Association Between Pulmonary Hypertension and Transcatheter Aortic Valve Replacement: Analysis of a Nationwide Inpatient Sample Database

Author(s): Dominika M. Zoltowska*, Yashwant Agrawal, Nilesh Patel, Nishtha Sareen, Jagadeesh K. Kalavakunta, Vishal Gupta, Abdul Halabi

Journal Name: Reviews on Recent Clinical Trials

Volume 14 , Issue 1 , 2019

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Graphical Abstract:


Introduction: This study was done to review the association of pulmonary hypertension (PH) with Transcatheter Aortic Valve Replacement (TAVR) procedures done in the US for years 2010 to 2012.

Methods: We used Nationwide Inpatient Sample (NIS) data to extract data for patients who were hospitalized with a primary/secondary diagnosis of TAVR as specified by International Classification of Disease (ICD-9) codes 35.05 and 35.06. PH was identified with ICD-9 codes 416.0 and 416.8. Logistic regression models were used to analyze the association between PH and clinical outcomes of TAVR.

Results: A total of 8,824 weighted discharges were identified with a primary/secondary diagnosis of TAVR, of which 1,976 (22.4%) also had PH. Mean age of patients undergoing TAVR with and without PH was 81.4 and 81.1 years, respectively. More females had a diagnosis of PH with TAVR when compared to males, (56.9% vs. 43.1). When controlling for demographics, diabetes and hypertension; the association between PH and TAVR was statistically significant (p<.0001). Estimated odds of TAVR with PH was 5.46 (95% CI: 4.63, 6.41) times greater than for TAVR without PH. Similarly, the estimated odds for a length of stay greater than 1 week for TAVR with PH was 1.43 (95% CI: 1.12, 1.82; p=.0034) times greater than odds for TAVR without PH. PH was not statistically significant for in-hospital mortality in patients receiving TAVR (p=0.7067).

Conclusion: This study suggests that underlying PH does not influence the immediate mortality of patients underlying TAVR. Further studies are needed to delve into the bearing of PH on TAVR.

Keywords: In-patient mortality, pulmonary hypertension, severe aortic stenosis, TAVR, transcatheter aortic, Nationwide Inpatient Sample (NIS).

Lindman BR, Clavel MA, Mathieu P, et al. Calcific aortic stenosis. Nat Rev Dis Primers 2016; 2: 16006.
Johnson LW, Hapanowicz MB, Buonanno C, et al. Pulmonary hypertension in isolated aortic stenosis Hemodynamic correlations and follow-up J Thorac Cardiovasc Surg 1988; 95: 603e607.
Franzone1 A, Pilgrim1 T, Stortecky1 S, Windecker1 S. Evolving indications for transcatheter aortic valve interventions. Curr Cardiol Rep 2017; 19: 107.
Minai OA, Yared JP, Kaw R, Subramaniam K, Hill NS. Perioperative risk and management in patients with pulmonary hypertension. Chest 2013; 144(1): 329-40.
Steiner C, Elixhauser A, Schnaier J. The healthcare cost and utilization project: An overview. Eff Clin Pract 2002; 5(3): 143-51.
Zhang Z. Model building strategy for logistic regression: Purposeful selection. Ann Transl Med 2016; 4(6): 111.
Zhang Z. Residuals and regression diagnostics: Focusing on logistic regression. Ann Transl Med 2016; 4(10): 195.
Vachiéry J-L, Adir Y, Barberà JA, et al. Pulmonary hypertension due to left heart diseases. J Am Coll Cardiol 2013; 62: D100-8.
Humbert M, Montani D, Evgenov OV, Simonneau G. Definition and classification of pulmonary hypertension. Handb Exp Pharmacol 2013; 218: 3-29.
Levy F, Bohbot Y, Sanhadji K, et al. Impact of pulmonary hypertension on long-termoutcome in patients with severe aortic stenosis. Eur Heart J Cardiovasc Imaging 2018; 19(5): 553-61.
Silver K, Aurigemma G, Krendel S, et al. Pulmonary artery hypertension in severe aortic stenosis: incidence and mechanism. Am Heart J 1993; 125: 146-50.
Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the management of patients with valvular heart disease: A report of the american college of cardiology/American heart association task force on clinical practice guidelines. Circulation 2017; 135(25): e1159-95.
Masri A, Abdelkarim I, Sharbaugh MS, et al. Outcomes of persistent pulmonary hypertension following transcatheter aortic valve replacement. Heart 2018; 104(10): 821-7.
Nashef SA, Roques F, Sharples LD, et al. EuroSCORE II. Eur J Cardiothorac Surg 2012; 41: 734-45.
Rady MY, Ryan T. Perioperative predictors of extubation failure and the effect on clinical outcome after cardiac surgery. Crit Care Med 1999; 27: 340-7.
Gutmann A, Kaier K, Reinecke H, et al. Impact of pulmonary hypertension on in-hospital outcome after surgical or transcatheter aortic valve replacement. EuroIntervention 2017; 13: 804-10.
Parikh R, Varghese B, Khatoon HN, et al. Increased mortality from complications of pulmonary hypertension in patients undergoing transcatheter aortic valve replacement. Pulm Circ 2017; 7(2): 391-8.

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Article Details

Year: 2019
Published on: 30 January, 2019
Page: [56 - 60]
Pages: 5
DOI: 10.2174/1574887113666181120113034
Price: $65

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