title: The association of chronic lung disease with early mortality and respiratory adverse events after aortic valve replacement.
abstract: BACKGROUND
  We studied the association between components of chronic lung disease (CLD) assessment and operative outcomes in patients undergoing aortic valve replacement (AVR) for aortic stenosis.
  
  
  METHODS
  From 2011 to 2012, 9,177 patients included in The Society of Thoracic Surgeons (STS) Cardiac Surgery Database underwent AVR for aortic stenosis with complete pulmonary function tests (PFT) and CLD data (31% of AVRs). We evaluated markers of CLD and their association with operative mortality, pulmonary morbidity, and length of hospital stay using multivariable logistic regression analysis.
  
  
  RESULTS
  In a selected population of AVR patients with PFTs, CLD was prevalent in 50% (mild, 25.6%; moderate, 13.2%; severe, 11.2%). Predicted forced expiratory volume in 1 second (FEV1) was obtained in all patients and diffusion capacity of the lung for carbon monoxide (DLCO), arterial oxygen tension (PaO2), and arterial carbon dioxide tension (PaCO2) in 31%. The STS predicted risk of operative mortality, mortality, pulmonary morbidity, and hospital stay increased with severity of CLD and with low FEV1, DLCO, and PaO2. Moderate and severe CLD were independently associated with operative mortality (odds ratio [OR] 2.88, 95% confidence interval [CI]: 2.0-4.5), pulmonary morbidity (OR 2.33, 95% CI: 1.93-2.8), and prolonged hospital stay (OR 2.73, 95% CI: 2.17-3.45). Low FEV1 was independently associated with pulmonary morbidity and prolonged hospital stay. Low PaO2 and DLCO were independently associated with a combined mortality and pulmonary morbidity endpoint.
  
  
  CONCLUSIONS
  CLD is associated with adverse operative outcomes in selected patients with aortic stenosis undergoing AVR. FEV1, DLCO, and PaO2 may add important information to current risk adjustment models beyond the broad CLD classification.
authors.affiliation: Division of Cardiac Surgery, Wexner Medical Center, Ohio State University, Columbus, Ohio. Electronic address: juan.crestanello@osumc.edu.
authors.forename: Juan A
authors.initials: JA
authors.lastname: Crestanello
authors.affiliation: Division of Cardiac Surgery, Wexner Medical Center, Ohio State University, Columbus, Ohio.
authors.forename: Robert S D
authors.initials: RS
authors.lastname: Higgins
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Xia
authors.initials: X
authors.lastname: He
authors.affiliation: Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.
authors.forename: Paramita
authors.initials: P
authors.lastname: Saha-Chaudhuri
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Englum
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: J Matthew
authors.initials: JM
authors.lastname: Brennan
authors.affiliation: Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Vinod H
authors.initials: VH
authors.lastname: Thourani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D002170:Canada / Q000453:epidemiology; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008171:Lung Diseases / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications; D011379:Prognosis; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology