Postoperative complications of transcatheter and surgical aortic valve replacement in patients with borderline pulmonary hypertension:A retrospective cohort study

BackgroundBorderline pulmonary hypertension (mean pulmonary artery pressure 20-24 mmHg) is increasingly recognized as a clinically significant condition that may influence perioperative outcomes in patients undergoing aortic valve replacement. This study aims to explore the 30-day composite complication rates and mortality among patients with borderline pulmonary hypertension who received transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). MethodsThe retrospective cohort study included 194 patients with borderline pulmonary hypertension who underwent either TAVR (n = 67) or SAVR (n = 127) between 2012 and 2023. Propensity score matching (1:1) was used to balance baseline characteristics. The primary outcome was a composite of 30-day postoperative complications and mortality. Secondary outcomes included 1-year mortality, individual complications, and perioperative clinical parameters. ResultsThe 30-day composite complications and mortality were 56 of 67 (83.6%) patients undertaking TAVR, compared with 101 of 127 (79.5%) patients taking SAVR. After matching, 42 patients were included in each group. There was no significant difference in the incidence of the primary composite outcome between TAVR and SAVR groups (85.7% vs. 85.7%). One-year mortality was also comparable (2.4% vs. 0%). TAVR was associated with a higher rate of cardiovascular complications (21.4% vs. 4.8%) but a lower rate of renal complications (0% vs. 26.2%). TAVR patients had shorter operative time, earlier extubation, reduced blood loss, and shorter intensive care unit and hospital stays, but higher hospitalization costs. ConclusionsIn patients with borderline pulmonary hypertension, TAVR and SAVR demonstrated similar rates of 30-day composite complications and 1-year mortality. These findings support a support individualized treatment decisions to valve replacement strategy in this clinically vulnerable population.