Aortic valve replacement with pulmonary hypertension: Meta‐analysis of 70 676 patients

Abstract

Background and Aim of the Study: We compared early and late outcomes of surgical aortic valve replacement (SAVR) in patients with aortic stenosis (AS) and pulmonary hypertension (PHT). Methods: We searched MEDLINE and EMBASE databases until July 2018 for studies comparing patients with AS and none, mild-moderate, or severe PHT undergoing SAVR. Random-effects meta-analysis was performed. Results: There were 12 observational studies with 70 676 patients with median follow-up 4.0 years (interquartile range, 2.6-4 years). Compared to patients with no PHT, patients with any PHT undergoing SAVR were older (mean difference [MD], 2.31 years; 95% confidence interval [CI], 1.38-3.23 years; P < .01), with greater comorbidities and reduced ejection fraction (MD, −4.36; 95%CI, −5.94 to −2.78; P < .01). Patients with any PHT had higher unadjusted (5.2% vs 2.4%; risk ratio [RR], 2.27; 95%CI, 2.04-2.53; P < .01) and adjusted (RR, 1.65; 95%CI, 1.28-2.14; P < .01) inhospital mortality compared with no PHT. Severe (RR, 3.53; 95%CI, 1.46-8.54;P < .01) and mild-moderate PHT (RR, 2.13; 95%CI, 1.28-3.55; P < .01) were associated with higher unadjusted in-hospital mortality compared with no PHT. Any PHT was associated with a higher unadjusted risk of stroke (RR, 1.64; 95%CI, 1.42-1.90; P < .01), acute kidney injury (RR, 2.02; 95%CI, 1.50-2.72; P < .01), prolonged ventilation (RR, 1.62; 95%CI, 1.04-2.52; P = .03), and longer hospital stay (MD, 1.76 days; 95%CI, 0.57-2.95; P < .01). Severe (HR, 2.44; 95%CI, 1.60-3.72; P < .01) but not mild-moderate PHT (HR, 2.25; 95%CI, 0.91-5.59; P = .08) was associated with higher adjusted long-term mortality compared with no PHT.Conclusions: Patients with severe AS and severe PHT had a significant increase in operative mortality and more than double the risk of long-term mortality following SAVR compared with patients with no PHT. Such patients may benefit from a less invasive transcatheter aortic valve intervention. K E Y W O R D Saortic stenosis, aortic valve replacement, pulmonary hypertension

The prognostic value of fQRSTa in patients with aortic stenosis undergoing surgical aortic valve replacement

“…A total of 372 patients with severe degenerative AS who underwent successful sAVR were included in this retrospective study. Baseline clinical, demographic, and laboratory parameters are demonstrated in [9], P = .013) compared to the first group and it was statistically significant.…”

“…Aortic stenosis (AS) is the most common form of degenerative valvular heart disease and surgical valve replacement (sAVR) continues to be the gold standard therapy in severe symptomatic AS, especially in developing countries due to its increasing prevalence. 1 Although several prognostic risk factors of sAVR were described, [2][3][4][5][6][7][8][9][10][11] new prognostic markers are of great interest.…”

Prognostic impact of main pulmonary artery to ascending aorta diameter ratio in patients with severe aortic stenosis underwent transcatheter aortic valve implantation

“…14 As is implicit within the components of the STS score, increased pulmonary artery pressure (PAP) and RVD are directly associated with increased mortality in severe AS patients. 15,16 Therefore, accurately delineating PAP and RV functions in patients planned for TAVI or SAVR is of vital importance in determining procedural risk.…”

“…While no cardiac damage was observed in only 2.8% of patients in whom TAVI or SAVR was indicated for severe AS, the incidence of stages 1, 2, 3, and 4 cardiac damage in these patients was 12.8%, 50.8%, 24.9%, and 8.7%, respectively 14 . As is implicit within the components of the STS score, increased pulmonary artery pressure (PAP) and RVD are directly associated with increased mortality in severe AS patients 15,16 . Therefore, accurately delineating PAP and RV functions in patients planned for TAVI or SAVR is of vital importance in determining procedural risk.…”