Abstract 19884: Determinants and Prognostic Value of Pulmonary Hypertension in Patients Undergoing Trans-catheter or Surgical Aortic Valve Replacement
Objectives: We evaluated the determinants and prognostic value of pulmonary hypertension (PH) in patients with severe aortic stenosis (AS) undergoing trans-catheter (TAVR) or surgical aortic valve replacements (SAVR).
Methods: We evaluated 290 high-risk patients who underwent successful TAVR or SAVR at our institution from 2008-2012.
Results: Patients with PASP ≥ 50mmHg (n = 86) vs. PASP <50mmHg (n = 204) had significantly more mitral regurgitation (MR) grade ≥ 2, restrictive filling pattern with mitral E/A ≥2, more atrial fibrillation, and higher BNP (p < 0.01).
In patients with PASP ≥ 50 mmHg vs. PASP < 50mmHg 1-year mortality was: 26% vs. 18% (p = 0.227) for TF-TAVR, 47%, vs. 21% (p = 0.030) for TA-TAVR, and 36% vs. 14% (p = 0.033) for SAVR. At 1 month of follow-up: prevalence of MR grade ≥ 2 decreased from 49% to 31% in patients with PASP ≥ 50mmHg (p = 0.029) but was unchanged (23% vs. 22%) in patients with PASP < 50mmHg. Persistent or new PASP ≥ 50 mmHg at 1 month was associated with an increased 1-year mortality of 38%, compared with 16% in patients with PASP < 50 mmHg at 1 month (p < 0.001) (Figure). In subset of patients with baseline MR ≥2 grades, the 1-year mortality was significantly higher in patients with baseline PASP ≥ 50 mmHg vs. PASP < 50mmHg (48% vs. 13%, p < 0.001). For persistent MR ≥ 2 grades at 1 month of follow-up: the 1-year mortality was significantly higher in patients with persistent PASP ≥ 50 mmHg vs. PASP < 50mmHg (50% vs. 12%, p = 0.002) (Figure). In the cox regression analysis, persistent PASP ≥50 mmHg at 1 month was the most significant predictor of 1-year mortality (HR 3.2, 95% CI 1.6-6.1, p value = 0.001).
Conclusions: Severe PH is associated with increased mortality after both TA-TAVR and SAVR. TF-TAVR is associated with lower mortality in patients with PH. Persistent PH after the procedure is associated with worsened mortality. MR is a major determinant of PH.
Author Disclosures: A.M. Rafique: None. H. Jilaihawi: None. T. Chakravarty: None. N. Doctor: None. R. Arsanjani: None. A. Hage: None. M. Kashif: None. M. Gheorghiu: None. R. Makkar: None.
- © 2014 by American Heart Association, Inc.