Effect of pulmonary hypertension on patients with aortic stenosis who undergo transcatheter aortic valve replacement
Yousefzai R, Allaqaband S, Shetabi K, Anigbogu M, Murtaza G, Agarwal A, Cho C, Palakuru S, O'Hair D, Bajwa T. Effect of pulmonary hypertension on patients with aortic stenosis who undergo transcatheter aortic valve replacement: D-056. Catheter Cardiovasc Inter. 2014 May;83(Suppl 1):S219.
Background: Pulmonary hypertension (PHTN) is associated with worse outcome after surgical aortic valve replacement. The effect of severe PHTN has not been well-studied in patients who undergo transcatheter aortic valve replacement (TAVR). We compared patients with and without severe PHTN who undergo TAVR.
Methods:From January 2012 to September 2013, 46 patients with severe aortic stenosis underwent TAVR at our institution. Right ventricular systolic pressure (RVSP), a surrogate for PHTN, was measured. Outcomes were compared between patients with (RVSP > 50 mmHg) or without (RVSP
Results: Of 46 TAVR patients, 18 (39%) had severe PHTN and 28 (61%) did not. The severe PHTN group had more men; all other clinical characteristics, number of interventions required, symptoms and operative mortality (STS score) were similar. Patients with severe PHTN had a larger left atrium and higher right-sided pressure; other echocardiographic and angiographic characteristics were similar. One-year mortality was higher in patients with severe PHTN (50% vs. 14%, log-rank p=0.0075). After adjusting for STS score, PHTN remained a strong predictor of mortality (hazard ratio 6.31, 95% confidence interval 1.68-23.70) (Figure). Patients with severe PHTN required longer use of inotropes; however, length of stay and need for intervention were similar.
Conclusion: One-year mortality following TAVR is significantly higher in patients with severe PHTN.