Author + information
- Salil Desai,
- Hersh Maniar,
- Toshinobu Kazui,
- Eric Novak,
- Ralph Damiano,
- Marc Moon,
- Jennifer Lawton and
- Alan Zajarias
In patients with chronic obstructive pulmonary disease (COPD) and aortic stenosis (AS), worsening dyspnea can be mistakenly attributed to advancing lung disease. Inappropriate diagnosis of lung pathology may characterize patients as inoperable, limiting their treatment options. We evaluated the impact of COPD on perioperative complications, resource utilization, functional status and long–term mortality in patients with severe AS undergoing isolated aortic valve replacement (AVR).
At our institution, 671 consecutive patients undergoing isolated AVR for severe AS from 1997 to 2012 were stratified by the presence and severity of COPD as absent (n=495), oxygen–dependent (O2dep) (n=47) and non–O2dep (n=129). All outcomes were analyzed by stepwise multivariate models.
Operative mortality was higher in patients with O2dep COPD when compared to those with non–O2dep COPD or those without COPD (8.5% vs. 4.7% and 3.2%, p=0.46 and p=0.09, respectively). At 6 months, NYHA class improved in O2dep COPD (3.3±0.8 to 2.3±0.7, p<0.01) and oxygen dependence was eliminated in 28% of preoperative users (95% CI: 14 – 45%). In multivariate analysis, COPD was not associated with perioperative pulmonary complications, atrial fibrillation, hospital readmission, discharge location, or operative and long–term mortality. O2dep COPD was an independent predictor of longer hospital (21%[[Unable to Display Character: ∆]] in days; 95% CI: 2 – 45%; p=0.03) and intensive care unit stay (42%[[Unable to Display Character: ∆]] in hours; 95% CI: 9 – 83%; p=0.01). A 10% increase in predicted forced expiratory volume was an independent predictor of shorter intensive care unit stay (−18%[[Unable to Display Character: ∆]] in hours; 95% CI: −28 – −8%; p<0.01), decreased perioperative pulmonary complications (OR: 0.60; 95% CI: 0.41 – 0.88; p=0.01), reduced 6–month oxygen dependence (OR: 0.54; 95% CI: 0.32 – 0.92; p=0.02) and improved 6–month NYHA class (OR: 1.32; 95% CI: 1.00 – 1.74; p=0.05).
Patients with COPD and AS have an acceptable mortality risk for AVR. In these patients, oxygen dependence and worsening dyspnea can be attributed to heart failure progression and can improve after AVR. Worse pulmonary function is associated with increased postoperative resource utilization.
West, Room 2010
Sunday, March 10, 2013, 11:30 a.m.–11:45 a.m.
Session Title: Valvular Heart Disease: Prognostic Features and Technical Advances to Optimize TAVR Outcomes
Abstract Category: 32. Valvular Heart Disease: Therapy
Presentation Number: 931–6
- 2013 American College of Cardiology Foundation