Abstract 13665: Clinical Outcomes and Predictors of Residual Pulmonary Hypertension in Patients Undergoing Transcatheter Aortic Valve Replacement

Background: Although transcatheter aortic valve replacement (TAVR) improves pulmonary hypertension (PH) secondary to aortic stenosis (AS), PH can remain after TAVR. We sought to investigate the outcomes and predictors of residual PH after TAVR.

Methods: A total of 491 consecutive patients underwent TAVR between 2014 and 2023 at our institution. After excluding patients without baseline or postoperative transthoracic echocardiography, we stratified 483 patients according to baseline and postprocedural PH estimated by systolic pulmonary artery pressure >36 mmHg as follows: no PH group (n=285), improved PH group (n=87), residual PH group (n=111). Outcome measures were the composite of cardiac death and heart failure (HF) hospitalization. Logistic regression analysis was used to identify the predictors of residual PH. Variables included in the model were age, atrial fibrillation (AF), left ventricular ejection fraction, left atrial dilatation, moderate/severe mitral regurgitation, moderate/severe tricuspid regurgitation (TR).

Results: The mean age was 83.6±5.4 years, and 314 (65%) were female. Patients in residual PH group were more likely to have AF, higher left atrial volume index, moderate/severe MR, and moderate/severe TR, compared with patients in no PH group. Compared with no PH group, the cumulative incidence of the composite of cardiac death and HF hospitalization were comparable in improved PH group (6.1% vs. 10.5 at 2 years, P=0.3), but significantly higher in residual PH group (6.1% vs. 20.6% at 2 years, P=0.002) (Figure). Multivariable logistic regression analysis showed that AF (Odds ratio [OR] 1.91, 95% confidence interval [CI] 1.09-3.32), moderate/severe TR (OR 4.09, 95% CI 2.30-7.28) were independently associated with residual PH.

Conclusions: Among patients undergoing TAVR, residual PH were associated with increased risk of adverse cardiac events. AF, moderate or severe TR were independent predictors of residual PH after TAVR.