title: Impact of chronic obstructive pulmonary disease on Valve Academic Research Consortium-defined outcomes after transcatheter aortic valve implantation (from the FRANCE 2 Registry).
abstract: The purposes of the present study were to determine the impact of chronic obstructive pulmonary disease (COPD) on Valve Academic Research Consortium-defined outcomes in patients undergoing transcatheter aortic valve implantation (TAVI). A total of 3,933 consecutive patients underwent TAVI from January 2010 to December 2011 in 34 centers and were included in the French national TAVI registry "FRANCE 2"; 895 (22.7%) had concomitant COPD, 3,038 (77.3%) did not. There were no significant differences in procedural characteristics or 30-day Valve Academic Research Consortium-defined outcomes between those with and without COPD. Multivariate regression analysis showed COPD to be an independent predictor of 1-year mortality and combined efficacy end point after adjustment for concomitant co-morbidities (hazard ratio 1.19, 95% confidence interval 1.005 to 1.41, p = 0.03 and hazard ratio 1.52, 95% confidence interval 1.29 to 1.79, p <0.001, respectively). The higher mortality rate at 1 year in patients with COPD was related to cardiovascular deaths (COPD 10.0% vs non-COPD 6.2%, p = 0.008). Subgroup analysis found that the effect of COPD on 1-year mortality rate was constant across different subgroups, especially the type of approach and the type of anesthesia subgroups. In conclusion, concomitant COPD in patients referred for TAVI characterizes a high-risk population. The excess in mortality is largely determined by a higher rate of cardiovascular deaths and exists regardless of the type of procedure performed and its results.
authors.affiliation: Department of Cardiology, EA3920, University Hospital Besançon, Besançon, France. Electronic address: rchopard@chu-besancon.fr.
authors.forename: Romain
authors.initials: R
authors.lastname: Chopard
authors.affiliation: Department of Cardiology, EA3920, University Hospital Besançon, Besançon, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meneveau
authors.affiliation: Department of Cardiovascular Surgery, EA3920, University Hospital Besançon, Besançon, France.
authors.forename: Sidney
authors.initials: S
authors.lastname: Chocron
authors.affiliation: Department of Cardiology, University Hospital of Brest, Brest, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Gilard
authors.affiliation: Department of Cardiac Surgery, University Hospital Dupuytren, Limoges, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Laskar
authors.affiliation: Department of Cardiology, University Hospital of Rouen, Rouen, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Eltchaninoff
authors.affiliation: Department of Cardiology, Bichat-Claude-Bernard Hospital, AP-HP, Paris, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Iung
authors.affiliation: Department of Cardiology, University Hospital of La Pitié Salpêtrière, Paris, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
authors.affiliation: Department of Cardiology, University Hospital Henri Mondor, Créteil, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Teiger
authors.affiliation: URC Eco, Hôtel-Dieu, AP-HP, Paris, France.
authors.forename: Karine
authors.initials: K
authors.lastname: Chevreul
authors.affiliation: Department of Cardiovascular Surgery, University Hospital of Lille, Lille, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Prat
authors.affiliation: University Lyon 1, Lyon, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Lievre
authors.affiliation: Division of Thoracic, Cardiac and Vascular Surgery, Rennes University Hospital, Rennes, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Leguerrier
authors.affiliation: Jacques Cartier Institute, Massy, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Donzeau-Gouge
authors.affiliation: Clinique Pasteur, Toulouse, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Fajadet
authors.affiliation: Department of Cardiology, EA3920, University Hospital Besançon, Besançon, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Schiele
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D012042:Registries; D016896:Treatment Outcome