Is Transcatheter Aortic Valve Replacement Better Than Surgical Aortic Valve Replacement in Patients With Chronic Obstructive Pulmonary Disease? A Nationwide Inpatient Sample Analysis.

BACKGROUND

Chronic obstructive pulmonary disease (COPD) patients are at increased risk of respiratory related complications after cardiac surgery. It is unclear whether transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) results in favorable outcomes among COPD patients.

METHODS AND RESULTS

Patients were identified from the Nationwide Inpatient Sample database from 2011 to 2014. Patients with age ≥60, COPD, and either went transarterial TAVR or SAVR were included in the analysis. A 1:1 propensity-matched cohort was created to examine the outcomes. A matched pair of 1210 TAVR and 1208 SAVR patients was identified. Respiratory-related complications such as tracheostomy (0.8% versus 5.8%; odds ratio [OR], 0.14; <0.001), acute respiratory failure (16.4% versus 23.7%; OR, 0.63; =0.002), reintubation (6.5% versus 10.0%; OR, 0.49; <0.001), and pneumonia (4.5% versus 10.1%; OR, 0.41; <0.001) were significantly less frequent with TAVR versus SAVR. Use of noninvasive mechanical ventilation was similar between TAVR and SAVR (4.1% versus 4.8%; OR, 0.84; =0.41). Non-respiratory-related complications, such as in-hospital mortality (3.3% versus 4.2%; OR, 0.64; =0.035), bleeding requiring transfusion (9.9% versus 21.7%; OR, 0.38; <0.001), acute kidney injury (17.7% versus 25.3%; OR, 0.63; <0.001), and acute myocardial infarction (2.4% versus 8.4%; OR, 0.19; <0.001), were significantly less frequent with TAVR than SAVR. Cost ($56 099 versus $63 146; <0.001) and hospital stay (mean, 7.7 versus 13.0 days; <0.001) were also more favorable with TAVR than SAVR.

CONCLUSIONS

TAVR portended significantly fewer respiratory-related complications compared with SAVR in COPD patients. TAVR may be a preferable mode of aortic valve replacement in COPD patients.