Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
Clinical Outcome Following Transcatheter Aortic Valve Implantation in Patients With Chronic Obstructive Pulmonary Disease
P. Doldi1, J. Steffen1, M. Zadrozny1, L. Stolz1, J. Gmeiner1, T. Stocker1, M. Orban1, H. D. Theiss1, K. Rizas1, N. Kneidinger2, S. Sadoni3, J. Buech3, C. Hagl3, S. Massberg1, J. Hausleiter1, S. Deseive1, D. Braun1
1Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, München; 2Medizinische Klinik und Poliklinik V, LMU Klinikum der Universität München, München; 3Herzchirurgische Klinik und Poliklinik, LMU Klinikum der Universität München, München;

Background

Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality among patients undergoing transcatheter aortic valve replacement (TAVR). To what extent TAVR can improve symptoms and prognosis in patients with different stages of COPD is uncertain.

Objective

The objective was to evaluate clinical outcome of patients with COPD after TAVR.

Methods and results

We retrospectively analysed patients undergoing TAVR at the Munich University Hospital who had a preprocedural pulmonary function test (PFT). Patients were divided into 5 groups according to current guidelines of the Global Initiative for Chronic Obstructive Lung Disease (GOLD): No COPD and COPD GOLD 1-4. Outcome predictors as well as symptomatic improvement have been analysed accordingly.

Out of 863 patients included in this analysis, 440 patients suffered from COPD according to PFT results. Procedural characteristics as well as clinical endpoints according to the VARC-3 definition were comparable between COPD and non-COPD patients. Patients with COPD showed significantly lower survival rates after TAVR compared to non-COPD patients (hazard ratio [HR] 1.74, 95% confidence interval (CI) 1.36, 2.22, p<0.001). Additionally, estimated 2-year survival decreased with increasing severity of COPD (GOLD 1: 76%, GOLD 2: 73%, GOLD 3: 63%, GOLD 4: 44%; p<0.001, Figure 1A). Receiver operator curves (ROC) analysis showed that a FEV1 cut-off at 66% had the best discriminatory value for mortality in COPD patients undergoing TAVR. A baseline FEV1% value <66 was associated with a significantly lower survival compared to both, COPD patients with FEV1% >66 and non-COPD patients (p <0.001 by log rank test). Symptomatic benefit evaluated by improvement in New York Heart Association (NYHA) functional class of at least one grade at follow-up decreased with rising COPD severity (No COPD: 71%; GOLD 1 and 2: 70%; GOLD 3: 60% and GOLD 4: 54%, Figure 1B).

Conclusion

This study of the yet largest TAVR cohort with concise PFT data highlights the prognostic impact of COPD severity on outcome and symptomatic benefit. Although TAVR is safe in patients with COPD, increasing disease severity negatively impacts survival and symptomatic benefit. These results may facilitate decision making for TAVR in this high risk patient population.

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