ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Structural Interventional Cardiology
Long-term outcome of patients with severe pulmonary hypertension undergoing transcatheter aortic valve implantation
Provisionally accepted
Oliver D. Bhadra1*
Lara Waldschmidt2
Till Joscha Demal1David Grundmann2Ina Von Der Heide2Laura Hannen2
Lisa Voigtlaender2Johannes Schirmer1
Sebastian Ludwig2
Simon Pecha1Stefan Blankenberg2Hermann Reichenspurner1
Niklas Schofer2
Andreas Schaefer1- 1Department of Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- 2Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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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 2008–2021, 3610 patients with preoperatively documented systolic pulmonary artery pressure (sPAP) underwent TAVI at our institution. The cut off for severe PH was defined as sPAP >55mmHg as determined by echocardiography. Severe PH was preoperatively identified in 456 patients. This group was compared to 3154 patients with sPAP ≤55mmHg. Data were retrospectively analysed according to updated Valve Academic Research Consortium (VARC-3) definitions. Results TAVI patients with sPAP >55mmHg presented with higher median age (sPAP ≤55mmHg: 81.6 years (interquartile range (IQR): 77.2-85.1) vs. sPAP>55mmHg: 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.
Keywords: TAVI, SPAP, Long term follow up, aortic valve disease, pulmonary hypertension
Received: 01 Aug 2025; Accepted: 24 Nov 2025.
Copyright: © 2025 Bhadra, Waldschmidt, Demal, Grundmann, Von Der Heide, Hannen, Voigtlaender, Schirmer, Ludwig, Pecha, Blankenberg, Reichenspurner, Schofer and Schaefer. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Oliver D. Bhadra
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