Author + information
- Gavin Hickey1,
- Dustin Kliner2,
- Jeffrey Xu3,
- Floyd Thoma2,
- Andrew Althouse2,
- Joon Lee2,
- John Schindler2,
- Thomas Gleason3 and
- Joao Cavalcante4
Pulmonary hypertension (PH) is common in patients with severe aortic stenosis treated with transcatheter aortic valve replacement (TAVR). Though PH in this population is primarily driven by elevated left-sided pressure (post-capillary PH), some patients have increased pulmonary vascular resistance (PVR), thus combined pre- and post-capillary PH. We sought to determine if increased PVR in PH patients undergoing TAVR would be associated with increased mortality when compared to those with normal pulmonary pressure, or elevated pulmonary artery pressure and normal PVR.
We performed a retrospective study of 439 patients treated at a single center who had right heart catheterization (RHC) prior to TAVR. PH was defined as a mean pulmonary artery pressure (mPAP) ≥ 25 mmHg. We report the frequency of PH as well as the proportion with PVR ≥ 3 Wood units (WU). Kaplan-Meier analysis and Cox proportional-hazards regression were used to quantify the effect of high PVR on subsequent mortality within the PH population.
Of the 439 patients with baseline RHC, 305 (70%) had PH prior to TAVR, of which 122 (40%) had PVR ≥ 3 WU. After adjustment for baseline characteristics using STS-PROM score, TAVR patients with PH and PVR≥3 had the highest mortality (HR=1.58, 95% CI 0.95-2.64, p=0.079), while patients with PH and PVR<3 had only slightly increased mortality (HR=1.04, 95% CI 0.62-1.75, p=0.865).
TAVR patients with PH and high PVR have the highest mortality, moreso than those with PH and normal PVR, or without PH. Therefore, PVR provides additional risk stratification in TAVR patients with PH. Use of RHC prior to TAVR may provide useful insight into long-term outcome.
STRUCTURAL: Valvular Disease: Aortic