title: Preoperative pulmonary function tests predict mortality after surgical or transcatheter aortic valve replacement.
abstract: OBJECTIVE
  To determine the role of preoperative pulmonary function tests (PFTs) in patients with aortic stenosis (AS) evaluated for aortic valve replacement (AVR), and to evaluate the association between lung disease and mortality in specific subgroups.
  
  
  METHODS
  Between 2008 and 2013, 535 patients with preoperative PFTs underwent AVR (transcatheter AVR [TAVR], n = 246; surgical AVR [SAVR], n = 289). The severity of lung disease determined by the Society of Thoracic Surgeons (STS) definition was evaluated in those with and without a clinical suspicion for lung disease (smoking, inhaled steroids/bronchodilators, or home oxygen). The association between lung disease and 1-year mortality was evaluated.
  
  
  RESULTS
  Of the 186 patients (35%) without suspected lung disease, 39 (21%) had moderate/severe lung disease by PFT analysis. Among all patients, 1-year mortality was 12% in those with no lung disease, 17% in those with no mild lung disease, 22% in those with moderate lung disease, and 31% in those with severe lung disease (P < .001, log-rank test). After adjustment, moderate/severe lung disease was associated with increased 1-year mortality (adjusted hazard ratio, 2.07; 95% confidence interval, 1.30-3.29; P = .002); this association was not altered by smoking history, suspicion of lung disease, New York Heart Association class, or AVR type (interaction P value nonsignificant for all).
  
  
  CONCLUSIONS
  In patients with AS evaluated for AVR, the STS risk score is significantly influenced by the severity of lung disease, which is determined predominantly by PFT results. Even when lung disease is not suspected, PFTs are abnormal in many patients undergoing AVR. Moderate/severe lung disease, diagnosed predominantly by PFTs, is an independent predictor of mortality after SAVR or TAVR. Collectively, these findings suggest that PFTs should be a routine part of the risk stratification of patients considered for AVR.
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Mo.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Henn
authors.affiliation: Cardiovascular Division, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Mo.
authors.forename: Alan
authors.initials: A
authors.lastname: Zajarias
authors.affiliation: Cardiovascular Division, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Mo.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Lindman
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Mo.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Greenberg
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Mo.
authors.forename: Spencer J
authors.initials: SJ
authors.lastname: Melby
authors.affiliation: Cardiovascular Division, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Mo.
authors.forename: Nishath
authors.initials: N
authors.lastname: Quader
authors.affiliation: Cardiovascular Division, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Mo.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Vatterott
authors.affiliation: Cardiovascular Division, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Mo.
authors.forename: Cassandra
authors.initials: C
authors.lastname: Lawler
authors.affiliation: Cardiovascular Division, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Mo.
authors.forename: Marci S
authors.initials: MS
authors.lastname: Damiano
authors.affiliation: Cardiovascular Division, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Mo.
authors.forename: Eric
authors.initials: E
authors.lastname: Novak
authors.affiliation: Cardiovascular Division, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Mo.
authors.forename: John M
authors.initials: JM
authors.lastname: Lasala
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Mo.
authors.forename: Marc R
authors.initials: MR
authors.lastname: Moon
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Mo.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Lawton
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Mo.
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Damiano
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Mo. Electronic address: maniarh@wudosis.wustl.edu.
authors.forename: Hersh S
authors.initials: HS
authors.lastname: Maniar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000503:physiopathology*; D008171:Lung Diseases / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D016016:Proportional Hazards Models; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: TAVR; aortic stenosis; aortic valve replacement; preoperative evaluation; pulmonary function tests