Outcome of Transcatheter Aortic Valve Replacement for Pure Native Aortic Regurgitation in Patients with Pulmonary Hypertension

Abstract

Background: In recent years, transcatheter aortic valve replacement (TAVR) has emerged as a pivotal treatment for pure native aortic regurgitation (PNAR). Given patients with severe aortic regurgitation (AR) are prone to suffer from pulmonary hypertension (PH), understanding TAVR's efficacy in this context is crucial. This study aims to explore the short-term prognosis of TAVR in PNAR patients with concurrent PH.

Methods: Patients with PNAR undergoing TAVR at Zhongshan Hospital, Affiliated with Fudan University, were enrolled between June 2018 to June 2023. They were categorized based on pulmonary artery systolic pressure (PASP) into groups with or without PH. The baseline characteristics, imaging records, and follow-up data were collected.

Results: Among the 103 patients recruited, 48 were afflicted with PH. In comparison to PNAR patients without PH, the PH group exhibited higher rates of renal dysfunction (10.4% vs. 0.0%, p = 0.014), increased Society of Thoracic Surgeons scores (6.4 $\pm$ 1.9 vs. 4.7 $\pm$ 1.6, p $<$ 0.001), and elevated Nterminal fragment of pro-brain natriuretic peptide (NT-proBNP). Transthoracic ultrasound examination revealed that patients with PH displayed lower left ventricular ejection fraction, larger left ventricle dimension, and more frequent moderate to severe tcuspid regurgitation (TR). Following TAVR, both groups experienced significant reductions in PASP, mitral regurgitation (MR) and TR. There were no significant differences in the incidence of postoperative adverse events in patients with or without PH.

Conclusions: We found TAVR to be a safe and effective treatment for patients with PNAR and PH, reducing the degree of aortic regurgitation and PH without increasing the risk of postoperative adverse events.

Keywords: pulmonary artery hypertension; pure native aortic regurgitation; retrospective; transcatheter aortic valve replacement.

Fig. 1.

Changes in the NYHA functional classification in PNAR patients Pre- and Post-TAVR, with and without PH. Assessment of the NYHA functional class changes in patients with PNAR undergoing TAVR, categorized by the presence or absence of PH. (A) illustrates the progression in patients without PH, while (B) details those with PH. These comparisons highlight the procedural impact on cardiac functional status over the follow-up period. Abbreviations: PH, pulmonary artery hypertension; TAVR, transcatheter aortic valve replacement; NYHA, New York Heart Association; PNAR, pure native aortic regurgitation.

Fig. 2.

Changes in PASP pre- and post-TAVR in PNAR patients, segregated by PH status. Comparison of PASP before and after TAVR in patients with PNAR, differentiated by the absence (A) or presence (B) of PH. The figure underscores the procedural impact on PASP across both patient categories over the follow-up period, demonstrating the effectiveness of TAVR in modifying hemodynamic parameters. Abbreviations: PH, pulmonary artery hypertension; TAVR, transcatheter aortic valve replacement; PASP, systolic pulmonary artery pressure; PNAR, pure native aortic regurgitation.