Does severe pulmonary hypertension affect long-term survival after TAVI for severe aortic stenosis?

Pulmonary hypertension (PH) is common in patients with severe aortic stenosis (AS). Severe PH has been associated with mortality up to two years following transcatheter aortic valve implantation (TAVI). Data on longer-term outcomes in TAVI patients with severe PH are limited. We aimed to compare all-cause mortality at five years post-TAVI in patients with and without severe PH and to identify any patient factors associated with reduced long-term survival. TAVI patients meeting our inclusion criteria between January 2013 and October 2017 at a specialist cardiac centre in the UK were retrospectively analysed. Severe PH was defined as a systolic pulmonary arterial pressure >40 mmHg, estimated on transthoracic echocardiography. Data on patient demographics, comorbidities and mortality were obtained from routinely collected registry data. Kaplan-Meier and Cox-proportional hazards analyses were performed. The median ages of the patients were 84 and 83 years in the group without severe PH and the group with severe PH, respectively. Severe PH was present in 95 out of 219 patients (43%). Patients with severe PH had higher levels of disability, left ventricular impairment and serum creatinine. On multi-variate analysis, the presence of severe PH was not associated with an increased mortality (adjusted hazard ratio [HR]=1.23, p=0.29). Peripheral vascular disease (PVD) was associated with a significantly increased risk of death at five years' follow-up (adjusted HR=2.24, p=0.002). A lower body mass index (BMI) was also independently associated with reduced survival (adjusted HR=0.96, for an increase of 1 kg/m², p=0.038). In conclusion, our data show that severe PH in patients with AS did not affect five-year survival post-TAVI. Reduced BMI and PVD were significantly associated with long-term all-cause mortality in patients undergoing TAVI.