Pulmonary arterial pressure changes in Patients Undergoing Transcatheter Aortic Valve Replacement

Background
There are limited data on the effect of transcatheter aortic valve replacement (TAVR) on pulmonary arterial pressure (PAP). The purpose of this study was to evaluate the effect of TAVR on PAP using tricuspid regurgitation pressure gradient (TRPG) as a surrogate for PAP.

Methods
Data were analyzed retrospectively form 161 consecutive TAVR patients (age 83 ± 10 years; 53% male) who underwent TAVR in a single US hospital and had pre- and post-TAVR echocardiograms (within 60 days) with sufficient tricuspid regurgitation to determine TRPG. The primary outcome was the change in TRPG, and the secondary outcome was the difference in all-cause mortality between the high TRPG (≥ 25 mmHg) and the low TRPG groups (< 25 mmHg) at one year.

Results
There was a statistically significant decrease in TRPG post-TAVR (3 +/- 11 mmHg, P = 0.002). All-cause mortality was not significantly different between the high and low pre-TAVR TRPG groups. There was not a significant association between the change in TRPG and the post-TAVR aortic valve area or gradient or a patient's history of COPD, hypertension, or diabetes.

Conclusions
There is a significant decrease in PAP after TAVR as evidenced by a decrease in the TRPG. Larger, prospective studies are needed for adequate power to assess definitively the effect of PAP reduction on TAVR patients’ outcomes. Figure: Panel-1 Barr graph showing TRPG pre- and post-TAVR (with error bars). Panel-2 Bar graph showing 30-day mortality rates in high and low pre-TAVR TRPG groups.