Persistent Severe PH After TAVR Surgery a Strong Predictor of Mortality, Study Finds

Patients undergoing a minimally invasive surgery known as transcatheter aortic valve replacement (TAVR) can improve their quality of life, according to a new study. The study also showed that persistent severe pulmonary hypertension (PH) after the TAVR procedure, in comparison to severe PH at baseline before the intervention, is a strong predictor of one-year mortality.

The findings were published in the study “Persistence of Severe Pulmonary Hypertension After Transcatheter Aortic Valve Replacement,” published in the journal Circulation: Cardiovascular Interventions.

According to the American Heart Association, TAVR is considered a minimally invasive procedure that can be done through very small surgical openings, and is recommended for patients who are considered at high risk for standard valve replacement surgery, in which the chest is opened to complete the procedure.

TAVR involves repairing the heart valve without removing the previously damaged valve. This is done by wedging a replacement valve into the aortic valve space, and then having the tissue in the replacement valve take over the job of regulating blood flow. For a better understanding of the procedure, click here to watch a short video.

A vast amount of evidence shows that pulmonary hypertension is a common co-morbidity in patients with severe aortic stenosis who undergo TAVR, and this elevated pulmonary artery pressure pre-procedure may impact mortality post-procedure.

In the study, researchers aimed to understand how the pattern, evolution, and clinical impact of different severity levels of PH impacted one-year mortality rates in patients after undergoing TAVR. Clinicians studied 990 patients who were enrolled from six high-volume clinical centers and divided into the following groups based on severity grade of PH:

1. Group 1, which included 346 patients (35%) with systolic pulmonary artery pressure (sPAP) <40 mm Hg considered to have no PH;
2. Group 2, which included 426 patients with sPAP 40 to 60 mm Hg considered to have moderate PH;
3. Group 3, which included 218 patients with sPAP greater than 60 mm Hg considered to have severe PH.

Each group of patients underwent transthoracic echocardiography before the TAVR procedure; three days after TAVR; and at one, five, and 12 months, so researchers could clinically assess morbidity and survival outcomes.

The results revealed that:

• Compared to groups 1 and 2, patients in group 3 had a higher level of heart failure (New York Heart Association 3 to 4), and a higher rate of hospitalization for heart failure;
• At one year, when compared with patients in group 1, patients in groups 2 and 3 had both a higher overall mortality and a higher cardiac mortality;
• After onw month the sPAP decreased ≥15 mm Hg in 32% and 35% of the patients in groups 2 and 3;
• A persistent severe PH after one month was a statistical predictor of a patient’s one-year mortality, whereas the one-month reduction of sPAP was not.

The findings offer clinical evidence that validates the associated benefit of TAVR in terms of a substantial gain in quality of life for patients with and without a reduction of sPAP at early follow-up.

The study also showed that the persistence of severe pulmonary hypertension after TAVR is a better predictor of one-year mortality than that of a patient with baseline severe PH.

Findings such as these allow clinicians to have a better understanding of what to look for in patients when recommending surgery and the right post-procedure protocols after TAVR, so that patients’ survival rates can be extended as much as possible.