Faculty Collaboration Database

The impact of increased pulmonary arterial pressure on outcomes after transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2020 Dec;96(7):E723-E734

Date

04/04/2020

Pubmed ID

32243048

DOI

10.1002/ccd.28862

Scopus ID

2-s2.0-85083054819 (requires institutional sign-in at Scopus site)   8 Citations

Abstract

OBJECTIVE: To evaluate the impact of increased pulmonary artery systolic pressure (PASP) on outcomes after transcatheter aortic valve replacement (TAVR).

METHODS: A total of 242 patients who underwent TAVR were retrospectively reviewed. Transthoracic echocardiography estimated PASP. The cohorts were divided into three groups according to the numerical change of PASP; Increased (post-TAVR PASP at 1 month minus pre-TAVR PASP, ≥ + 5 mmHg; n = 52), No change (-5 to +5 mmHg; n = 86) and Decreased (≤ -5 mmHg; n = 104). Patient demographics and clinical outcomes until 1 year were evaluated. Logistic regression model was used for multivariate risk analysis.

RESULTS: At 1 year, the Increased group showed higher mortality (21 ± 6%) than the No change group (5 ± 2%) (hazard ratio [HR]: 4.8, 95% confidence interval [CI]: 1.7-13.5; p < .01) and the Decreased group (8 ± 3%) (HR: 2.8, 95% CI: 1.1-6.7; p = .02). Rehospitalization rate for valve-related or heart failure was also higher in the Increased group (21 ± 6%) than the No change group (10 ± 3%) (HR: 2.4, 95% CI: 1.1-6.0; p = .04). Predictors of PASP deterioration were hypertension (odds ratio [OR]: 3.9, 95% CI: 1.1-13.8; p = .04) and left ventricular end-diastolic diameter >50 mm (OR: 2.2, 95% CI: 1.1-4.6; p = .04), and the increased PASP remained an independent predictor of 1-year all-cause mortality (HR; 2.7, 95% CI: 1.0-6.8; p = .04).

CONCLUSIONS: Regardless of the baseline PASP, patients with increased PASP at 1 month after successful TAVR were at higher risk of mortality and rehospitalization within 1 year. Strict medical management should be considered for patients who showed dilated left ventricle preoperatively.

Author List

Ujihira K, Kohmoto T, Gimelli G, Raval A, Jacobson K, Wolff M, Osaki S

Author

Takushi Kohmoto MD, PhD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Aged, 80 and over
Aortic Valve Stenosis
Arterial Pressure
Echocardiography
Female
Humans
Male
Middle Aged
Patient Readmission
Postoperative Complications
Pulmonary Artery
Recovery of Function
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Transcatheter Aortic Valve Replacement
Treatment Outcome