Impact of Periprocedural Pulmonary Hypertension on Outcomes After Transcatheter Aortic Valve Replacement

Abstract

Background: There are limited data on the prognostic impact of periprocedural pulmonary hypertension (PH) after transcatheter aortic valve replacement (TAVR).

Objectives: The aim of this study was to investigate the prognostic impact of normalized, new-onset, and residual PH after TAVR.

Methods: The OCEAN-TAVI (Optimized Transcatheter Valvular Intervention-Transcatheter Aortic Valve Implantation) registry is an ongoing, multicenter Japanese registry that includes 2,588 patients who underwent TAVR. Patients were classified into 4 groups according to periprocedural systolic pulmonary artery pressure by echocardiography: no PH before and after TAVR (no PH), PH before but not after TAVR (normalized PH), PH after but not before TAVR (new-onset PH), and PH before and after TAVR (residual PH). A systolic pulmonary artery pressure cutoff of >36 mm Hg was applied for PH. The primary endpoint was all-cause mortality at 2 years. Logistic regression analysis was used to identify clinical predictors of residual and new-onset PH.

Results: In total, 1,872 patients were divided into 4 groups: 1,027 (54.9%) in the no PH group, 257 (13.7%) in the normalized PH group, 280 (15.0%) in the new-onset PH group, and 308 (16.5%) in the residual PH group. There was a significant difference in all-cause mortality among the 4 groups at 2 years (11.0%, 12.8%, 18.6%, and 24.7%, respectively; P < 0.01). Among 565 patients who had preprocedural PH, 257 (45.5%) experienced normalization of PH, with mortality comparable with that in the no PH group. In multivariable logistic regression analysis, predictors of residual PH after TAVR were atrial fibrillation and baseline tricuspid regurgitation moderate or greater, whereas prosthesis-patient mismatch was a predictor of new-onset PH.

Conclusions: Risk stratification on the basis of post-TAVR PH status can identify patients at increased mortality after TAVR. Prosthesis-patient mismatch was identified as a novel predictor of new-onset PH. (Optimized Transcatheter Valvular Intervention-Transcatheter Aortic Valve Implantation [OCEAN-TAVI]; UMIN000020423).

Keywords: PH; PPM; TAVR; aortic stenosis; prosthesis-patient mismatch; pulmonary hypertension; sPAP; systolic pulmonary artery pressure; transcatheter aortic valve replacement.