Transcatheter mitral valve repair safe, effective for patients with COPD
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The presence of chronic obstructive pulmonary disease is not associated with intra-hospital or 1-year outcomes for patients with mitral regurgitation undergoing transcatheter mitral valve repair, data from a single-center study show.
“Due to the concomitant risk factors, a relevant percentage of patients with CVD needing cardiac surgery or intervention have chronic obstructive pulmonary disease (COPD) as well,” Mhd Nawar Alachkar, MD, cardiology consultant with the clinic for cardiology and angiology at Regiomed Klinikum Coburg, Germany, told Healio. “Those patients are usually undertreated because they would often be refused from the surgical and anesthesia team due to their respiratory limitations.”
In a retrospective study, Alachkar and colleagues analyzed data from 340 patients undergoing transcatheter mitral valve repair (TMVR) between January 2014 and December 2019 at University Hospital RWTH in Aachen, Germany. All patients had symptomatic mitral regurgitation. COPD diagnosis was based on pulmonary function tests. Researchers assessed intra‐hospital, 30‐day and 1‐year outcomes for patients with and without COPD.
The findings were published in Catheterization and Cardiovascular Interventions.
Within the cohort, 24% of patients had COPD, with 62% of those having stage 2 COPD.
Researchers did not observe any between-group differences in intra‐hospital mortality for those with vs. without COPD (both 5%; P = .95). Among patients who had a successful procedure and survived to discharge, researchers observed a trend toward more rehospitalization due to decompensated HF at 30‐day follow‐up among those with COPD (12.9% vs. 6.8%; P = .08) with no difference in mortality.
At median follow‐up of 1 year, NYHA category was similar for patients with and without COPD and there was no significant difference in rehospitalization (COPD, 29.9%; no COPD, 34%; P = .5).
There was a trend toward increased 1‐year mortality among patients with COPD vs. those without COPD (31.2% vs. 20.6%; P = .06). However, there was no between-group difference for the composite endpoint of rehospitalization or death at 1 year (COPD, 48%; no COPD, 42.5%; P = .4).
In regression analyses, researchers did not observe a correlation between COPD severity and worse TMVR outcomes.
“Patients with COPD and severely limited pulmonary function tests who have an indication for transcatheter mitral valve repair should not be excluded only because of this impairment, as we did not find any difference in outcome between patients with and without COPD,” Alachkar told Healio. “More research is needed for this group of patients, especially with the increasing use of transcatheter tricuspid valve repair, as patients with COPD usually have pulmonary hypertension and right heart problems, and therefore more tricuspid valve regurgitation.”
For more information:
Mhd Nawar Alachkar, MD, can be reached at nawar-alashkar@hotmail.com; Twitter: @nawar_alachkar.
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