Suri Rakesh M, Gulack Brian C, Brennan J Matthew, Thourani Vinod H, Dai Dadi, Zajarias Alan, Greason Kevin L, Vassileva Christina M, Mathew Verghese, Nkomo Vuyisile T, Mack Michael J, Rihal Charanjit S, Svensson Lars G, Nishimura Rick A, O'Gara Patrick T, Holmes David R
Cleveland Clinic, Cleveland, Ohio.
Duke University, Durham, North Carolina.
Ann Thorac Surg. 2015 Dec;100(6):2136-45; discussion 2145-6. doi: 10.1016/j.athoracsur.2015.05.075. Epub 2015 Aug 29.
In this study, we sought to determine the clinical outcomes after transcatheter aortic valve replacement (TAVR) among patients with chronic lung disease (CLD) and to evaluate the safety of transaortic versus transapical alternate access approaches in patients with varying severities of CLD.
Clinical records for patients undergoing TAVR from 2011 to 2014 in The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry were linked to Medicare hospital claims (n = 11,656). Clinical outcomes were evaluated across strata of CLD severity, and the risk-adjusted association between access route and post-TAVR mortality was determined among patients with severe CLD.
In this cohort (median age, 84 years; 51.7% female), moderate to severe CLD was present in 27.7% (14.3%, moderate; 13.4%, severe). Compared with patients with no or mild CLD, patients with severe CLD had a higher rate of post-TAVR mortality to 1-year (32.3% versus 21.0%; adjusted hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.31 to 1.66), as did those with moderate CLD (25.5%; adjusted HR, 1.16; 95% CI, 1.03 to 1.30). The adjusted rate of mortality was similar for transapical versus transaortic approaches to 1 year (adjusted HR, 1.17; 95% CI, 0.83 to 1.65).
Moderate or severe CLD is associated with an increased risk of death to 1-year after TAVR, and among patients with severe CLD, the risk of death appears to be similar with either transapical or transaortic alternate-access approaches. Further study is necessary to understand strategies to mitigate risk associated with CLD and the long-term implications of these findings.
