The Association between Blood Pressure Changes and Clinical Outcomes in Patients Undergoing Transcatheter Aortic Valve Implantation

Introduction: Several hemodynamic changes occur after transcatheter aortic valve implantation (TAVI). Changes in systemic blood pressure (BP) after TAVI have been described, yet is not established whether these changes are associated with worse clinical outcomes. We aimed to examine the association between BP change after TAVI and short and long-term clinical outcomes.

Methods: A retrospective study of consecutive patients who underwent TAVI in Rabin Medical Center between 2008-2016. Complete data regarding BP measurements before and after the procedure were acquired from the patients` medical records. The primary endpoint was the composite of death, stroke, hospitalization, and non-improvement in New York Heart Association functional class at 1-year post the TAVI procedure. Short term clinical outcomes were defined according to the VARC-2 definitions.

Results: Included were 414 patients (mean age 82y, 43% male). Compared with pre-procedural BP levels, there was an immediate increase in the mean systolic BP (from 129.04 to 149.21mmHg, P<0.001), a decrease in mean diastolic BP (from 64.54 to 61.19 mmHg, P<0.001), and thus an increase in mean pulse pressure (from 64.5 to 88.02 mmHg, P<0.001). The rate of the primary endpoint was higher among patients with a net increase in pulse pressure after the procedure (18% vs. 6%, P= 0.012). Mortality rate at 1-year was also higher among patients with a net increase in the pulse pressure (7% vs. 3%, P= 0.009). On multivariate analysis, adjusted for age, STS score, and paravalvular leak, pulse pressure after TAVI was non-linearly and independently associated with the primary endpoint. Changes in BP after TAVI were not significantly associated with short-term complications including bleeding.

Conclusions: An immediate increase in pulse pressure after TAVI is associated with long-term worse clinical outcomes including mortality. Further studies are needed to examine this association and the treatment for increased BP after TAVI.