Decrease of pulmonary hypertension impacts on prognosis after transcatheter aortic valve replacement
2014; European Association of Percutaneous Cardiovascular Interventions; Volume: 9; Issue: 9 Linguagem: Inglês
10.4244/eijv9i9a177
ISSN1969-6213
AutoresJan‐Malte Sinning, Christoph Hammerstingl, Derek Chin, Alexander Ghanem, Robert Schueler, Alexander Sedaghat, Johan Bence, Tomasz Spyt, Nikos Werner, Jan Kovac, Eberhard Grube, Georg Nickenig, Mariuca Vasa‐Nicotera,
Tópico(s)Cardiovascular Function and Risk Factors
ResumoTranscatheter aortic valve replacement (TAVR) is established as a treatment strategy for patients with end-stage aortic stenosis, many of whom are suffering from severe pulmonary hypertension (PH). In cardiac surgery patients, PH is associated with less symptomatic improvement and increased late mortality. This study elucidates the impact of PH on outcome after TAVR.Pre and 90 days post-TAVR, pulmonary artery systolic pressure (PASP) was determined non-invasively by echocardiography in 353 patients undergoing TAVR. PH was classified as absent ( 60 mmHg). Three hundred and fifty-three patients at high surgical risk, indicated by a logistic EuroSCORE of 26.6±16.5%, underwent TAVR. The severity of PH before TAVR was related to outcome with two-year mortality rates of 13.9%, 27.3%, and 48.4% for PASP 60 mmHg, respectively (p=0.001). In patients with baseline PASP >60 mmHg, PASP decreased from 65.6±7.6 mmHg to 49.5±14.0 mmHg (p<0.001) at 90 days after TAVR. Patients with persistent severe PH had a worse prognosis than patients with a decrease of PASP below 60 mmHg (two-year mortality rate: 50.0% vs. 18.6%; p=0.001).Severe pulmonary hypertension predicts adverse outcome after TAVR. Reduction of PASP after the procedure is associated with favourable prognosis.
Referência(s)