Clin Res Cardiol 101, Suppl 1, April 2012

V1146 - Impact of Pulmonary Hypertension on Outcome after Transcatheter Aortic Valve Implantation: Results From the German Aortic Valve Interventions Registry
A. Lauten1, R. Zahn2, H. Sievert3, A. Linke4, E. Grube5, U. Gerckens6, S. Sack7, M. Ferrari1, J. Senges8, H.-R. Figulla1 on behalf of German Transcatheter Aortic Valve Interventions-Re
1Klinik für Innere Medizin I, Universitätsklinikum Jena, Jena; 2Medizinische Klinik B - Abteilung für Kardiologie, Klinikum der Stadt Ludwigshafen GmbH, Ludwigshafen; 3St. Katharinen-Krankenhaus, Cardiovaskuläres Centrum Frankfurt, Frankfurt am Main; 4Klinik für Innere Medizin/Kardiologie, Universität Leipzig - Herzzentrum GmbH, Leipzig; 5Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn; 6Kardiologisches Zentrum, Gemeinschaftskrankenhaus Bonn gGmbH, Haus St. Petrus, Bonn; 7Klinik für Kardiologie, Pneumologie und Intern. Intensivmedizin, Klinikum Schwabing, Städt. Klinikum München GmbH, München; 8Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen;
Objective: Pulmonary Hypertension (PH) is considered a significant risk factor in patients with severe aortic stenosis (AS) undergoing surgical aortic valve replacement. However, the prognostic implications of PH is unclear in high-risk patients with AS undergoing Transcatheter Aortic Valve Implantation (TAVI). Therefore, we sought to assess the impact of preoperative PH on outcome after TAVI based on data of the German Aortic Valve Interventions Registry.
Methods and Results: Between January 2009 and June 2010, a total of 1285 patients undergoing TAVI were included in this registry (mean age 81.7±6.1, 41.9% males). Patients were grouped according to systolic pulmonary artery pressure (PASP): group I, 277 patients, (21.6%) with PASP <30mmHg, group II, 598 patients (46.5%) with PASP 30-50 mmHg and group III, 410 patients (31.9%) with PASP >50mmHg. Patients in group III had a significantly higher Euroscore (26±16mmHG vs. group I 18±11mmHg vs. group II 18±11mmHg; p<0.0001) and were more symptomatic with significantly more patients presenting in NYHA class IV (28.5% vs. group I 13.6% vs. group II 8.3%; p<0.0001).
In all subgroups the majority of TAVI-procedures was performed transfemorally with a high procedural success rate. The rate of TAVI-associated complications was comparable in all groups (cerebrovascular accident: group I 3.3% vs. group II 3.9 % vs. group III 2.0%, p=0.25; permanent pacemaker: group I 33.8% vs. group II 38.1 % vs. group III 35.2%, p=0.24). Functional NYHA class and survival at 30 days demonstrated excellent outcome in all groups irrespective of PA pressure (30-day survival group I: 91.2% vs. group II 93.0% vs. group III 91.9%; p=0.59). All subgroups experienced a significant improvement of self-assessed quality-of-life (according to EuroQol5d-visual analogue scale) with the largest gain in group III (0.112±0.35 vs. group I 0.055±0.32 vs. group II 0.04±0.32; p=0.15).
Conclusion: In conclusion, non-surgical patients with severe AS have a high prevalence of PH. However, based on the registry data this condition does not increase complication rate and early mortality after TAVI. Patients with PH benefit from the procedure with functional improvement and significantly improved postoperative quality-of-life.
Clin Res Cardiol 101, Suppl 1, April 2012
Zitierung mit Vortrags- oder Posternummer s.o.
DOI 10.1007/s00392-012-1100-6