Transcatheter Aortic Valve Replacement Results in Improvement of Pulmonary Function in Patients With Severe Aortic Stenosis.
BACKGROUND
Chronic obstructive pulmonary disease (COPD) has been identified as a risk factor for morbidity and mortality after transcatheter aortic valve replacement (TAVR). We hypothesized that a portion of pulmonary dysfunction in patients with severe aortic stenosis may be of cardiac origin, and has potential to improve after TAVR.


METHODS
A retrospective analysis was made of consecutive TAVR patients from April 2008 to October 2014. Of patients who had pulmonary function testing and serum B-type natriuretic peptide data available before and after TAVR, 58 were found to have COPD (26 mild, 14 moderate, and 18 severe). Baseline variables and operative outcomes were explored along with changes in pulmonary function. Multiple regression analyses were performed to adjust for preoperative left ventricular ejection fraction and glomerular filtration rate.


RESULTS
Comparison of pulmonary function testing before and after the procedure among all COPD categories showed a 10% improvement in forced vital capacity (95% confidence interval: 4% to 17%) and a 12% improvement in forced expiratory volume in 1 second (95% confidence interval: 6% to 19%). There was a 29% decrease in B-type natriuretic peptide after TAVR (95% confidence interval: -40% to -16%). An improvement of at least one COPD severity category was observed in 27% of patients with mild COPD, 64% of patients with moderate COPD, and 50% of patients with severe COPD. There was no 30-day mortality in any patient group.


CONCLUSIONS
In patients with severe aortic stenosis, TAVR is associated with a significant improvement of pulmonary function and B-type natriuretic peptide. After TAVR, the reduction in COPD severity was most evident in patients with moderate and severe pulmonary dysfunction.
Division of Cardiothoracic Surgery, Structural Heart and Valve Center, Cardiothoracic Surgery Clinical Research Center, Emory University School of Medicine, Atlanta, Georgia.
Richard C
RC
Gilmore
Division of Cardiothoracic Surgery, Structural Heart and Valve Center, Cardiothoracic Surgery Clinical Research Center, Emory University School of Medicine, Atlanta, Georgia. Electronic address: vthoura@emory.edu.
Vinod H
VH
Thourani
Division of Cardiothoracic Surgery, Structural Heart and Valve Center, Cardiothoracic Surgery Clinical Research Center, Emory University School of Medicine, Atlanta, Georgia.
Hanna A
HA
Jensen
Division of Cardiology, Structural Heart and Valve Center, Cardiothoracic Surgery Clinical Research Center, Emory University School of Medicine, Atlanta, Georgia.
Jose
J
Condado
Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia.
José Nilo G
JN
Binongo
Division of Cardiothoracic Surgery, Structural Heart and Valve Center, Cardiothoracic Surgery Clinical Research Center, Emory University School of Medicine, Atlanta, Georgia.
Eric L
EL
Sarin
Division of Cardiology, Structural Heart and Valve Center, Cardiothoracic Surgery Clinical Research Center, Emory University School of Medicine, Atlanta, Georgia.
Chandan M
CM
Devireddy
Division of Cardiothoracic Surgery, Structural Heart and Valve Center, Cardiothoracic Surgery Clinical Research Center, Emory University School of Medicine, Atlanta, Georgia.
Bradley
B
Leshnower
Division of Cardiology, Structural Heart and Valve Center, Cardiothoracic Surgery Clinical Research Center, Emory University School of Medicine, Atlanta, Georgia.
Kreton
K
Mavromatis
Division of Cardiothoracic Surgery, Structural Heart and Valve Center, Cardiothoracic Surgery Clinical Research Center, Emory University School of Medicine, Atlanta, Georgia.
Amjad
A
Syed
Division of Cardiothoracic Surgery, Structural Heart and Valve Center, Cardiothoracic Surgery Clinical Research Center, Emory University School of Medicine, Atlanta, Georgia.
Robert A
RA
Guyton
Division of Cardiology, Structural Heart and Valve Center, Cardiothoracic Surgery Clinical Research Center, Emory University School of Medicine, Atlanta, Georgia.
Peter C
PC
Block
Division of Cardiothoracic Surgery, Structural Heart and Valve Center, Cardiothoracic Surgery Clinical Research Center, Emory University School of Medicine, Atlanta, Georgia.
Amy
A
Simone
Division of Cardiothoracic Surgery, Structural Heart and Valve Center, Cardiothoracic Surgery Clinical Research Center, Emory University School of Medicine, Atlanta, Georgia.
Patricia
P
Keegan
Division of Cardiology, Structural Heart and Valve Center, Cardiothoracic Surgery Clinical Research Center, Emory University School of Medicine, Atlanta, Georgia.
James
J
Stewart
Division of Cardiothoracic Surgery, Structural Heart and Valve Center, Cardiothoracic Surgery Clinical Research Center, Emory University School of Medicine, Atlanta, Georgia.
Mohammad
M
Rajaei
Division of Cardiology, Structural Heart and Valve Center, Cardiothoracic Surgery Clinical Research Center, Emory University School of Medicine, Atlanta, Georgia.
Brian
B
Kaebnick
Division of Cardiology, Structural Heart and Valve Center, Cardiothoracic Surgery Clinical Research Center, Emory University School of Medicine, Atlanta, Georgia.
Stamatios
S
Lerakis
Division of Cardiology, Structural Heart and Valve Center, Cardiothoracic Surgery Clinical Research Center, Emory University School of Medicine, Atlanta, Georgia.
Vasilis C
VC
Babaliaros
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000503:physiopathology* / Q000601:surgery; D012189:Retrospective Studies; D012720:Severity of Illness Index; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome; D014797:Vital Capacity / Q000502:physiology
D020097:Natriuretic Peptide, Brain