Impact of COPD on Outcome in Patients Undergoing Transfemoral versus Transapical TAVI

Markus Mach; Matthias Koschutnik; Manuel Wilbring; Bernhard Winkler; Matthias Reinweber; Konstantin Alexiou; Utz Kappert; Christopher Adlbrecht; Georg Delle-Karth; Martin Grabenwöger; Klaus Ehrhard Matschke

doi:10.1055/s-0039-1685177

The Thoracic and Cardiovascular Surgeon, Table of Contents

Thorac Cardiovasc Surg 2019; 67(04): 251-256
DOI: 10.1055/s-0039-1685177

Original Cardiovascular

Georg Thieme Verlag KG Stuttgart · New York

Impact of COPD on Outcome in Patients Undergoing Transfemoral versus Transapical TAVI

Markus Mach

¹Department of Cardiovascular Surgery, Heart Team Vienna, Hospital Hietzing and the Karl Landsteiner Institute for Cardiovascular Research, Vienna, Austria

²Division of Cardiac Surgery, Medical University of Graz, Austria

,

Matthias Koschutnik

¹Department of Cardiovascular Surgery, Heart Team Vienna, Hospital Hietzing and the Karl Landsteiner Institute for Cardiovascular Research, Vienna, Austria

,

Manuel Wilbring

³Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany

,

Bernhard Winkler

¹Department of Cardiovascular Surgery, Heart Team Vienna, Hospital Hietzing and the Karl Landsteiner Institute for Cardiovascular Research, Vienna, Austria

,

Matthias Reinweber

⁴Department for Statistical Data Management, Clinical Research Center Vienna, Vienna, Austria

,

Konstantin Alexiou

³Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany

,

Utz Kappert

³Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany

,

Christopher Adlbrecht

⁵Fourth Medical Department, Heart Team Vienna, Hospital Hietzing and the Karl Landsteiner Institute for Cardiovascular & Intensive Care Research, Vienna, Austria

,

Georg Delle-Karth

⁵Fourth Medical Department, Heart Team Vienna, Hospital Hietzing and the Karl Landsteiner Institute for Cardiovascular & Intensive Care Research, Vienna, Austria

,

Martin Grabenwöger

¹Department of Cardiovascular Surgery, Heart Team Vienna, Hospital Hietzing and the Karl Landsteiner Institute for Cardiovascular Research, Vienna, Austria

⁶Sigmund Freud University, Medical Faculty, Vienna, Austria

,

Klaus Ehrhard Matschke

³Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany

› Author Affiliations

Abstract

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Abstract

Objective The purpose of this study was to evaluate the impact of chronic obstructive pulmonary disease (COPD) on clinical outcomes in patients referred for transfemoral (TF) as well as transapical (TA) aortic valve implantation and furthermore to delineate possible advantages of the TF access.

Methods One thousand eight hundred forty-two patients undergoing transcatheter aortic valve implantation (TAVI) at two study centers were included in the present analysis. The outcome was measured and classified according to Valve Academic Research Consortium-II criteria. Kaplan–Meier estimate was used to assess long-term survival.

Results The present analysis suggests that COPD has limited influence on post-procedural outcome after TAVI. Comparing the TF to TA approach, no significant difference on the impact of COPD on clinical outcomes has been found, except for longer post-procedural ventilation times in COPD patients treated via TA access (p < 0.001).

Conclusions COPD in patients referred for TAVI procedure was associated with poorer overall long-term survival, thus characterizing a high-risk population for futile treatment; however, the selection of access did not result in a significant difference in most Valve Academic Research Consortium-II-defined clinical outcomes in COPD patients.

Keywords

TAVI - COPD - transfemoral - transapical - clinical outcome - survival

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References

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Supplementary Material

Supplementary Material