Outcomes of Patients With Severe Chronic Lung Disease Who Are Undergoing Transcatheter Aortic Valve Replacement.
BACKGROUND
In this study, we sought to determine the clinical outcomes after transcatheter aortic valve replacement (TAVR) among patients with chronic lung disease (CLD) and to evaluate the safety of transaortic versus transapical alternate access approaches in patients with varying severities of CLD.


METHODS
Clinical records for patients undergoing TAVR from 2011 to 2014 in The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry were linked to Medicare hospital claims (n = 11,656). Clinical outcomes were evaluated across strata of CLD severity, and the risk-adjusted association between access route and post-TAVR mortality was determined among patients with severe CLD.


RESULTS
In this cohort (median age, 84 years; 51.7% female), moderate to severe CLD was present in 27.7% (14.3%, moderate; 13.4%, severe). Compared with patients with no or mild CLD, patients with severe CLD had a higher rate of post-TAVR mortality to 1-year (32.3% versus 21.0%; adjusted hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.31 to 1.66), as did those with moderate CLD (25.5%; adjusted HR, 1.16; 95% CI, 1.03 to 1.30). The adjusted rate of mortality was similar for transapical versus transaortic approaches to 1 year (adjusted HR, 1.17; 95% CI, 0.83 to 1.65).


CONCLUSIONS
Moderate or severe CLD is associated with an increased risk of death to 1-year after TAVR, and among patients with severe CLD, the risk of death appears to be similar with either transapical or transaortic alternate-access approaches. Further study is necessary to understand strategies to mitigate risk associated with CLD and the long-term implications of these findings.
Cleveland Clinic, Cleveland, Ohio. Electronic address: surir@ccf.org.
Rakesh M
RM
Suri
Duke University, Durham, North Carolina.
Brian C
BC
Gulack
Duke University, Durham, North Carolina.
J Matthew
JM
Brennan
Emory University, Atlanta, Georgia.
Vinod H
VH
Thourani
Duke University, Durham, North Carolina.
Dadi
D
Dai
Washington University, St. Louis, Missouri.
Alan
A
Zajarias
Mayo Clinic, Rochester, Minnesota.
Kevin L
KL
Greason
Southern Illinois University School of Medicine, Springfield, Illinois.
Christina M
CM
Vassileva
Mayo Clinic, Rochester, Minnesota.
Verghese
V
Mathew
Mayo Clinic, Rochester, Minnesota.
Vuyisile T
VT
Nkomo
Baylor University, Plano, Texas.
Michael J
MJ
Mack
Mayo Clinic, Rochester, Minnesota.
Charanjit S
CS
Rihal
Cleveland Clinic, Cleveland, Ohio.
Lars G
LG
Svensson
Mayo Clinic, Rochester, Minnesota.
Rick A
RA
Nishimura
Brigham and Women's Hospital, Boston, Massachusetts.
Patrick T
PT
O'Gara
Mayo Clinic, Rochester, Minnesota.
David R
DR
Holmes
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D002908:Chronic Disease; D005260:Female; D006760:Hospitalization; D006801:Humans; D008171:Lung Diseases / Q000150:complications* / Q000401:mortality / Q000601:surgery; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome; D014481:United States