Objective: No appropriate guidelines concerning perioperative management of transcatheter aortic valve implantation (TAVI) exist for patients with aortic valve stenosis (AS) and concomitant pulmonary hypertension. Peak tricuspid regurgitation velocity (PTRV) has been estimated to be a non-invasive representation of pulmonary artery pressure. We aimed to determine whether the preoperative background and clinical course differed in patients who had undergone TAVI with or without a high PTRV. We further investigated the impact of a high PTRV after TAVI on clinical outcomes.
Methods: This retrospective, single-center, observational study included data derived from the cardiac catheter database of Aichi Medical University between April 2017 and December 2022. Of 96 patients who underwent TAVI at our hospital, echocardiographic examinations revealed tricuspid valve regurgitation in 78 patients, who were then divided into those with or without PTRV ≥2.8 m/s (high PTRV). These two groups were evaluated for preoperative backgrounds and postoperative courses. The primary endpoint was all-cause mortality, including 30-day and long-term mortality. Secondary endpoints were major adverse cardiac and cerebrovascular events (MACCE). Further, the postoperative outcome was evaluated between patients with or without a high PTRV after TAVI.
Results: High PTRV was significantly associated with chronic atrial fibrillation, factors related to heart failure, and AS severity before TAVI. No significant differences were observed in procedural and postoperative courses between the groups. Furthermore, we observed no 30-day mortality, and MACCE occurred in 14 patients, including 8 late deaths. High PTRV after TAVI was significantly associated with preoperative high PTRV, higher B-type natriuretic peptide levels, and higher transaortic valve pressure gradients; however, there was no significant difference in the clinical course in patients with or without a high PTRV after TAVI. Preoperative PTRV decreased significantly after TAVI (p <0.0001); despite a significant increase after 1 year (p = 0.03), the PTRV remained lower than preoperative levels (p <0.0001).
Conclusion: Patients with a high PTRV showed severe preoperative conditions; however, the postoperative course was acceptable, and the PTRV improved after TAVI. Thus, TAVI is associated with a significant reduction of PTRV, and concurrent high PTRV in patients with AS is not a contraindication for TAVI. Although high PTRV after TAVI was not associated with clinical outcomes, further evidence is warranted for high PTRV after TAVI.
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