Characterizing the Acute Changes in Pulmonary Capillary Wedge Pressure Associated With Transcatheter Pulmonary Valve Replacement.

BACKGROUND: After transcatheter pulmonary valve replacement (TPVR), changes in left ventricular loading conditions can result in increased pulmonary capillary wedge pressure (PCWP). Recognizing this effect may allow better understanding of the physiologic response of the left ventricle (LV) as well as early identification and treatment of procedural complications.

AIMS: Our aim was to describe the hemodynamic changes in LV filling pressures after TPVR measured by a PCWP before and after valve deployment.

METHODS: We present a single center, retrospective cohort of patients that underwent TPVR at the University of Colorado. Outcomes considered were need for ventilatory support, prolonged length of stay and ventricular arrhythmias. Abnormal wedge physiology was defined as an elevated pre-PCWP (>15 mmHg) or an increase (delta-PCWP) of at least 5 mmHg immediately after TPVR.

RESULTS: A total of 104 patients were included with a median age at procedure of 22.5 years of age (IQR 14.3-36.8, and range 6-67). Twenty-two (21.2%) patients were determined to have abnormal wedge physiology. Patients in this group were older (median 37, IQR 22.8-51 vs. 18.5, IQR 13-32.3, p < 0.001), with higher pre- and post-procedure right ventricular systolic and end diastolic pressures, higher mean pulmonary artery pressures and lower pre-procedure cardiac index (p < 0.05).

CONCLUSIONS: An alteration in the loading conditions of the LV is among several hemodynamic changes that occur after TPVR and can manifest as an elevated PCWP. An awareness of this phenomenon and monitoring of PCWP before and after TPVR may promote the initiation of early interventions in this patient population. In the setting of medical interventions, abnormal wedge physiology was not associated with longer length of stay, ventilatory support, or early ventricular arrhythmias.