Outcomes of persistent pulmonary hypertension following transcatheter aortic valve replacement

Ahmad Masri, Islam Abdelkarim, Michael S. Sharbaugh, Andrew D. Althouse, Jeffrey Xu, Wei Han, Stephen Y. Chan, William E. Katz, Frederick W. Crock, Matthew E. Harinstein, Dustin E. Kliner, Forozan Navid, Joon S. Lee, Thomas G. Gleason, John T. Schindler, João L. Cavalcante

Research output: Contribution to journalArticlepeer-review

23 Scopus citations

Abstract

Objectives To determine the prevalence and factors associated with persistent pulmonary hypertension (PH) following transcatheter aortic valve replacement (TAVR) and its relationship with long-Term mortality. Methods Consecutive patients who underwent TAVR from July 2011 through January 2016 were studied. The prevalence of baseline PH (mean pulmonary artery pressure ≥25 mm Hg on right heart catheterisation) and the prevalence and the predictors of persistent≥moderate PH (pulmonary artery systolic pressure (PASP)>45 mm Hg on 1 month post-TAVR transthoracic Doppler echocardiography) were collected. Cox models quantified the effect of persistent PH on subsequent mortality while adjusting for confounders. Results Of the 407 TAVR patients, 273 (67%) had PH at baseline. Of these, 102 (25%) had persistent≥moderate PH. Mortality at 2 years in patients with no baseline PH versus those with PH improvement (follow-up PASP≤45 mm Hg) versus those with persistent≥moderate PH was 15.4%, 16.6% and 31.3%, respectively (p=0.049). After adjusting for Society of Thoracic Surgeons Predicted Risk of Mortality and baseline right ventricular function (using tricuspid annular plane systolic excursion), persistent≥moderate PH remained associated with all-cause mortality (HR=1.82, 95% CI 1.06 to 3.12, p=0.03). Baseline characteristics associated with increased likelihood of persistent≥moderate PH were ≥moderate tricuspid regurgitation, ≥moderate mitral regurgitation, atrial fibrillation/flutter, early (E) to late (A) ventricular filling velocities (E/A ratio) and left atrial volume index. Conclusions Persistency of even moderate or greater PH at 1 month post-TAVR is common and associated with higher all-cause mortality.

Original languageEnglish (US)
Pages (from-to)821-827
Number of pages7
JournalHeart
Volume104
Issue number10
DOIs
StatePublished - May 1 2018
Externally publishedYes

Keywords

  • aortic stenosis
  • pulmonary vascular disease
  • transcatheter valve interventions

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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