Transcatheter versus Surgical Aortic Valve Replacement for Patients With Pulmonary Hypertension

Introduction: Transcatheter aortic valve replacement (TAVR) has become a viable alternative to surgical aortic valve replacement (SAVR) for high-risk patients with aortic stenosis. One such high-risk group is patients with pulmonary hypertension (PH), which is known to increase surgical risk and adversely affect outcomes. This study aims to compare midterm and long-term survival in TAVR and SAVR among patients with PH.

Methods: A retrospective review of patients with PH undergoing an aortic valve replacement was conducted at a single institution. From May 2012 to June 2020, 427 patients with PH underwent a primary isolated TAVR (n = 249) or SAVR (n = 178). PH was assessed using an estimated pulmonary artery systolic pressure ≥40 mmHg. Propensity score matching was used to adjust for confounders.

Results: Before matching, Kaplan-Meier estimated survival was significantly lower for TAVR compared to SAVR (P < 0.01). After matching, 87 well-balanced pairs remained. Post propensity score matching, Kaplan-Meier estimated survival was still significantly lower for the TAVR group as compared to the SAVR group (P = 0.045).

Conclusions: These data support the feasibility and safety of SAVR in selected patients with PH, and the presence of PH should not preclude consideration of SAVR in appropriate surgical candidates. Further multicenter research is needed to explore confounders and deepen our understanding of the long-term outcomes in this high-risk population.