Outcomes of persistent pulmonary hypertension following transcatheter aortic valve replacement. Issue 10 (29th September 2017)

• Record Type: Journal Article
• Authors: Masri, Ahmad; Abdelkarim, Islam; Sharbaugh, Michael S; Althouse, Andrew D; Xu, Jeffrey; Han, Wei; Chan, Stephen Y; Katz, William E; Crock, Frederick W; Harinstein, Matthew E; Kliner, Dustin E; Navid, Forozan; Lee, Joon S; Gleason, Thomas G; Schindler, John T; Cavalcante, João L
• Is Part Of: Heart. Volume 104:Issue 10(2018)
• Page Start: 821
• Page End: 827
• Publication Date: 2017-09-29
• Subjects: pulmonary vascular disease -- transcatheter valve interventions -- aortic stenosis; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2017-311978
• Languages: English
• ISSNs: 1355-6037

Abstract

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.