Patients with baseline pulmonary hypertension undergoing mTEER had a 2.55-fold higher risk of death or HF hospitalization if post-procedure PH persisted (HR 2.55).
Does residual post-procedure pulmonary hypertension increase the risk of mortality and heart failure hospitalizations in patients undergoing mTEER?
In patients undergoing mTEER, failure to improve baseline pulmonary hypertension post-procedure is associated with a 2.5-fold increased risk of mortality and heart failure hospitalizations, whereas baseline elevated pulmonary vascular resistance alone is not.
Absolute Event Rate: 0% vs 0%
Abstract Background Limited data exists pertaining to the impact of pulmonary hypertension (PH) and elevated pulmonary vascular resistance (PVR) on clinical outcomes in patients undergoing transcatheter mitral valve edge to edge repair (mTEER). Purpose Identify PH patients at risk for readmission and mortality following mTEER. Methods We included patients who underwent mTEER between January 2021 and August 2024. The primary endpoint was a composite of all-cause mortality and heart failure (HF) hospitalizations. We evaluated the impact of baseline and post-procedure PH. PH was defined as right ventricular systolic pressure (RSVP) ≥50 mmHg as measured by echocardiogram. Elevated PVR was defined as PVR 2 on right heart catheterization (RHC). Results A total of 158 patients with mean age of 76 and STS median score of 5.1 (IQR 1.44-9.34) were included in the analysis. Over a follow up period of 330 days (IQR 140-655), 39 patients died and 40 patients had HF hospitalizations. Mean RAP and RVSP was 8 and 50 mmHg at baseline, and 7 and 43 mmHg at discharge, respectively. Out of 77 patients with PH at baseline, 37 (48.1%) had reduction in post-procedure RVSP to 50 mmHg. Baseline PH was not significantly associated with the primary endpoint (p=0.64). However, among patients who had baseline PH, those who had residual post-procedure PH were at significantly higher risk of primary endpoint compared to those with reduced RVSP (hazard ratio: 2.55, 95% CI 1.06-6.170; log rank p=0.031). Among 27 patients with pre-procedure PH who underwent RHC, 20 patients (74.1%) had elevated PVR. There was no significant difference in the primary endpoint between patients with and without elevated PVR (log rank p=0.574). Conclusion Patients with baseline PH via echocardiography who underwent mTEER had significantly higher incidence of all-cause death and heart failure hospitalizations if their PH did not improve after the procedure. However, elevated PVR was not associated with increased mortality and heart failure hospitalizations.
Guzman et al. (Sat,) reported a other. Patients with baseline pulmonary hypertension undergoing mTEER had a 2.55-fold higher risk of death or HF hospitalization if post-procedure PH persisted (HR 2.55).