Transcatheter aortic valve replacement (TAVR) was associated with significantly fewer respiratory-related complications compared with surgical aortic valve replacement (SAVR) in patients with chronic obstructive pulmonary disease (COPD), according to the results of a study published in the Journal of the American Heart Association.
Tomo Ando, MD, from the Division of Cardiology at Wayne State University/Detroit Medical Center in Michigan, and colleagues identified patients from the Nationwide Inpatient Sample database from 2011 to 2014 and included patients who had undergone transarterial TAVR or SAVR in the analysis. They created a 1:1 propensity-matched cohort to examine the outcomes.
The investigators identified matched pairs of 1210 patients who received TAVR and 1208 patients who received SAVR. Respiratory complications such as tracheostomy (0.8% vs 5.8%; odds ratio [OR], 0.14; P <.001), acute respiratory failure (16.4% vs 23.7%; OR, 0.63; P =.002), reintubation (6.5% vs 10.0%; OR, 0.49; P <.001), and pneumonia (4.5% vs 10.1%; OR, 0.41; P <.001) occurred significantly less often with TAVR than SAVR. Use of noninvasive mechanical ventilation was similar in both groups (4.1% vs 4.8%; OR, 0.84; P =.41).
Non-respiratory-related complications such as in-hospital mortality (3.3% vs 4.2%; OR, 0.64; P =.035), bleeding requiring transfusion (9.9% vs 21.7%; OR, 0.38; P <.001), acute kidney injury (17.7% vs 25.3%; OR, 0.63; P <.001), and acute myocardial infarction (2.4% vs 8.4%; OR, 0.19; P <.001), also occurred significantly less often with TAVR than SAVR. Costs ($56,099 vs $63,146; P <.001) were lower and mean hospital stays (7.7 vs 13.0 days; P <.001) were shorter with TAVR vs SAVR.
Limitations of the study included the inability to assess the outcomes based on the severity of COPD; patients with different levels of COPD may benefit differently from these 2 procedures. In addition, due to the retrospective nature of the study, not all confounders were reported and this could have biased the results. Finally, the Nationwide Inpatient Sample database may be subject to coding errors.
The investigators argued that these results suggest that patients with symptomatic, severe aortic stenosis and COPD should be considered for TAVR rather than SAVR given the significantly lower in-hospital mortality rates and respiratory-related complications. They added that further study is warranted to investigate whether different stages of COPD benefit similarly from TAVR compared with SAVR.
Ando T, Adegbala O, Akintoye E, et al. Is transcatheter aortic valve replacement better than surgical aortic valve replacement in patients with chronic obstructive pulmonary disease? A Nationwide Inpatient Sample Analysis [published online April 1, 2018]. J Am Heart Assoc. doi:10.1161/JAHA.117.008408