title: Outcomes of patients with chronic lung disease and severe aortic stenosis treated with transcatheter versus surgical aortic valve replacement or standard therapy: insights from the PARTNER trial (placement of AoRTic TraNscathetER Valve).
abstract: OBJECTIVE
  The study aimed to evaluate the impact of chronic lung disease (CLD) on outcomes of severe aortic stenosis patients across all treatment modalities.
  
  
  BACKGROUND
  Outcomes of patients with CLD undergoing transcatheter aortic valve replacement (TAVR) have not been systematically examined.
  
  
  METHODS
  All patients who underwent TAVR in the PARTNER (Placement of AoRTic TraNscathetER Valve) trial, including the continued access registry (n = 2,553; 1,108 with CLD), were evaluated according to CLD clinical severity. Additionally, outcomes of CLD patients included in the randomization arms of the PARTNER trial were compared: Cohort A patients (high-risk operable) treated by either TAVR (n = 149) or surgical aortic valve replacement (SAVR); (n = 138); and Cohort B patients (inoperable) treated by either TAVR (n = 72) or standard therapy only (n = 95).
  
  
  RESULTS
  Among all TAVR-treated patients, at 1-year follow-up, patients with CLD had higher mortality than those without it (23.4% vs. 19.6%, p = 0.02). Baseline characteristics of CLD patients who underwent TAVR were similar to respective controls. In Cohort A, 2-year all-cause death rates were similar (TAVR 35.2% and SAVR 33.6%, p = 0.92), whereas in Cohort B, the death rate was lower after TAVR (52.0% vs. 69.6% after standard therapy only, p = 0.04). Independent predictors for mortality in CLD patients undergoing TAVR included poor mobility (6-min walk test <50 m; hazard ratio: 1.67, p = 0.0009) and oxygen-dependency (hazard ratio: 1.44, p = 0.02). Although CLD patients undergoing TAVR have worse outcomes than patients without CLD, TAVR is better in these patients than standard therapy and is similar to SAVR.
  
  
  CONCLUSIONS
  Although patients with CLD undergoing TAVR had worse outcomes than patients without CLD, TAVR performed better in these patients than standard therapy and was similar to SAVR. However, CLD patients who were either poorly mobile or oxygen-dependent had poor outcomes. (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894).
authors.affiliation: MedStar Washington Hospital Center, Washington, DC.
authors.forename: Danny
authors.initials: D
authors.lastname: Dvir
authors.affiliation: MedStar Washington Hospital Center, Washington, DC. Electronic address: ron.waksman@medstar.net.
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
authors.affiliation: MedStar Washington Hospital Center, Washington, DC.
authors.forename: Israel M
authors.initials: IM
authors.lastname: Barbash
authors.affiliation: Center for Interventional Vascular Therapy, Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York.
authors.forename: Susheel K
authors.initials: SK
authors.lastname: Kodali
authors.affiliation: Sones Cardiac Catheterization Laboratory, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Lars G
authors.initials: LG
authors.lastname: Svensson
authors.affiliation: Sones Cardiac Catheterization Laboratory, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: E Murat
authors.initials: EM
authors.lastname: Tuzcu
authors.affiliation: Center for Interventional Vascular Therapy, Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York.
authors.forename: Ke
authors.initials: K
authors.lastname: Xu
authors.affiliation: MedStar Washington Hospital Center, Washington, DC.
authors.forename: Sa'ar
authors.initials: S
authors.lastname: Minha
authors.affiliation: Center for Interventional Vascular Therapy, Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Alu
authors.affiliation: Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Wilson Y
authors.initials: WY
authors.lastname: Szeto
authors.affiliation: Cardiac Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Vinod H
authors.initials: VH
authors.lastname: Thourani
authors.affiliation: Cardiovascular Interventional Center, Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Raj
authors.initials: R
authors.lastname: Makkar
authors.affiliation: Sones Cardiac Catheterization Laboratory, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Samir
authors.initials: S
authors.lastname: Kapadia
authors.affiliation: MedStar Washington Hospital Center, Washington, DC.
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.affiliation: Interventional Cardiology and Cardiac Catheterization Laboratories Martin B. Leon, Center for Interventional Vascular Therapy, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: John G
authors.initials: JG
authors.lastname: Webb
authors.affiliation: Center for Interventional Vascular Therapy, Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York.
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.affiliation: MedStar Washington Hospital Center, Washington, DC.
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006328:Cardiac Catheterization / Q000379:methods*; D002423:Cause of Death / Q000639:trends; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008171:Lung Diseases / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D008297:Male; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: 1-s forced expiratory volume; 6-min walk test; 6MWT; AS; BMI; CLD; FEV1; NRCA; NYHA; New York Heart Association; RCT; SAVR; STS; Society of Thoracic Surgeons; TAVR; aortic stenosis; body mass index; chronic lung disease; nonrandomized continued access; pulmonary disease; randomized controlled trial; surgical aortic valve replacement; transcatheter aortic valve replacement