Abstract 18550: Incidence and Effect of Persistent Pulmonary Hypertension After Transcatheter Aortic Valve Replacement
Introduction: Limited data are available regarding the decrease in pulmonary artery systolic pressure in patients undergoing transcatheter aortic valve implantation (TAVI). Moreover, there are still controversial issues concerning the effect of persistent PHT on the prognosis of these patients.
Hypothesis: This study is designed to elucidate the incidence and effect of persistent PHT on all-cause mortality of patients with severe aortic stenosis undergoing TAVI.
Methods: Patients with severe and symptomatic aortic stenosis (effective orifice area [EOA]≤1cm2), scheduled for TAVI with a self-expanding valve at our institution, were consecutively enrolled. Prospectively collected echocardiographic data before and after TAVI were retrospectively analysed in all patients. Pulmonary artery systolic pressure was estimated as the sum of the right ventricular to the right atrial gradient during systole and the right atrial pressure. PHT following TAVI was classified as normal if <35mmHg and persistent if ≥35mmHg. Primary clinical end-point was cumulative mortality defined according to the criteria proposed by the Valve Academic Research Consortium-2.
Results: We included 174 patients (mean age: 80.0±6.8 years) in the study. The primary clinical end point occurred in 42 patients (23.6%) during a follow-up period of 24.8±20.4 months. Mean pulmonary artery systolic pressure was reduced in all patients following TAVI (43.8±12.3 versus 41.2±9.3mmHg, p<0.01). Mortality rate was higher in patients with persistent PHT compared to patients with normal PHT after TAVI (37%% versus 10.8%, p<0.01). Patients that reached the primary clinical end point had a higher post procedural mean systolic pulmonary pressure (43.4±7.6 versus 40.4±9.7mmHg, p=0.04). In multivariate regression analysis, persistence of PHT [OR=3.269 (95% CI: 1.322-8.044, p=0.01)] was an independent predictor of cumulative mortality.
Conclusions: The early reduction of systolic pulmonary pressure after TAVI is found to be associated with reduced cumulative mortality. The present results suggest that persistent pulmonary hypertension consist an independent predictor of long term mortality.
- Aortic valve stenosis
- Percutaneous non-coronary cardiac intervention
- Transcatheter aortic valve implantation
- Pulmonary hypertension
Author Disclosures: M. Drakopoulou: None. K. Toutouzas: None. A. Michelongona: None. K. Stathogiannis: None. G. Latsios: None. A. Synetos: None. G. Trantalis: None. G. Lazaros: None. E. Tsiamis: None. D. Tousoulis: None.
- © 2016 by American Heart Association, Inc.