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Impact of transcatheter aortic valve implantation (TAVI) on pulmonary hyper-tension and clinical outcome in patients with severe aortic valvular stenosis

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An Erratum to this article was published on 19 November 2014

Abstract

Background

Transcatheter aortic valve implantation (TAVI) is a proven alternative to open heart surgery in elderly patients. Pulmonary hypertension (PH) is known as a significant risk factor in patients with severe aortic stenosis (AS) undergoing surgical aortic valve replacement. However, the prognostic impact of PH in high-risk patients undergoing TAVI is still unknown. The aim of this study was to gain more insight in the clinical outcome and mortality of patients with PH after TAVI.

Methods and results

Between July 2009 and September 2012, a total of 439 patients were treated by TAVI in conjunction with a complete invasive right heart study at our institution. Patients were divided into two groups with regard to their pulmonary arterial mean pressure (PAMP) before TAVI (A: PAMP < 25 mmHg and B: PAMP ≥ 25 mmHg). Patients with baseline PH had a significantly higher logES (A: 19.40 vs. B: 28.17 %; p < 0.001) and were more frequently in NYHA functional class IV (A: 15.4 vs. B: 25.1 %; p = 0.013). Invasive right heart data demonstrated an immediate improvement after TAVI in patients with PH. Despite a similar clinical benefit among survivors, 30-day and 1-year mortality were higher in patients with PH (30-day mortality: A: 4.8 vs. B: 10.4 %; p = 0.021, 1 year mortality: A: 13.9 vs. B: 23.4 %; p = 0.014).

Conclusions

Pulmonary hypertension is an independent risk factor for survival after TAVI. Nevertheless, TAVI leads to an acute improvement of nearly all invasively assessed variables in patients with PH, with a similar improvement in functional NYHA class compared to patients without PH, indicating a similar benefit among survivors.

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Conflict of interest

Dr. Ulrich Schäfer is a clinical proctor for Edwards Lifesciences Inc. and Medtronic Inc. and Prof. Karl-Heinz Kuck has received honoraria payments from both companies. The other authors have no financial interests in any products or companies described in this article.

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  1. Division of Cardiology, ASKLEPIOS Clinics St. Georg Hospital, Lohmühlenstr. 5, 20099, Hamburg, Germany

    Dimitry Schewel, Jury Schewel, Julia Martin, Lisa Voigtländer, Christian Frerker, Thomas Thielsen, Karl-Heinz Kuck & Ulrich Schäfer

  2. Clinical Research and Development, ASKLEPIOS Proresearch, Hamburg, Germany

    Peter Wohlmuth

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  1. Dimitry Schewel
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Schewel, D., Schewel, J., Martin, J. et al. Impact of transcatheter aortic valve implantation (TAVI) on pulmonary hyper-tension and clinical outcome in patients with severe aortic valvular stenosis. Clin Res Cardiol 104, 164–174 (2015). https://doi.org/10.1007/s00392-014-0772-5

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