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Impact of persistent pulmonary hypertension on the outcome of patients undergoing transcatheter aortic valve replacement

Session The ageing heart: a target for interventions and aggressive pharmacotherapy

Speaker Konstantinos Toutouzas

Event : ESC Congress 2018

  • Topic : cardiovascular disease in special populations
  • Sub-topic : Cardiovascular Disease in the Elderly
  • Session type : Moderated Posters

Authors : K Stathogiannis (Athens,GR), K Toutouzas (Athens,GR), M Drakopoulou (Athens,GR), G Latsios (Athens,GR), A Synetos (Athens,GR), G Trantalis (Athens,GR), G Oikonomou (Athens,GR), M Xanthopoulou (Athens,GR), V Penesopoulou (Athens,GR), E Tsiamis (Athens,GR), D Tousoulis (Athens,GR)

K. Stathogiannis1 , K. Toutouzas1 , M. Drakopoulou1 , G. Latsios1 , A. Synetos1 , G. Trantalis1 , G. Oikonomou1 , M. Xanthopoulou1 , V. Penesopoulou1 , E. Tsiamis1 , D. Tousoulis1 , 1Hippokration Hospital, University of Athens, 1st Department of Cardiology - Athens - Greece ,

European Heart Journal ( 2018 ) 39 ( Supplement ), 439

Background: Persistent severe pulmonary hypertension (PH) is considered to negatively affect early and late outcomes of patients undergoing aortic valve surgery. Data however, on the incidence of persistent PH after transcatheter aortic valve replacement (TAVR) and its impact on outcome is limited.

Purpose: We sought to investigate the impact of persistent PH on clinical outcomes of patients undergoing TAVR with a self-expanding valve.

Methods: Consecutive patients with severe symptomatic aortic stenosis scheduled for TAVR in our tertiary center were included in the study. Prospectively collected data before and after TAVR were retrospectively analyzed in all patients. Severe PH was defined as systolic pulmonary arterial pressure (sPAP) ≥50mmHg as assessed by echocardiography. For analysis purposes, patients with a sPAP decrease after TAVR to below 50mmHg were compared to patients with persistent PHTN following TAVR. All outcomes were evaluated according to the VARC-2 criteria.

Results: Of the 225 patients included in the present study, 56 (25%) patients had severe PH prior to TAVR. This group of patients was older (81.6±6 vs 79.3±7.8, p=0.047), presented with higher logEuroscore (28.4±10.2% vs 23±9.7%, p=0.001), lower ejection fraction (47.6±8.8% vs 51.5±9%, p=0.005), higher rate of at least moderate mitral regurgitation (43% vs 20%, p=0.014) and higher rate of at least moderate tricuspid regurgitation (44% vs 17%, p<0.01) compared to the group with sPAP<50mmHg. Patients with severe PH prior to TAVR, had a significant reduction in mean sPAP after TAVR (63.2±8.7mmHg to 50.2±14.6mmHg, p<0.01). Following TAVR, 55% of the patients with prior severe PH experienced a reduction in sPAP to below 50 mmHg. In multivariate analysis, low pre-TAVR ejection fraction (p=0.007, OR 0.947, 95% CI 0.91–0.98) was identified as an independent predictor for persistent PH. At long-term follow-up, 42% of patients with PH had died compared to 19% of patients that had no PH (p=0.009).

Conclusions: Our data suggest that TAVR is associated with a significant reduction in sPAP in more than half of the patients with pre-procedural PH. The persistence of severe PH after TAVR is a stronger predictor of mortality than baseline severe PH.

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