Abstract 17796: Pulmonary Artery Hypertension Improves Rapidly In Patients With Severe Aortic Stenosis Who Underwent Transcatheter Aortic Valve Replacement
Background: Patients who associate severe aortic stenosis (AS) and severe pulmonary arterial hypertension (PAH) have a bad prognosis. There are poor data on the effect of transcatheter aortic valve replacement (TAVI) in these patients. We assessed the effects of improved left ventricular output on PAH in patients receiving TAVI with the CoreValve Medtronic System TM.
Methods: 67 consecutive patients (82±6.2 years, 52% female) with TAVI were divided in two groups: group I, of 25 patients (37%), with history of chronic obstructive pulmonary disease (COPD) and with severe secondary PAH (defined as systolic pressure in pulmonary artery (sPAP) >50 mmHg); group II, of 42 patients (63%), with no history of COPD, divided in two subgroups — IIa, with sPAP<50 mmHg (26 patients), and IIb, with sPAP>50 mmHg (16 patients). Echocardiography before TAVI and after 30 days assessed LV function (by ejection fraction — LVEF), RV function (by TAPSE) and dimensions, severity of secondary tricuspid regurgitation (tricuspid jet area — TJA), and sPAP.
Results: There were no significant differences for age, aortic valve gradient, valve area between groups. At 30 days post TAVI, patients with sPAP>50 mmHg had a significant decrease of PAH with concomitant improvement of RV function and dimensions (table), whereas patients with PAP<50 mmHg had only an improvement of PAH. As expected, there was no improving for patients with secondary PAH. LVEF increased from 47±12 to 53±10% (p<0.01), significant among all three groups. There was a positive correlation between the increase of LVEF and decrease of PAP secondary to AS (R<sup>2<reset>=0.52, p= 0.02). Severe PAH and ejection fraction less than 30% were an independent predictors of in-hospital mortality (R<sup>2<reset>=0.49, p= 0.03).
Conclusions: PAH secondary to severe AS is common and can be expected to improve after TAVI. PAH is an important predictor for in-hospital mortality.
- © 2010 by American Heart Association, Inc.