Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, Aachen, Germany.
Department of Pneumology and Intensive Care Medicine, University Hospital RWTH, Aachen, Germany.
Catheter Cardiovasc Interv. 2022 Jul;100(1):145-153. doi: 10.1002/ccd.30238. Epub 2022 May 26.
To evaluate the safety and efficacy of transcatheter mitral valve repair (TMVR) in patients with chronic obstructive pulmonary disease (COPD).
Heart failure and COPD share many clinical features and commonly coexist. Data about the safety and efficacy of TMVR in patients with COPD is not conclusive.
Three hundred and forty consecutive patients undergoing TMVR were retrospectively included. COPD diagnosis was based on pulmonary function tests (PFTs). Intra-hospital, 30-day- and 1-year outcomes were compared between both groups.
Eighty-two patients had COPD (24%). There was no difference in intra-hospital mortality between patients with and without COPD (both 5%, p = 0.95). Among patients who had a successful procedure and survived to discharge there was a trend toward more rehospitalization due to decompensated heart failure at 30-day follow-up in patients with COPD (12.9% vs. 6.8%, p = 0.08) with no difference in mortality. At median follow-up of 1 year, New York heart association (NYHA) category was comparable among both groups and there was no significant difference in rehospitalization (COPD: 29.9% vs. non-COPD: 34%, p = 0.5). There was a trend toward increased 1-year mortality in COPD patients (31.2% vs. 20.6%, p = 0.06). However, a composite endpoint of rehospitalization or death at 1 year did not differ between both groups (48% vs. 42.5%, p = 0.4). Regression analysis showed no correlation between COPD severity and worse TMVR outcomes.
COPD is highly prevalent among patients undergoing TMVR. However, TMVR seems to be safe and effective in COPD patients. COPD severity and PFT impairment alone should not be considered as a contraindication for TMVR.
评估经导管二尖瓣修复术（TMVR）治疗慢性阻塞性肺疾病（COPD）患者的安全性和疗效。
心力衰竭和 COPD 具有许多共同的临床特征，且常同时存在。关于 COPD 患者 TMVR 安全性和疗效的数据尚无定论。
回顾性纳入 340 例连续接受 TMVR 的患者。COPD 的诊断基于肺功能测试（PFTs）。比较两组患者的院内、30 天和 1 年结局。
82 例患者患有 COPD（24%）。COPD 患者和无 COPD 患者的院内死亡率无差异（均为 5%，p=0.95）。在成功进行手术并存活出院的患者中，COPD 患者在 30 天随访时有心力衰竭失代偿的趋势（12.9%比 6.8%，p=0.08），但死亡率无差异。在 1 年的中位随访中，两组的纽约心功能协会（NYHA）分级相当，再住院率无显著差异（COPD：29.9%比非 COPD：34%，p=0.5）。COPD 患者 1 年死亡率有增加趋势（31.2%比 20.6%，p=0.06）。然而，两组 1 年时再住院或死亡的复合终点无差异（48%比 42.5%，p=0.4）。回归分析显示 COPD 严重程度与 TMVR 结局恶化之间无相关性。
TMVR 患者中 COPD 患病率较高。然而，TMVR 似乎对 COPD 患者安全有效。COPD 严重程度和 PFT 损害本身不应作为 TMVR 的禁忌症。
