Management of Symptomatic Severe Aortic Stenosis in Patient With Very Severe Chronic Obstructive Pulmonary Disease

Autor: Mohammad Q. Raza, Paul Schoenhagen, Jasneet Devgun, Stephanie Mick, Nadeen N. Faza, Amar Krishnaswamy, L. Leonardo Rodriguez, Samir R. Kapadia, Jose L. Navia, E. Murat Tuzcu, Amgad Mentias, Lars G. Svensson, Eric E. Roselli, Ali O Malik
Rok vydání: 2016
Předmět:
Pulmonary and Respiratory Medicine
Aortic valve
Balloon Valvuloplasty
medicine.medical_specialty
Time Factors
medicine.medical_treatment
macromolecular substances
Kaplan-Meier Estimate
030204 cardiovascular system & hematology
Patient Readmission
Severity of Illness Index
Transcatheter Aortic Valve Replacement
03 medical and health sciences
Pulmonary Disease
Chronic Obstructive
0302 clinical medicine
Aortic valve replacement
Valve replacement
Risk Factors
Internal medicine
medicine
Humans
030212 general & internal medicine
Ohio
Proportional Hazards Models
Retrospective Studies
Heart Failure
Heart Valve Prosthesis Implantation
COPD
business.industry
Cardiovascular Agents
General Medicine
Aortic Valve Stenosis
medicine.disease
Surgery
Aortic valvuloplasty
Stenosis
medicine.anatomical_structure
Treatment Outcome
Heart failure
Aortic valve stenosis
Aortic Valve
Cardiology
Cardiology and Cardiovascular Medicine
business
Zdroj: Seminars in thoracic and cardiovascular surgery. 28(4)
ISSN: 1532-9488
Popis: Transcatheter aortic valve replacement (TAVR) is a viable option for patients with severe chronic obstructive pulmonary disease (COPD) who are deemed inoperable or high risk for surgery. We sought to determine outcomes of patients with severe aortic stenosis (AS) and severe COPD referred for aortic valve replacement (AVR). One hundred thirty-one patients with severe AS and severe COPD (GOLD criteria) were evaluated at our center between 2008 and 2013 and were divided retrospectively into 4 groups: 1-medical management, 2-balloon aortic valvuloplasty, 3-surgical aortic valve replacement (SAVR), and 4-TAVR. Baseline, clinical, and echo data were recorded. Primary outcome was cardiovascular death. From the study cohort, 54 (41.2%), 29 (22.1%), 21 (16.0%), and 27 (20.6%) were included in groups 1-4, respectively; the age was 74.9 ± 8.8, 76.2 ± 8.8, 78.8 ± 7.4, and 82.8 ± 6.8 years, respectively (P0.01). There was no significant difference between the groups for hypertension, diabetes, aortic valve area or gradients, forced expiratory volume in first second, right ventricular systolic pressure, ejection fraction, and Society of Thoracic Surgeons predicted risk of mortality score. At 3 ± 1.5 years, death occurred in 87%, 97%, 47.7%, and 51.8% of patients in groups 1-4, respectively. Heart failure readmissions occurred in 43%, 42%, 9.6%, and 14.8% of patients in groups 1-4, respectively. When SAVR and TAVR groups were compared, there was no significant difference in survival (P = 0.719) or heart failure readmissions (P = 0.19). In patients with severe or very severe COPD and severe AS, replacing the severely stenotic aortic valve by either SAVR or TAVR improves survival and reduces rehospitalization compared with medical therapy or balloon aortic valvuloplasty.
Databáze: OpenAIRE
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