Objectives

Echocardiography is the method of choice in clinical practice to determine pulmonary hypertension (PH) prior to transcatheter aortic valve implantation (TAVI). This study aims to characterize TAVI patients with echocardiographically determined severe PH and to investigate clinical outcomes and impact on technical success of this subset of patients.

Methods

From 2008 –2021, 3.609 patients with documented systolic pulmonary artery pressure (sPAP) underwent TAVI at our institution. The cut off for severe PH was defined as sPAP of >55mmHg. 450 patients with severe PH were identified (study group) and compared to 3.159 patients with sPAP <55mmHg (control group). Data were retrospectively analysed according to updated Valve Academic Research Consortium (VARC-3) definitions.

Results

Patients in the control group presented with lower overall risk profile compared to study group patients ([control group vs. study group] age: 80.7±6.8 vs. 81.4±6.5 years, p=0.7; STS score: 5.6±6.4 vs. 6.6±4.7%, p=0.001; LVEF<30%: 10.1 vs. 14.6%, p=<0.001) Rate of transfemoral access was more frequent in the control group (78.4 vs. 71.1%, p=0.001). Transvalvular gradients after TAVI showed no significant difference between groups (9.5±7.8 vs. 9.1±4.4mmHg, p=0.28) There were no significant differences in rates of device success (91.7 vs. 91.8%, p=1.0), myocardial infarction (MI) (0.8 vs. 1.4%, p=0.26) renal failure (RF) >AKIN II (3.2 vs. 4.5%, p=0.2), disabling or non-disabling stroke (3.2 vs. 4.5%, p=0.16), permanent pacemaker implantation (PPI) (14.4 vs. 17.9%, p=0.06) or paravalvular leak (PVL) ≥moderate (3.9 vs. 5.7%, p=0.08) in both groups. Major Bleeding and 30-day mortality were significantly increased in the study group (8.9 vs. 14.6%, p=<0.001; 5.9 vs. 10.0%, p=0.002). Acute mortality <24h was low and without significant difference between groups (0.7 vs. 1.3%, p=0.13). Subanalysis of the study group showed no significant difference for major bleeding or mortality in transfemoral vs. non-transfemoral treated patients (13.3 vs. 17.9%, p=0.23; 9.3 vs. 11.7%, p=0.49).

Conclusion

Patients with a severe PH demonstrated increased rates of 30-day mortality and major bleeding and may therefore represent a subset of patients at particularly high risk. Acute mortality <24h was low in both groups. However, no significant differences on technical success as well as periprocedural complications such as PVL, MI, stroke, PPI, or RF were observed. Hemodynamic outcome was similar. These results indicate that perioperative management of TAVI patients with PH may be of particular importance for clinical outcomes.