title: Decrease of pulmonary hypertension impacts on prognosis after transcatheter aortic valve replacement.
abstract: OBJECTIVE
  Transcatheter aortic valve replacement (TAVR) is established as a treatment strategy for patients with end-stage aortic stenosis, many of whom are suffering from severe pulmonary hypertension (PH). In cardiac surgery patients, PH is associated with less symptomatic improvement and increased late mortality. This study elucidates the impact of PH on outcome after TAVR.
  
  
  RESULTS
  Pre and 90 days post-TAVR, pulmonary artery systolic pressure (PASP) was determined non-invasively by echocardiography in 353 patients undergoing TAVR. PH was classified as absent (<30 mmHg), mild-to-moderate (30-60 mmHg), and severe (>60 mmHg). Three hundred and fifty-three patients at high surgical risk, indicated by a logistic EuroSCORE of 26.6±16.5%, underwent TAVR. The severity of PH before TAVR was related to outcome with two-year mortality rates of 13.9%, 27.3%, and 48.4% for PASP <30 mmHg, 30-60 mmHg, and >60 mmHg, respectively (p=0.001). In patients with baseline PASP >60 mmHg, PASP decreased from 65.6±7.6 mmHg to 49.5±14.0 mmHg (p<0.001) at 90 days after TAVR. Patients with persistent severe PH had a worse prognosis than patients with a decrease of PASP below 60 mmHg (two-year mortality rate: 50.0% vs. 18.6%; p=0.001).
  
  
  CONCLUSIONS
  Severe pulmonary hypertension predicts adverse outcome after TAVR. Reduction of PASP after the procedure is associated with favourable prognosis.
authors.affiliation: Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany.
authors.forename: Jan-Malte
authors.initials: JM
authors.lastname: Sinning
authors.forename: Christoph
authors.initials: C
authors.lastname: Hammerstingl
authors.forename: Derek
authors.initials: D
authors.lastname: Chin
authors.forename: Alexander
authors.initials: A
authors.lastname: Ghanem
authors.forename: Robert
authors.initials: R
authors.lastname: Schueler
authors.forename: Alexander
authors.initials: A
authors.lastname: Sedaghat
authors.forename: Johan
authors.initials: J
authors.lastname: Bence
authors.forename: Tomasz
authors.initials: T
authors.lastname: Spyt
authors.forename: Nikos
authors.initials: N
authors.lastname: Werner
authors.forename: Jan
authors.initials: J
authors.lastname: Kovac
authors.forename: Eberhard
authors.initials: E
authors.lastname: Grube
authors.forename: Georg
authors.initials: G
authors.lastname: Nickenig
authors.forename: Mariuca
authors.initials: M
authors.lastname: Vasa-Nicotera
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D016896:Treatment Outcome