Persistent Severe PH Predicts Death One Year Post-TAVR

What is the incidence of severe pulmonary hypertension after transcatheter aortic valve replacement and does it have prognostic value?

PH improvement one month after TAVR plateaus and this early improvement is not associated with lower mortality.

The association of persistent severe PH after TAVR with mortality is far stronger than that of baseline severe PH with mortality. This may reflect cases wherein the improved hemodynamic post-TAVR cannot improve pulmonary circulation.

Excluded were patients with past failed aortic bioprosthesis and past mitral valve surgery. Patients were divided into 3 groups based on severity of PH in order to observe impact on QOL, prognosis, and outcomes. 

One-month outcomes: No difference in overall or cardiac mortality across groups.

One-year outcomes: Overall mortality: 1.5 times higher risk in group 2, 2.3 times higher risk in group 3, vs group 1. Cardiac mortality: 1.3 times higher risk in group 2, 1.7 times higher risk in group 3, vs group 1.

Independent predictors of 1-year mortality: baseline sPAP >60 mm Hg; persitent severe PH after 1 month; CrC <30 mL/min; severe mitral regurgitation.

The authors conclude that even in cases where PH is irreversible the positive ipmact on QOL means that even is severe PH persists, global status may be improved.

Authors also note that further studies are needed to evaluate whether changes in pulmonary circulation become irreversible at an advanced stage of PH, even with aortic valve replacement and reduction of left-sided filling pressure.

Source: Testa L, Latib A, De Marco F, et al. Persistence of severe pulmonary hypertension after transcatheter aoritic valve replacement: incidence and prognostic impact. Circ Cardiovasc Interv. 2016;9(6).