TAVR outcomes similar to AVR for patients with chronic lung disease

For patients with chronic lung disease, outcomes after transcatheter aortic valve replacement were similar to those after surgical aortic valve replacement and superior to standard therapy, according to new data from the PARTNER trial.

However, among patients with severe aortic stenosis who underwent TAVR, those with chronic lung disease had higher mortality rates at 1 year compared with patients without chronic lung disease (23.4% vs. 19.6%; P=.02).

Among patients with high-risk operable chronic lung disease, those who underwent TAVR (n=149) had similar all-cause mortality rates at 2 years to those who underwent surgical aortic valve replacement (AVR; n=138; 35.2% vs. 33.6%; P=.92). At 2 years, there was no difference in mortality rates based on TAVR access routes (transfemoral TAVR, 36.1%; transapical TAVR, 33.6%; surgical AVR, 33.5%; P=.99).

Among patients with inoperable chronic lung disease, those who underwent TAVR (n=72) had lower all-cause mortality rates at 2 years compared with those who received standard therapy (n=95; 52% vs. 69.6%; P=.04). Patients who underwent TAVR also had lower rates of repeat hospitalization compared with those who received standard therapy.

Poor mobility (HR=1.67 for patients with 6-minute walk test <50 m) and oxygen dependency (HR=1.44) were identified as independent predictors of mortality for patients with chronic lung disease undergoing TAVR.

At 1 year, oxygen-dependent patients with chronic lung disease had a mortality rate of 29.7% vs. 21.4% for patients with chronic lung disease but without oxygen dependency (P=.004). Oxygen-dependent patients with chronic lung disease also had worse NYHA functional status at 30 days and 1 year compared with patients with chronic lung disease but without oxygen dependency and with patients without chronic lung disease.

Poor mobility in patients with chronic lung disease undergoing TAVR was associated with higher 1-year all-cause mortality (P=.02) and higher 1-year non-CV mortality (P<.001).

Other predictors of all-cause mortality at 1 year in patients with chronic lung disease undergoing TAVR included renal disease, low BMI, higher mean pulmonary artery pressure and higher aortic valve gradient, the researchers wrote.

“The importance of a careful preoperative evaluation of [chronic lung disease] patients undergoing evaluation for TAVR cannot be overestimated,” Danny Dvir, MD, of MedStar Washington Hospital Center, Washington, D.C., and colleagues wrote. “A heart-team discussion, which includes a pulmonologist, should balance the potential risks and benefits for the individual patient as well as the plan for perioperative management.”

Disclosure: See the full study for a list of the researchers’ relevant financial disclosures.