Increased mortality from complications of pulmonary hypertension in patients undergoing transcatheter aortic valve replacement

Raj Parikh; Benson Varghese; Huma N Khatoon; Julie A Kovach; Clifford J Kavinsky; Rajive Tandon

doi:10.1177/2045893217697709

Increased mortality from complications of pulmonary hypertension in patients undergoing transcatheter aortic valve replacement

Pulm Circ. 2017 Apr-Jun;7(2):391-398. doi: 10.1177/2045893217697709. Epub 2017 May 12.

Authors

Raj Parikh¹, Benson Varghese², Huma N Khatoon³, Julie A Kovach³, Clifford J Kavinsky³, Rajive Tandon²

Affiliations

¹ 1 Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA.
² 2 Division of Pulmonary and Critical Care, Rush University Medical Center, Chicago, IL, USA.
³ 3 Division of Cardiology, Rush University Medical Center, Chicago, IL, USA.

Abstract

Aortic stenosis (AS) leads to pulmonary hypertension (PH) and right ventricle (RV) failure. Our goal was to describe mortality related to postoperative complications in PH patients undergoing transcatheter aortic valve replacement (TAVR). Ninety-three TAVR patients were analyzed (controls, sPAP < 50 mmHg; cases, sPAP ≥ 50 mmHg). Significant findings in cases included increased mortality (365 days), post-TAVR atrioventricular block (AVB) and acute kidney injury (AKI), and increased mean length of stay (LOS). This novel study highlights complications of PH as independent risk factors for death and significant morbidity post TAVR. Optimization of preoperative volume status and RV afterload reduction, while addressing AVB and AKI, may play a vital role in reducing mortality and LOS.

Keywords: aortic stenosis; atrioventricular block; mortality; pulmonary hypertension; right ventricular failure; transcatheter aortic valve replacement (TAVR).