Maladies cardiovasculaires et diagnostic

Clinical Impact and Prognosis of Pulmonary Hypertension after Transcatheter Aortic Valve Implantation

Abstract

Green Lisa, Rioufol G, Vergnat M, Obadia JF, Saroul C, Gevigney GDD, Cudraz EB, CroisilleP and FinetGM

Background: Transcatheter Aortic Valve Implantation (TAVI) is a therapeutic option for patients presenting with severe aortic stenosis and in whom surgery is contraindicated. Pre-procedural Pulmonary Hypertension (PH) has been shown to be a factor of poor prognosis in surgical and TAVI studies.

Aims: We sought to evaluate the clinical impact and prognostic implications of the presence of post-TAVI PH.

Methods: The outcome of post-TAVI Pulmonary Artery Systolic Pressure (PASP) was studied in 58 high-risk patients with severe symptomatic aortic stenosis, by assessing clinical presentation and prognosis and determining predictive factors.

Results: Post-TAVI PH (PASP>40 mmHg) affected 43% of patients at 6 months. Despite excellent aortic results in both groups, patients with post-TAVI PH were more symptomatic, with were severer according to the New York Heart Association classification (class III or IV), higher cardiovascular mortality and more frequent readmission for cardiac failure. On univariate analysis, factors for elevated PASP were: female sex, history ofmyocardial infarction, pacemaker implantation and permanent pacing, atrial fibrillation, and degree of mitral regurgitation. On multivariate analysis, only atrial fibrillation remained an independent factor for post-TAVI PH.

Conclusion: PH is frequently present after TAVI and allows identification of a subgroup of patients with poorer clinical presentation and cardiovascular prognosis. Further studies and especially complementary myocardial investigation seem necessary.