Long-term outcome of patients with severe pulmonary hypertension undergoing transcatheter aortic valve implantation

TL;DR

Patients with severe pulmonary hypertension face higher risks and worse outcomes after a heart valve procedure called TAVI.

Contribution

This study identifies severe pulmonary hypertension as a high-risk factor for poor outcomes in TAVI patients.

Findings

Patients with severe PH had higher acute mortality and worse long-term survival after TAVI.

Severe PH was linked to increased acute adverse events like bleeding and renal failure.

Higher rates of complications and mortality persisted up to five years post-TAVI in severe PH patients.

Abstract

Recent reports suggest that pulmonary hypertension (PH) is associated with a significantly higher acute mortality after transcatheter aortic valve implantation (TAVI). The aim of this study is to characterize patients undergoing TAVI with preoperative echocardiographically determined severe PH and to investigate acute clinical and long-term outcomes.

From 2008 to 2021, 3,610 patients with preoperatively documented systolic pulmonary artery pressure (sPAP) underwent TAVI at our institution. The cut off for severe PH was defined as sPAP > 55 mmHg as determined by echocardiography. Severe PH was preoperatively identified in 456 patients. This group was compared to 3,154 patients with sPAP ≤ 55 mmHg. Data were retrospectively analysed according to updated Valve Academic Research Consortium (VARC-3) definitions.

TAVI patients with sPAP > 55 mmHg presented with higher median age (sPAP ≤ 55 mmHg: 81.6 years [interquartile range (IQR): 77.2–85.1] vs. sPAP > 55 mmHg: 82.3 (IQR 77.8–85.8), p = 0.01) and higher prevalence of significant left ventricular dysfunction (LVEF < 35%) (9.7 vs. 15.5%, p < 0.001). Acute outcomes were impaired in patients with severe PH. The detrimental effect of severe PH persisted in Kaplan–Meier analysis one-year after TAVI (mortality rate 20.0 vs. 30.2%, p < 0.001) and in 60-month follow-up (52.0 vs. 65.1%, p < 0.001).

TAVI patients with severe PH represent a high-risk subgroup with unfavourable acute outcomes and increased one-year and long-term mortality. Moreover, the presence of severe PH is associated with increased rates of acute adverse events, including bleeding, need for PPM implantation and renal failure.

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