Author + information
- Mohamad Kabach1,
- Jesus Pino Moreno2,
- Abdulah Alrifai1,
- Elie Donath2,
- Varun Shah2,
- Pradeep Dayanand2,
- Edwin Grajeda2,
- Lawrence Lovitz2,
- Mark Rothenberg3,
- Roberto J. Cubeddu4,
- Cristiano Faber2 and
- Marcos Nores5
- 1University of Miami/JFK Medical Cener, West Palm Beach, Florida, United States
- 2University of Miami School of Medicine/JFK Medical Center, West Palm Beach, Florida, United States
- 3University of Miami School of Medicine/JFK Medical Center, Atlantis, Florida, United States
- 4Cleveland Clinic Florida, Weston, Florida, United States
- 5JFK Medical Center, Wellington, Florida, United States
The degree of preoperative pulmonary compromise, as measured by the PFTs, is an important component of the STS risk score for TAVR. The two most common approaches for assessing lung function are the GOLD for COPD severity and the STS criteria to determine chronic lung disease (CLD). Unfortunately, there isn’t much clarity regarding which approach is better suited to assess pre-operative pulmonary function. The purpose of this research was to determine how different those two classification schemes are and how that impacted the determination of COPD and the magnitude of effect of COPD on certain outcomes.
All patients with severe AS who underwent TAVR between 03/2013 to 3/2016 were identified. The baseline characteristics, clinical, procedural and follow-up data of all patients that underwent TAVR were obtained and followed for up to one year post-procedure. The variables of interest were: FEV1, FVC, VC, DLCO and FEV1/FVC ratio. A multivariate logistic regression analysis was performed.
373 patients were ultimately included. 204/373 (55%) patients were classified as CLD based on STS’ classification with a mean FEV1 of 56.8%. In contrast, only 96/373 (26%) patients were classified as COPD based on GOLD criteria with a mean FEV1/FVC of 67.23%. 133 of the 277 patients that did not have COPD (by GOLD) were classified as either mild, moderate or severe CLD. At 30-days follow up, there was no association between PFTs and 30 days mortality (whether the presence of CLD was based on STS’ classification or based on COPD GOLD criteria) however for length of stay, there was a highly statistically significant relationship between STS’ classification that was not evident using the GOLD criteria.
There is an important discrepancy between classification schemes involving GOLD for COPD and STS for CLD. Although some overlap obviously exists between the two – a large number of patients have different degrees of disease and that can lead to different interpretations of how COPD affects post-op outcomes in this population. The purpose of this analysis is to highlight this potential issue and ensure that investigators provide clarity in terms of how they define pulmonary disease.
STRUCTURAL: Valvular Disease: Aortic