Impact of chronic obstructive pulmonary disease on one-year outcome after Transcatheter Aortic Valve Replacement

Background

Chronic obstructive pulmonary disease (COPD) patients are at increased risk of complications post surgical aortic valve replacement.

Purpose

We sought to assess the prognostic impact of COPD in patients undergoing transcatheter aortic valve replacement (TAVR).

Methods

This is an observational single-center retrospective study involving all patients who underwent TAVR for severe aortic stenosis from 2009 to 2019. The existence of COPD was defined as the presence of lung symptoms requiring long-term use of bronchodilators or steroids, and its severity was assessed according to GOLD classification. Propensity score matching was performed. The main endpoint consisted of the one-year composite endpoint of all-cause mortality, stroke, or hospitalizations for valve-related symptoms or worsening heart failure.

Results

A total of 412 patients (mean age 79.6 ± 7.8 years, mean STS score 5.3 ± 3.6) were included. COPD was found in 115 patients (27.9%): stage 1 (n = 61, 53%), stage 2 (n = 28, 24.4%), stage 3 (n = 22, 19.1%) and stage 4 (n = 4, 3.5%). COPD patients were younger (P = 0.007) with a higher STS score (P = 0.024) in comparison with no COPD patients. Matching on the propensity score resulted in a data set of 102 matched pairs. COPD was associated with increased length of stay (LOS) post TAVR (median 3 [IQI 3–7] vs. 2 [IQI 1–5]; P = 0.007). COPD patients had lower survival than no COPD patients (88.1% vs. 95.5%; P = 0.048) while no difference was found in terms of one-year survival free from stroke and rehospitalization. A trend toward lower survival free from the composite endpoint was observed in COPD patients (81.5% vs. 90.5%; P = 0.076). Symptoms improvement was similar between COPD and no COPD patients (improvement ≥ 1 NYHA class: 85.1% vs. 83.3%; P = 0.766) (Fig. 1).

Conclusion

COPD could result in longer LOS, lower survival and worse cardiovascular outcome at one year following TAVR. Very few patients with severe GOLD 4 were included in this study.