Frederick W. Crock

Outcomes of persistent pulmonary hypertension following transcatheter aortic valve replacement

Objectives To determine the prevalence and factors associated with persistent pulmonary hypertension (PH) following transcatheter aortic valve replacement (TAVR) and its relationship with long-term mortality. Methods Consecutive patients who underwent TAVR from July 2011 through January 2016 were studied. The prevalence of baseline PH (mean pulmonary artery pressure ≥25 mm Hg on right heart catheterisation) and the prevalence and the predictors of persistent≥moderate PH (pulmonary artery systolic pressure (PASP)>45 mm Hg on 1 month post-TAVR transthoracic Doppler echocardiography) were collected. Cox models quantified the effect of persistent PH on subsequent mortality while adjusting for confounders. Results Of the 407 TAVR patients, 273 (67%) had PH at baseline. Of these, 102 (25%) had persistent≥moderate PH. Mortality at 2 years in patients with no baseline PH versus those with PH improvement (follow-up PASP≤45 mm Hg) versus those with persistent≥moderate PH was 15.4%, 16.6% and 31.3%, respectively (p=0.049). After adjusting for Society of Thoracic Surgeons Predicted Risk of Mortality and baseline right ventricular function (using tricuspid annular plane systolic excursion), persistent≥moderate PH remained associated with all-cause mortality (HR=1.82, 95% CI 1.06 to 3.12, p=0.03). Baseline characteristics associated with increased likelihood of persistent≥moderate PH were ≥moderate tricuspid regurgitation, ≥moderate mitral regurgitation, atrial fibrillation/flutter, early (E) to late (A) ventricular filling velocities (E/A ratio) and left atrial volume index. Conclusions Persistency of even moderate or greater PH at 1 month post-TAVR is common and associated with higher all-cause mortality.

TCT-676 Prevalence of Residual Mitral and Tricuspid Regurgitation (MR/TR) following Transcatheter Aortic Valve Replacement (TAVR): Residual Mod/Severe MR and TR is Associated with Higher Mortality post TAVR

NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York, United States; Emory University School of Medicine, Atlanta, Georgia, United States; Emory University Hospital Midtown, Atlanta, Georgia, United States; Columbia University Medical Center, Wilson, North Carolina, United States; NewYorkPresbyterian Hospital/Columbia University Medical Center, New York, New York, United States; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York, United States; The Heart Hospital Baylor Plano, Plano, Texas, United States

POOR AGREEMENT BETWEEN TRANSTHORACIC ECHOCARDIOGRAPHY AND RIGHT HEART CATHETERIZATION FOR ASSESSMENT OF PULMONARY HYPERTENSION SEVERITY: CLINICAL APPLICATIONS IN THE TAVR ERA

Background: Pulmonary hypertension (PH) is common and prognostically important in patients undergoing transcatheter aortic valve replacement (TAVR). However, the accuracy of PH severity assessment by transthoracic echocardiogram (TTE) when compared to gold standard right heart catheterization (RHC)

Echocardiographic evaluation and guidance for MitraClip procedure

Transcatheter mitral valve repair using the MitraClip system (Abbott, Abbott Park, Il, USA) has become a world-wide, well-established therapeutic alternative to treat symptomatic patients with severe mitral regurgitation and prohibitive surgical risk. This article offers a comprehensive review of the important clinical and imaging aspects related to the patient selection, imaging evaluation and intraprocedural guidance for optimal results using this transcatheter device therapy. This article provides an updated framework for the interested practitioners summarizing the current understanding and applications for this device based on the current literature and growing experience of this technique.

PACEMAKER DEPENDENCY AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT IS ASSOCIATED WITH REDUCTION IN GLOBAL LEFT VENTRICULAR FUNCTION

Consequences of conduction abnormalities requiring a permanent pacemaker (PPM) after transcatheter aortic valve replacement (TAVR) are still unclear. Our aim was to determine risk factors for PPM after TAVR and associated effects on LV function over time. Of 389 consecutive TAVR patients, we

PATIENT-PROSTHESIS MISMATCH IN THE ERA OF TRANSCATHETER AORTIC VALVE REPLACEMENT: IS THIS A REAL PROBLEM?

Body surface area-indexed effective orifice area (EOAi) measured by transthoracic echocardiography has been recommended for assessment of patient-prosthesis mismatch (PPM) post aortic valve replacement (AVR). Recent studies have shown a high prevalence of PPM in both post surgical and transcatheter