Cardiovascular Disease |

Enhanced Mortality Associated With Pulmonary Hypertension in Patients Undergoing Transcatheter Aortic Valve Replacement FREE TO VIEW

Raj Parikh, MD; Benson Varghese, MD; Huma Khatoon, MBBS; Clifford Kavinsky, MD; Rajive Tandon, MD
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Rush University Medical Center, Chicago, IL

Chest. 2015;148(4_MeetingAbstracts):62A. doi:10.1378/chest.2278908
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SESSION TITLE: Cardiovascular Disease Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Aortic stenosis (AS) resulting in left ventricular hypertrophy with resultant dysfunctional lusitropy leads to pulmonary vascular remodeling (Group 2 pulmonary hypertension). The aim of this study is to examine the effect of pulmonary hypertension (PH) in patients undergoing transcatheter aortic valve replacement (TAVR).

METHODS: We conducted a retrospective post-hoc analysis of 59 patients who underwent TAVR from June 2011 to February 2015 at a single tertiary care facility. Moderate/severe PH was defined as pulmonary artery systolic pressure greater than or equal to 50 mmHg versus mild PH (systolic PAP less than 50 mmHg) at time of TAVR as based on right heart catheterization (RHC). Moderate/severe PH (n = 19, 32.2%) None/mild PH (n = 40, 67.8%)

RESULTS: Pre TAVR acute kidney injury (AKI) was significant for moderate/severe PH (22.2% vs 5%; p = 0.0463). There was a tendency for development of post TAVR AKI (33.33% vs 12.5%, p = 0.0612). AKI was defined by The Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guidelines. Post TAVR incidence of heart block (11.11% vs 0%; p = 0.0319) and permanent pacemaker placement (16.67% vs 2.5%; p = 0.0489) were also significant for the moderate/severe PH patients. Significant increases in mortality were seen at 60 days (26.32% vs 5%; p = 0.018), 90 days (31.58% vs 5%; p = 0.0053), and 120 days (31.58% vs 5%; p = 0.0053) for the moderate/severe PH patients.

CONCLUSIONS: Our study finds that PH has a significant deleterious impact in patients undergoing TAVR. Increased short-term mortality, up to three months post TAVR and AKI highlights how right ventricular dysfunction complicates outcomes in this very frail patient population.

CLINICAL IMPLICATIONS: The development of PH is a poor prognostic indicator in aortic stenosis patients who are undergoing TAVR. Pre-operative optimization of PH with pulmonary vasodilators and inotropes with maintenance of euvolemia may play a pivotal role in long-term outcomes post-TAVR.

DISCLOSURE: The following authors have nothing to disclose: Raj Parikh, Benson Varghese, Huma Khatoon, Clifford Kavinsky, Rajive Tandon

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