Pulmonary Hypertension Predicts Patient Outcome After Heart Valve Replacement Surgery

In a recent study entitled “Prevalence and Impact of Pulmonary Hypertension on Patients With Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement,” a team of MDs reported that pulmonary hypertension (PH) is an independent factor capable of predicting patient outcomes after Transcatheter aortic valve replacement surgery. The study was published in The American Journal of Cardiology.

Pulmonary hypertension (PH) is characterized by an increase in blood pressure within lung vasculature (including arteries, veins and capillaries) resulting in dizziness and shortness of breath associated with fainting episodes and leg swelling, among other symptoms. In patients with severe aortic stenosis (AS) – when the heart’s aortic valve is too narrow, limiting the amount of blood flow exiting the heart – who need aortic valve surgery, PH is a frequent comorbidity associated with a poor prognosis. The reason for the increased risk is due to alterations in blood flow and pressure, features determined as part of a process known as hemodynamics. Because of this, a different surgery strategy called Transcatheter aortic valve replacement (TAVR) might offer an alternative to patients with severe AS and PH, since it does not seem to cause significant hemodynamic alterations.

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The researchers evaluated the occurrence of PH in patients with severe AS who were submitted to TAVR, and how the surgery impacted pulmonary artery hemodynamics in the long run. To this end, 415 patients were analyzed – all the patients presented severe AS and underwent TAVR surgery at MedStar Washington Hospital Center in Washington, D.C.

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It was found that after TAVR surgery an overall decrease in patients’ systolic pulmonary artery pressure (SPAP) was achieved, however, only 26% of patients with moderate to severe PH do experience a significant reduction (SPAP >10 mmHg). While patients with moderate to severe pulmonary hypertension (described as SPAP > 50 mm Hg) are not at higher risk for post-surgery complications, their death rates are significantly higher than those with no or mild PH.

The authors explained that their findings suggest the presence of PH is an independent predictor of poor patient outcomes after TAVR (both short and long-term), as established for cardiac surgery.