Risk of death nearly doubles after heart valve surgery for PH patients
Coexisting conditions may affect mortality both short and long term
Having pulmonary hypertension (PH) increases the risk of death, both in the short and long term, for individuals undergoing surgery for the heart valve disease aortic stenosis, a new analysis of published studies has found.
Noting the older age, generally, of people with aortic stenosis undergoing the procedure, the researchers said it’s possible that an interaction between PH and coexisting conditions — such as coronary artery disease, chronic kidney disease, or diabetes — may increase the risk of death, or mortality, for these patients.
Still, the risk of death was roughly doubled, both at 30 days and one year post-heart valve surgery, for people with PH, the data showed.
But even so, having PH had no impact on the risk of major bleeding events, heart attack, stroke, or pacemaker implantation after the procedure, the researchers noted.
Collectively, according to the team, these findings underscore “the need for careful assessment and management of PH in this [patient] population.”
The study, “Effect of pulmonary hypertension on the prognosis of patients with severe aortic stenosis after transcatheter aortic valve replacement: a systematic review and meta-analysis,” was published in the journal BMC Cardiovascular Disorders.
Aortic stenosis, a common heart valve disease in older people, is marked by the narrowing of the aortic valve. This narrowing impedes blood flow between the heart’s lower left chamber, or ventricle, and the body’s main artery, the aorta. It makes the left ventricle work harder to pump blood through the valve, which can lead to a thickening of the ventricle walls and eventually heart failure.
Transcatheter aortic valve replacement, or TAVR, is a minimally invasive surgical procedure used to treat aortic stenosis. It involves replacing the diseased aortic valve with a new valve, which is delivered to the heart via a catheter, typically through a blood vessel in the leg.
Conflicting evidence on effects of PH on heart valve surgery
PH, or elevated blood pressure in the blood vessels that supply the lungs, is a common complication of aortic stenosis. The presence of PH can impose additional stress on the heart, especially the right ventricle, which pumps blood through the lungs, potentially worsening post-TAVR outcomes.
Despite its clinical significance, the impact of PH on mortality and heart-related problems in people with aortic stenosis undergoing TAVR remains under debate. Some studies suggest that PH is an independent predictor of adverse outcomes post-TAVR, while others report no impact.
Faced with conflicting evidence, a research team in China conducted a meta-analysis — a pooled assessment of published studies that evaluated the impact of PH on TAVR outcomes in aortic stenosis patients.
“By pooling data from multiple cohort studies, we aim to clarify the [outcome] implications of PH in this patient population, thus informing clinical decision-making and risk stratification for [aortic stenosis] patients with [co-occurring] PH,” the researchers wrote.
No impact found in study on risk of stroke, need for pacemaker
The researchers selected seven studies for the meta-analysis, which encompassed 5,042 patients who underwent TAVR. Among them, 2,750 had PH and 2,292 did not. The average age of study participants in both groups ranged from 78 to 84.7.
The results showed that, in studies that reported on outcomes within 30 days of the procedure, having PH more than doubled the risk of death by any cause.
Still, PH had no impact on major bleeding events, the risk of stroke, or the need for pacemaker implantation during that time.
Future studies should explore targeted therapies to optimize outcomes for [valve replacement surgery] patients with PH, as well as investigate underlying mechanisms contributing to increased mortality.
Regarding outcomes, one year after TAVR, having PH nearly doubled the risk of death by any cause, and more than doubled the risk of cardiovascular death. PH, however, did not increase the risk of heart attacks or stroke in the long term.
The results remained the same even when individual studies were sequentially excluded from the analysis, suggesting that “the meta-analysis results are stable and reliable,” the team noted.
The researchers acknowledged that one key limitation of this analysis is the potential influence of coexisting conditions before TAVR — among them coronary artery disease, hypertension, or diabetes — on the outcomes in the PH and non-PH groups.
Ultimately, though, “this meta-analysis demonstrates that PH is significantly associated with increased short- and long-term mortality in [aortic stenosis] patients treated with TAVR,” the researchers concluded.
The team called for more research to “better identify high-risk subgroups that may benefit from tailored management” or other steps, before surgery, to improve patient outcomes.
“Future studies should explore targeted therapies to optimize outcomes for TAVR patients with PH, as well as investigate underlying mechanisms contributing to increased mortality,” the scientists wrote.
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