Author + information
- Luca Testa1
A severe pulmonary hypertension (PHy) is deemed to negatively affect the outcome after Transcatheter Aortic Valve Replacement (TAVR). However, a clear understanding of the pattern, evolution and clinical impact of different grades of PHy in this setting is lacking.
990 consecutive patients were enrolled in 6 high volume centers and analyzed as follows: group 1, systolic pulmonary pressure(sPAP) <40mmHg (346 patients,35%); group 2, sPAP 40 to 60mmHg (426 patients,43%); and group 3, sPAP >60mmHg (218 patients,22%).
At 1 month, mortality rate did not differ across the groups. As compared to group 1 and 2, patients in group 3 had a higher rate of NYHA 3-4(26%vs12% and 10%), and a higher rate of hospitalization for heart failure (7%vs3% and 3%). At 1 year, as compared to patients in group 1, patients in group 2 and 3 had both a higher overall mortality: [HR1.5(1.3-3.2),p=0.01,andHR2.3(1.8-2.8),p=0.001] and a higher cardiac mortality [HR1.3(1.1-2.1),p=0.01 and HR1.7(1.3-2.5),p=0.002]. After 1 month, the sPAP decreased >15mmHg in 32% and 35% of the patients in group 2 and 3. Baseline sPAP >60mmHg (HR1.6(1.1-2.3),p=0.03) and, in a larger extent, a persistent severe PHy after 1 month (HR2.4(1.5-2.8),p=0.004), independently predicted 1-year mortality, while the 1-month reduction of the sPAP did not.
The persistence of severe PHy after TAVR is a stronger predictor of 1 year mortality than baseline severe PHy. The early reduction of sPAP is not associated with a reduced mortality. The benefit of TAVR in terms of quality of life is substantial in patients with as well as without a reduction of sPAP at early follow up.
STRUCTURAL: Valvular Disease: Aortic