Improvement in Right Heart Pressures Following Transcatheter Aortic Valve Implantation (TAVI)

Abstract

Introduction: Transcatheter aortic valve implantation (TAVI) is a well-recognised alternative to aortic valve surgery for high risk surgical patients (Siontis, Praz et al., 2016). Elevated left-sided pressures due to aortic valve disease may contribute to pulmonary hypertension. The aim of this study was to evaluate whether TAVI could lead to echocardiographically measureable improvements in the pulmonary hypertension. Methods: We performed a retrospective analysis of all patients undergoing TAVI in our institution from August 2008 to November 2016. Pulmonary artery systolic pressure was estimated by measuring right ventricular systolic pressure (RVSP). RVSP was assessed using tricuspid regurgitant jet velocity by continuous wave spectral Doppler with transthoracic echocardiography, both prior to and within the first week following TAVI. Patients were graded according to severity of pulmonary hypertension as mild (RVSP 25-39 mmHg), moderate (RVSP 40-54 mmHg), or severe (RVSP >55 mmHg). Results: Between 2008-2016, 222 patients (mean age 85 ± 6.2 years) underwent TAVI. 202 had pre and post operative echocardiograms available for comparison. Of these, 115 patients (56.9%) had pre operative echocardiographic evidence of elevated RVSP. 74 (64.3%) were mild, 32 (27.8%) moderate, and 9 (7.8%) were severe. Post-TAVI, the mean reduction in RVSP across all three groups was 8.7% (SD ± 27.8%) (p = 0.00005). Patients with both moderate and severe pulmonary hypertension at baseline had significant mean RVSP reduction of 18% (SD ± 23.7%) (p = 0.0002) and 29.8% (SD ± 20.7%) (p = 0.001) respectively. No significant change was recorded in the mild group. Conclusion: TAVI resulted in statistically significant reductions in pulmonary hypertension in patients with moderate-to-severely elevated pulmonary pressures at baseline.