los Angeles, California, USA.Follow
Ashish Pershad, Division of Cardiology, Chandler Regional and Mercy Gilbert Medical Center, Gilbert, Arizona, USA.
Daniel O'Hair, Advocate Aurora Health
Noah Jones, Division of Cardiology, Mount Carmel East Hospital, Columbus, Ohio, USA.
Raj Makkar, Division of Cardiovascular Medicine, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan, USA.
Mark Reisman, Department of Medicine, University of Washington, Seattle, Washington, USA.
Martin Leon, Division of Cardiology, Columbia University Medical Center, New York, New York, USA.
William O'Neill, Division of Cardiovascular Diseases, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
Charanjit Rihal, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Mayra Guerrero, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.

Affiliations

Aurora St. Luke's Medical Center

Abstract

Objectives: To assess the impact of pulmonary hypertension (PH) on outcomes of patients with severe mitral annular calcification (MAC) undergoing transcatheter mitral valve replacement (TMVR).

Background: PH is associated with poor outcomes after mitral valve surgery. Whether the presence of PH in patients with MAC undergoing (TMVR) is associated with poor outcomes, is unknown.

Methods: Retrospective evaluation of 116 patients from 51 centers in 11 countries who underwent TMVR with valve in mitral annular calcification (ViMAC) using balloon-expandable aortic transcatheter valves (THVs) from September 2012 to March 2017. Pulmonary artery systolic blood pressure (PASP) by echocardiogram was available in 90 patients. The subjects were stratified based on PASP: No PH = PASP ≤35 mmHg (n = 11); mild to moderate PH = PASP 36-49 mmHg (n = 21) and severe PH = PASP ≥50 mmHg (n = 58). Clinical, procedural, and echocardiographic outcomes were assessed.

Results: Mean age was 72.7 (±12.8) years, 59 (65.6%) were female, Society of Thoracic Surgeons score was 15.8 + 11.8% and 90.0% where in New York Heart Association (NYHA) class III-IV. There was no significant difference in all-cause mortality at 30 days (no PH = 27.3%, mild-moderate PH = 19.0%, severe PH = 31.6%; p = 0.55) or at 1 year (no PH = 54.5%, mild-moderate PH = 38.1%, severe PH = 56.1%; p = 0.36). No difference in adverse events, NYHA class or amount of residual mitral regurgitation at 1 year were observed between the groups.

Conclusion: This study suggests that the presence of PH in patients with predominantly mitral stenosis with MAC undergoing TMVR does not impact mortality or adverse events. Further studies are needed to fully understand the effect of PH in this group of patients.

Document Type

Article

PubMed ID

35019204

Teammate Access

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