Effect of pulmonary hypertension on patients with aortic stenosis who undergo transcatheter aortic valve replacement


Aurora Sinai / St. Luke's Medical Centers, Aurora Medical Group - Cardiovascular and Thoracic Surgery


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.

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