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Patients with severe aortic stenosis and coexisting pulmonary hypertension treated by transapical transcatheter aortic valve replacement—Is there a need for increased attention?
Author(s) -
Keymel Stefanie,
Papadopoulos Georgios,
Minol Jan P.,
Blehm Alexander,
Krüger Stefan,
Afzal Shazia,
Jung Christian,
Westenfeld Ralf,
Lichtenberg Artur,
Kelm Malte,
Zeus Tobias,
Veulemans Verena
Publication year - 2020
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28358
Subject(s) - medicine , pulmonary hypertension , cardiology , stenosis , valve replacement , clinical endpoint , pulmonary artery , aortic valve stenosis , aortic valve replacement , aortic valve , surgery , clinical trial
Objectives Aim of this study is to elucidate the impact of pulmonary hypertension on patients treated with a transapical aortic valve replacement. Background In patients with aortic stenosis (AS) the coexistence of pulmonary hypertension (PH) is associated with increased peri‐operative risk for surgical aortic valve replacement. For transcatheter aortic valve replacement (TAVR), it is unknown whether transapical TAVR (TA‐TAVR) is associated with increased peri‐interventional risk in PH patients. Methods We performed a single center analysis in 189 patients with severe AS with (AS + PH) or without PH (AS − PH) undergoing TA‐TAVR. PH was defined by mean pulmonary artery pressure ≥25 mmHg assessed by right heart catheterization (exclusion of 64 patients due to missing results). As the primary endpoint a combination of 30‐day mortality or cardiopulmonary resuscitation (CPR) was analyzed. Results Seventy three patients (58.4%) had PH. Increased peri‐interventional risk in AS + PH patients was reflected by an increased rate of the primary endpoint in comparison to AS − PH patients (24.7 vs. 3.8%; p = .002). A higher proportion of acute kidney injury (34.2 vs. 15.7%; p = .025) was found in AS + PH patients while AS − PH patients showed a higher rate of bleeding in comparison AS + PH patients (18.5 vs. 6.8% p = .050). Conclusion Patients with AS + PH treated by TA‐TAVR are at increased peri‐interventional risk for severe complications in comparison to AS − PH patients. Therefore, the identification of preventive therapeutic strategies is needed. Classifications TAVR, transapical, pulmonary hypertension, aortic stenosis.