title: Impact of transcatheter aortic valve implantation (TAVI) on pulmonary hyper-tension and clinical outcome in patients with severe aortic valvular stenosis.
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.
  
  
  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.
authors.affiliation: Division of Cardiology, ASKLEPIOS Clinics St. Georg Hospital, Lohmühlenstr. 5, 20099, Hamburg, Germany, d.schewel@gmx.de.
authors.forename: Dimitry
authors.initials: D
authors.lastname: Schewel
authors.forename: Jury
authors.initials: J
authors.lastname: Schewel
authors.forename: Julia
authors.initials: J
authors.lastname: Martin
authors.forename: Lisa
authors.initials: L
authors.lastname: Voigtländer
authors.forename: Christian
authors.initials: C
authors.lastname: Frerker
authors.forename: Peter
authors.initials: P
authors.lastname: Wohlmuth
authors.forename: Thomas
authors.initials: T
authors.lastname: Thielsen
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schäfer
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality* / Q000601:surgery*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D065467:Transcatheter Aortic Valve Replacement / Q000401:mortality*; D016896:Treatment Outcome