Reversibility of pulmonary artery hypertension in aortic stenosis after aortic valve replacement

Tracy, Gerald P.; Proctor, Michael S.; Hizny, Cathleen S.

doi:10.1016/0003-4975(90)90095-n

Cited by 43 publications

(24 citation statements)

References 8 publications

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“…Previous studies demonstrated rapid improvement in systolic, diastolic, and mean PAP after AVR, resulting in improvement in clinical outcome. 18,26,27 The present study found a decrease in PH after TAVI, associated with net functional benefit. Ben-Dor et al 3 showed a significant and sustained decrease in pulmonary pressure up to 1 year after TAVI, comparable with that seen after AVR.…”

Section: Discussionsupporting

confidence: 56%

Prognostic Implications of Pulmonary Hypertension in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation

Luçon

Oger

Bédossa

et al. 2014

Circ: Cardiovascular Interventions

108

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Background-Pulmonary hypertension (PH) is associated with poor prognosis in patients with severe aortic stenosis. The aim of this multicenter study was to describe clinical outcome after transcatheter aortic valve implantation. Methods and Results-The FRANCE 2 Registry included all patients undergoing transcatheter aortic valve implantation in France in 2010 and 2011. Patients were divided into 3 groups depending on systolic pulmonary artery pressure (sPAP) estimated in transthoracic echocardiography: group I, sPAP <40 mm Hg (no PH); group II, sPAP 40 to 59 mm Hg (mildto-moderate PH); and group III, sPAP ≥60 mm Hg (severe PH). Patients were followed up for 1 year. A total of 2435 patients whose pre-transcatheter aortic valve implantation sPAP was reported were included. A total of 845 were in group I (34.7%), 1112 in group II (45.7%), and 478 in group III (19.6%). Procedural success, early complications, and 30-day mortality were statistically similar across sPAP groups. One-year mortality was higher in groups II and III (group I, 22%; group II, 28%; and group III, 28%; P=0.032). Mild-to-moderate and severe PH were identified as an independent factor of all-cause mortality. The major adverse cardiovascular event rates did not differ according to sPAP. New York Health Association functional class improved significantly in all groups. Conclusions-PH (sPAP ≥40 mm Hg) in patients with aortic stenosis undergoing transcatheter aortic valve implantation was associated with increased 1-year mortality especially when severe (sPAP ≥60 mm Hg) but not with increased 30-day mortality, and functional status was significantly improved regardless of PAP level. (Circ Cardiovasc Interv. 2014;7:240-247.)

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Section: Discussionsupporting

confidence: 56%

Prognostic Implications of Pulmonary Hypertension in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation

Luçon

Oger

Bédossa

et al. 2014

Circ: Cardiovascular Interventions

108

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“…Invasive hemodynamic studies have demonstrated a consistently significant positive correlation between the level of PHT and the left ventricular end-diastolic pressure but not with either the LVEF or AVA in patients with severe AS scheduled to undergo AVR (3,5). Moreover, reports of a rapid decrease in PASP and normalization of severe diastolic dysfunction soon after AVR for AS suggest a causal relationship (4,8). The few patients in this series with invasive hemodynamic data had no diastolic transpulmonary gradients.…”

Section: Discussionmentioning

confidence: 67%

“…Diastolic dysfunction has long been associated with PHT in patients with AS (2)(3)(4)(5)8). Invasive hemodynamic studies have demonstrated a consistently significant positive correlation between the level of PHT and the left ventricular end-diastolic pressure but not with either the LVEF or AVA in patients with severe AS scheduled to undergo AVR (3,5).…”

Section: Discussionmentioning

confidence: 99%

“…The cumulative reported clinical experience with this subset is limited to small series and scattered case reports (3)(4)(5)(6)(7)(8)(9). Aortic valve replacement in these reports was associated with a low operative mortality (0% to 6%), but the patients were relatively young (mean age Յ65 years), highly select, and symptomatic with isolated, severe AS (3)(4)(5). Therefore, the conclusions may not apply to a broader section of the AS population that more closely resembles the patients encountered in daily practice.…”

mentioning

confidence: 99%

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Pulmonary artery hypertension in severe aortic stenosis: Incidence and mechanism

Silver

Aurigemma

Krendel

et al. 1993

American Heart Journal

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“…Pulmonary hypertension is common among patients who undergo aortic valve replacement for stenosis 4, 6, 9. In this study, PH was present in 47% of patients who underwent AVR.…”

Section: Discussionmentioning

confidence: 99%

Impact of pulmonary hypertension on outcomes after aortic valve replacement for aortic valve stenosis

Melby

Moon

Lindman

et al. 2011

The Journal of Thoracic and Cardiovascular Surgery

152

129

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Objective The presence of pulmonary hypertension (PH) historically has been considered a significant risk factor affecting early and late outcomes following valve replacement. Given the number of recent advances in the management of PH following cardiac surgery a better understanding of the impact of PH on outcomes may assist in the clinical management of these patients. The purpose of this study was to determine if pulmonary hypertension remains a risk factor in the modern era for adverse outcomes following aortic valve replacement (AVR) for aortic valve stenosis. Methods From January 1996 to June 2009, 1,080 patients underwent AVR for primary aortic valve stenosis, of which 574 (53%) had normal systolic pulmonary artery pressures (sPAP) and 506 (47%) had PH. PH was defined as mild (sPAP 35-44 mmHg), moderate (45-59mmHg), or severe (≥ 60mmHg). In the group of patients with PH, 204 had postoperative echocardiograms. Results Operative mortality was significantly higher in patients with PH (47/506, 9% versus 31/574, 5%; p=0.02). The incidence of postoperative stroke was similar (p=0.14), but patients with PH had an increased median hospital LOS (8 versus 7 days, p=0.001) and an increased incidence of prolonged ventilation (26% versus 17%, p<0.001). Preoperative PH was an independent risk factor for decreased long term survival (RR 1.7, p=0.02). Those with persistent PH postoperatively had decreased survival. Five-year survival (Kaplan-Meier) was 78 ± 6% with normal sPAP and 77 ± 7% with mild PH postoperatively, compared to 64 ± 8% with moderate PH and 45 ± 12% with severe PH (p<0.001). Conclusion In patients undergoing AVR, preoperative PH increased operative mortality and decreased long-term survival. Patients with persistent moderate or severe PH after AVR had decreased long-term survival. These data suggest that PH had a significant impact on outcomes in patients undergoing AVR and should be considered in preoperative risk assessment.

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Reversibility of pulmonary artery hypertension in aortic stenosis after aortic valve replacement

Cited by 43 publications

References 8 publications

Prognostic Implications of Pulmonary Hypertension in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation

Prognostic Implications of Pulmonary Hypertension in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation

Pulmonary artery hypertension in severe aortic stenosis: Incidence and mechanism

Impact of pulmonary hypertension on outcomes after aortic valve replacement for aortic valve stenosis

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