Chronic Lung Disease often affects patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR) or surgery. In fact, this is why patients with lung disease are often deemed inoperable and prescribed TAVR. This is the first time the benefit of TAVR has been assessed in this group of patients, for symptoms of these conditions can overlap, and it is difficult to determine what originate them.
Prevalence and severity of lung disease were determined at baseline in high and extreme risk patients with severe aortic stenosis enrolled in the CoreValve US Pivotal Trial.
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Clinical status was determined using the KCCQ-OS score, and health benefit was defined as alive with a ≥60 score.
Of 1030 patients studied, 55% presented some degree of lung disease (20% mild, 13% moderate, and 22% severe). All cause mortality was higher in patients with moderate or severe lung disease at one year post TAVR (19.6% with mild disease, 28.1% with moderate disease, and 26.9% with severe disease, vs. 19.2% for no lung disease patients with other comorbidities; p=0.030). The latter was observed also at 3 years (44.8% mild, 53% moderate and 51.9% severe vs. 37.7%; p < 0.001).
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80% of patients improved their dyspnea and increased their KCCQ-OS in nearly 20 points both at one and three years. Despite the latter, only 43.3% reached the health benefit criteria at one year, and only 22.5% at three years.
Conclusion
Moderate or severe lung disease increased post TAVR mortality at one and three years, and even though most improved their functional class, only a relatively small group reached the health benefit criteria.
Editorial Comment
Perioperative mortality was not affected by lung disease, but at long term, the impact is rather different, since more than half of patients died after 3 years. This does not come as a surprise, and was expected. However, no prior study had shown figures.
Original title: Long-Term Health Benefit of TAVR in Patients With Chronic Lung Disease.
Reference: Juan A. Crestanello et al. J Am Coll Cardiol Intv 2017, article in press
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