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Original research article
Outcomes of persistent pulmonary hypertension following transcatheter aortic valve replacement
  1. Ahmad Masri,
  2. Islam Abdelkarim,
  3. Michael S Sharbaugh,
  4. Andrew D Althouse,
  5. Jeffrey Xu,
  6. Wei Han,
  7. Stephen Y Chan,
  8. William E Katz,
  9. Frederick W Crock,
  10. Matthew E Harinstein,
  11. Dustin E Kliner,
  12. Forozan Navid,
  13. Joon S Lee,
  14. Thomas G Gleason,
  15. John T Schindler,
  16. João L Cavalcante
  1. Department of Medicine, Division of Cardiovascular Diseases, University of Pittsburgh, UPMC-Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr. João L Cavalcante, Heart & Vascular Institute - UPMC, University of Pittsburgh, 200 Lothrop Street, Scaife Hall, S-558 Pittsburgh, PA 15213, USA; cavalcantejl{at}upmc.edu

Abstract

Objectives To determine the prevalence and factors associated with persistent pulmonary hypertension (PH) following transcatheter aortic valve replacement (TAVR) and its relationship with long-term mortality.

Methods Consecutive patients who underwent TAVR from July 2011 through January 2016 were studied. The prevalence of baseline PH (mean pulmonary artery pressure ≥25 mm Hg on right heart catheterisation) and the prevalence and the predictors of persistent≥moderate PH (pulmonary artery systolic pressure (PASP)>45 mm Hg on 1 month post-TAVR transthoracic Doppler echocardiography) were collected. Cox models quantified the effect of persistent PH on subsequent mortality while adjusting for confounders.

Results Of the 407 TAVR patients, 273 (67%) had PH at baseline. Of these, 102 (25%) had persistent≥moderate PH. Mortality at 2 years in patients with no baseline PH versus those with PH improvement (follow-up PASP≤45 mm Hg) versus those with persistent≥moderate PH was 15.4%, 16.6% and 31.3%, respectively (p=0.049). After adjusting for Society of Thoracic Surgeons Predicted Risk of Mortality and baseline right ventricular function (using tricuspid annular plane systolic excursion), persistent≥moderate PH remained associated with all-cause mortality (HR=1.82, 95% CI 1.06 to 3.12, p=0.03). Baseline characteristics associated with increased likelihood of persistent≥moderate PH were ≥moderate tricuspid regurgitation, ≥moderate mitral regurgitation, atrial fibrillation/flutter, early (E) to late (A) ventricular filling velocities (E/A ratio) and left atrial volume index.

Conclusions Persistency of even moderate or greater PH at 1 month post-TAVR is common and associated with higher all-cause mortality.

  • pulmonary vascular disease
  • transcatheter valve interventions
  • aortic stenosis

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Footnotes

  • Contributors AM, IA, JSL, TGG, JTS and JLC: designed the study, data extraction, wrote and revised the manuscript. JX and WH: data extraction. MSS and ADA: designed the study, performed the analysis, wrote and revised the manuscript. SYC, WEK, FWC, MEH, DEK and FN: designed the study, reviewed the manuscript.

  • Funding This work was supported by the National Institutes of Health (HL096834, HL124021 to SYC) and the American Heart Association (14GRNT19600012 to SYC).

  • Competing interests JLC and TGG received investigator-initiated grant support from Medtronic. None of the other coauthors have any conflict of interest relevant to the content of this manuscript.

  • Ethics approval IRB-University of Pittsburgh.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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