Effect of Transcatheter Aortic Valve Replacement on Pulmonary Arterial Pressures in Patients with Preserved Left Ventricular Function

Dahiya, Garima

Effect of Transcatheter Aortic Valve Replacement on Pulmonary Arterial Pressures in Patients with Preserved Left Ventricular Function

Tuesday, May 21, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Garima Dahiya , Allegheny General Hospital, Pittsburgh, PA

Andreas Kyvernitakis , Allegheny Health Network, Pittsburgh, PA

Orestis Pappas, M.D. , Allegheny General Hospital, Wexford, PA

Rahul Sinha, DM, FACC, FAESC , Allegheny General Hospital, Wexford, PA

Georgios Lygouris , Allegheny General Hospital, Wexford, PA

Robert W Biederman, M.D. , Allegheny General Hospital, Pittsburgh, PA

David M Lasorda, D.O. , Allegheny General Hospital, Pittsburgh, PA

Manreet Kanwar , Allegheny General Hospital, Pittsburgh, PA

Background
Transcatheter aortic valve replacement (TAVR) is a widely utilized modality for patients with severe aortic stenosis (AS). The impact of TAVR on right ventricular (RV) function & pulmonary pressure is not well known. We evaluated the impact of TAVR on RV function and PA systolic pressure (PASP) by transthoracic echocardiography (TTE) in patients with severe AS and preserved left ventricular (LV) function.

Methods
Retrospective records of patients with severe AS, preserved LVEF & elevated PASP were reviewed. Pre-procedure, 1 month and 1 year post-TAVR TTEs were included. PASP was estimated as the sum of peak tricuspid regurgitation (TR) gradient and estimated right atrial pressure based on IVC collapsibility. Statistical differences were determined by paired t-test and repeat measures ANOVA.

Results
Of 123 patients in whom PASP could be estimated by TTE, 50.4% had elevated PASP at baseline. After 1 month post-TAVR, there was a significant decrease in PASP (mean mm Hg, 45.1 vs 39.5; P=0.01), an improvement in diastolic function (mean grade, 1.7 vs 1.2; P<0.001) & peak TR velocity (mean cm/s, 310 vs 282; P<0.001). These findings remained significant 1 year post TAVR. There was no significant change in RV end-diastolic diameter post TAVR.

Conclusions
There is a significant improvement in PASP in patients with underlying pulmonary hypertension undergoing TAVR, likely secondary to improved diastolic function. More studies are needed to investigate the effect of TAVR in patients with RV dysfunction.