Following transcatheter aortic valve replacement (TAVR), patients with chronic obstructive pulmonary disease (COPD) requiring in-home oxygen supplementation have poorer clinical outcomes and worse quality of life compared with patients not receiving home oxygen support. These findings were presented at the Transcatheter Cardiovascular Therapeutics (TCT) Scientific Symposium 2022 held from September 17th through 19th, in Boston, Massachusetts.
Patients with moderate to severe COPD have been associated with poorer outcomes following TAVR compared with the general TAVR population. It remains unclear, however, whether the subset of patients who required home oxygen support may be associated with poorer clinical outcomes than the patients with COPD not requiring home oxygen.
Investigators from Hartford Hospital in the United States evaluated data from a cohort of patients (N=2463) with COPD who received TAVR. In-hospital and 1-year outcomes were evaluated on the basis of home oxygen support. Quality of life was assessed using the Kansas City Cardiomyopathy Questionnaire (KCCQ12) instrument.
The home oxygen cohort (n=150) was younger (mean, 78.9 vs 81.5 years; P <.001), had greater Society of Thoracic Surgeons risk score (mean, 15.50 vs 9.29; P <.001), more had diabetes (43% vs 33%; P =.020) and carotid artery disease (36% vs 27%; P <.034). They had lower forced expiratory volume in 1 second predicted (mean, 50.3% vs 75.0%; P <.001) and diffusion capacity (mean, 48.6 vs 74.6; P <.001), and had worse KCCQ12 score (mean, 32.5 vs 49.1; P <.001) at baseline compared with the no home oxygen cohort (n=2313).
During hospitalization for TAVR implantation, the rates of procedural cardiac arrest (4.7% vs 1.0%; P <.001), postoperative atrial fibrillation (4.0% vs 1.5%; P =.013), and mortality (5.3% vs 1.6%; P =.001) were higher among the home oxygen group compared with no home oxygen, respectively. Similar rates of stroke (P =.388), major vascular complications (P =.411), and need for a permanent pacemaker (P =.678) were observed between groups.
At 1 year, the home oxygen cohort was associated with a higher mortality rate (14% vs 4.3%; P <.001) and lower KCCQ12 scores (mean, 69.5 vs 82.1; P <.001) compared with no home oxygen, respectively.
The data from this study indicate that, among patients with COPD receiving TAVR, the subset with more severe disease requiring home oxygen support are more likely to experience poorer outcomes in-hospital and at 1 year, in addition to having worse quality of life.
Hoover N, Kompella R, Masih R, et al. In-hospital and 1-year outcomes of transcatheter aortic valve replacement in patients requiring supplemental home oxygen use. Presented at: The Transcatheter Cardiovascular Therapeutics Scientific Symposium; September 17-19, 2022; Boston, MA. Abstract #430.