TAVR and pulmonary hypertension: Key details from a study of 35,000 patients
Patients with pulmonary hypertension (PH) who undergo transcatheter aortic valve replacement (TAVR) may face a higher risk of death, according to a meta-analysis published in Cureus.[1]
Current evidence about this topic “remains inconclusive,” researchers wrote; they hoped a meta-analysis examining multiple studies could help provide some clarity.
“While TAVR emerges as a safe and efficacious treatment for aortic stenosis (AS), surpassing surgical aortic valve replacement in attention, the heightened perioperative risk posed by PH necessitates thorough investigation into its balance of benefits and risks within this patient cohort,” explained corresponding author Sujith K. Palleti, MD, with Louisiana State University Health Sciences Center, and colleagues.
Palleti et al. explored data from more than 35,000 adult patients who participated in one of 15 real-world studies. Studies were completed in the United States, Germany, Japan, Italy, Switzerland, Brazil, Poland or Australia. A majority (52.57%) of patients presented with PH.
Overall, presenting with PH was associated with short- and long-term risks of death that were nearly 1.5 times higher than patients without PH. In both instances, “no significant heterogeneity was reported among the study results.” The group also found that cardiovascular mortality was 1.66 times more likely when patients presented with PH.
“Our analysis indicates a significant contrast in short-term mortality, long-term mortality and cardiovascular mortality, with all these outcomes exhibiting notably higher risks following TAVR in patients with PH compared to those without PH at baseline,” the authors wrote, adding that these data “align with previous studies underscoring the prognostic significance of baseline PH in patients with severe AS.”
One limitation of the team’s work is that PH was defined in different ways from one trial to the next. A mean pulmonary arterial pressure (mPAP) of 25 mmHg was used for multiple studies, for example, but a separate study used a mPAP of 35 mmHg. Other research teams focused on systolic pulmonary arterial pressure when defining PH.
“The need for standardized diagnostic criteria and cutoff points for PH assessment in TAVR patients is evident, emphasizing the importance of ongoing investigation in this area,” the authors wrote.
Read the full analysis here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.