What is the clinical evidence from this study?

Study design: Observational. Population: severe pulmonary hypertension undergoing transcatheter aortic valve implantation (n=3610). Intervention: Transcatheter Aortic Valve Implantation (TAVI) vs. patients with sPAP ≤ 55 mmHg. Primary outcome: mortality rates over time (HR 1.23, 95% CI 1.04-1.46, p=0.017).

February 2, 2026Frontiers in Cardiovascular Medicine0 citationsOpen Access

Long-term outcome of patients with severe pulmonary hypertension undergoing transcatheter aortic valve implantation

OBOliver D. BhadraCardiac Surgery JWJessica Weimann LWLara WaldschmidtInterventional Cardiology

Key Result

Patients with severe pulmonary hypertension undergoing TAVI have significantly higher mortality rates at one year and long-term compared to those without severe PH.

Key Points

The research aims to characterize patients with severe pulmonary hypertension undergoing TAVI and to analyze their clinical outcomes.
Retrospective analysis of 3,610 TAVI patients from 2008 to 2021.
Severe pulmonary hypertension defined as sPAP > 55 mmHg via echocardiography.
Comparison between patients with severe PH (456) and those without (3,154).
Outcomes evaluated based on VARC-3 definitions.
Patients with severe PH were older and had higher rates of left ventricular dysfunction.
Acute outcomes were worse for severe PH patients compared to those with normal sPAP.
One-year mortality was 30.2% in severe PH patients, significantly higher than 20.0% in others.
Five-year follow-up showed 65.1% mortality for severe PH versus 52.0% in non-severe cases.

Study Design

Type

Observational (n=3,610)

Multicenter

Structured PICO

Does severe pulmonary hypertension (sPAP > 55 mmHg) increase acute complications and long-term mortality in patients undergoing TAVI?

Population

3,610 patients undergoing transcatheter aortic valve implantation (TAVI) with preoperatively documented systolic pulmonary artery pressure (sPAP), median age 81.6 years, 51.2% male, single-center (Germany).

Intervention

Transcatheter aortic valve implantation (TAVI) in patients with severe pulmonary hypertension (sPAP > 55 mmHg as determined by echocardiography)

Comparator

Transcatheter aortic valve implantation (TAVI) in patients without severe pulmonary hypertension (sPAP ≤ 55 mmHg)

Outcome

Acute clinical outcomes and long-term mortality (at 30 days, 1 year, and 60 months), adjudicated according to updated Valve Academic Research Consortium (VARC-3) definitionshard clinical

In patients undergoing TAVI, the presence of severe pulmonary hypertension (sPAP > 55 mmHg) identifies a high-risk cohort with significantly increased acute periprocedural complications and higher long-term mortality up to 5 years.

Main Result

Effect estimate: HR 1.23 (95% CI 1.04-1.46)

Absolute Event Rate: 30.2% vs 20%

p-value: p=0.017

Limitations

Retrospective study design may introduce bias.
Single-center experience limits generalizability.
Non-invasive method may not capture complete hemodynamic profile of PH.

Abstract

Objectives Recent reports suggest that pulmonary hypertension (PH) is associated with a significantly higher acute mortality after transcatheter aortic valve implantation (TAVI). The aim of this study is to characterize patients undergoing TAVI with preoperative echocardiographically determined severe PH and to investigate acute clinical and long-term outcomes. Methods From 2008 to 2021, 3,610 patients with preoperatively documented systolic pulmonary artery pressure (sPAP) underwent TAVI at our institution. The cut off for severe PH was defined as sPAP 55 mmHg as determined by echocardiography. Severe PH was preoperatively identified in 456 patients. This group was compared to 3,154 patients with sPAP ≤ 55 mmHg. Data were retrospectively analysed according to updated Valve Academic Research Consortium (VARC-3) definitions. Results TAVI patients with sPAP 55 mmHg presented with higher median age (sPAP ≤ 55 mmHg: 81.6 years interquartile range (IQR): 77.2–85.1 vs. sPAP 55 mmHg: 82.3 (IQR 77.8–85.8), p = 0.01) and higher prevalence of significant left ventricular dysfunction (LVEF 35%) (9.7 vs. 15.5%, p 0.001). Acute outcomes were impaired in patients with severe PH. The detrimental effect of severe PH persisted in Kaplan–Meier analysis one-year after TAVI (mortality rate 20.0 vs. 30.2%, p 0.001) and in 60-month follow-up (52.0 vs. 65.1%, p 0.001). Conclusion TAVI patients with severe PH represent a high-risk subgroup with unfavourable acute outcomes and increased one-year and long-term mortality. Moreover, the presence of severe PH is associated with increased rates of acute adverse events, including bleeding, need for PPM implantation and renal failure.

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