Abstract 17524: Predictors of Mortality in Patients With Persistent Pulmonary Hypertension Following Transcatheter Aortic Valve Replacement
Introduction: Pulmonary hypertension (PH) is highly prevalent in patients with severe aortic stenosis referred for transcatheter aortic valve replacement (TAVR) evaluation. We sought to assess the prevalence and predictors of residual PH following TAVR and its relationship with mortality.
Methods: Single-center retrospective study of 406 patients (mean age 84, 52.1% men) who underwent TAVR from July 2011 through January 2016. We investigated the prevalence of moderate to severe PH (PA systolic pressure>45 mmHg) on echocardiography prior to TAVR, the prevalence and predictors of residual PH (PA systolic pressure>45 mmHg) on post TAVR follow up echo; median 29 days (IQR 29-36 days). Logistic regression was used to identify baseline factors associated with increased risk of residual PH; Kaplan-Meier curves and Cox models were used to quantify the effect of residual PH on subsequent mortality.
Results: Of the 406 TAVR patients, 181 (44.5%) had moderate to severe PH on echo prior to TAVR. Of these, 146 had a subsequent echo after TAVR with 87 (59.6%) showing residual moderate to severe PH. Prior moderate to severe TR was the only predictor of residual PH (OR=3.46, 95% CI 1.64-7.29, p=0.001). Mortality at 2 years in patients with no baseline PH, patients with baseline PH that improved, and patients with residual moderate to severe PH were 16%, 23%, and 35% (p=0.035), respectively. After adjusting for STS-PROM, patients with residual PH at one month had the highest mortality (HR=1.67, 95% CI 1.02-2.74, p=0.042)
Conclusion: Persistent moderate to severe PH one month post TAVR is very common and strongly associated with a higher 2-year mortality as compared to those with resolved PH. Pre-procedural moderate to severe TR is a predictor of residual PH and subsequent mortality. Whether this could a modifiable target for future therapies beyond TAVR requires further investigation.
Author Disclosures: A. Masri: None. M.S. Sharbaugh: None. A.D. Althouse: None. I. Abdelkarim: None. W. Han: None. W.E. Katz: None. F. Crock: None. M. Harinstein: None. D.E. Kliner: None. F. Navid: None. T.G. Gleason: None. J.S. Lee: None. J.T. Schindler: None. J.L. Cavalcante: None.
- © 2016 by American Heart Association, Inc.