Cited by 112Cardiac Valve Diseases and TreatmentsAortic Disease and Treatment ApproachesInfective Endocarditis Diagnosis and Management

Outcomes of Patients With Chronic Lung Disease and Severe Aortic Stenosis Treated With Transcatheter Versus Surgical Aortic Valve Replacement or Standard Therapy

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Dvir, Danny, Waksman, Ron, Barbash, Israel M., Kodali, Susheel K., Svensson, Lars G., Tuzcu, E. Murat, Xu, Ke, Minha, Sa'ar +9 more·2014·Journal of the American College of Cardiology

Abstract

Objectives The study aimed to evaluate the impact of chronic lung disease (CLD) on outcomes of severe aortic stenosis patients across all treatment modalities.Background Outcomes of patients with CLD undergoing transcatheter aortic valve replacement (TAVR) have not been systematically examined.Methods All patients who underwent TAVR in the PARTNER (Placement of AoRTic TraNscathetER Valve) trial, including the continued access registry (n = 2,553; 1,108 with CLD), were evaluated according to CLD clinical severity. Additionally, outcomes of CLD patients included in the randomization arms of the PARTNER trial were compared: Cohort A patients (high-risk operable) treated by either TAVR (n = 149) or surgical aortic valve replacement (SAVR); (n = 138); and Cohort B patients (inoperable) treated by either TAVR (n = 72) or standard therapy only (n = 95).Results Among all TAVR-treated patients, at 1-year follow-up, patients with CLD had higher mortality than those without it (23.4% vs. 19.6%, p = 0.02). Baseline characteristics of CLD patients who underwent TAVR were similar to respective controls. In Cohort A, 2-year all-cause death rates were similar (TAVR 35.2% and SAVR 33.6%, p = 0.92), whereas in Cohort B, the death rate was lower after TAVR (52.0% vs. 69.6% after standard therapy only, p = 0.04). Independent predictors for mortality in CLD patients undergoing TAVR included poor mobility (6-min walk test <50 m; hazard ratio: 1.67, p = 0.0009) and oxygen-dependency (hazard ratio: 1.44, p = 0.02). Although CLD patients undergoing TAVR have worse outcomes than patients without CLD, TAVR is better in these patients than standard therapy and is similar to SAVR.Conclusions Although patients with CLD undergoing TAVR had worse outcomes than patients without CLD, TAVR performed better in these patients than standard therapy and was similar to SAVR. However, CLD patients who were either poorly mobile or oxygen-dependent had poor outcomes. (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894).

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  • Results from some recent studies suggest that TAVR might be preferable to surgical aortic valve replacement in patients with diabetes, chronic obstructive pulmonary disease, pulmonary hypertension, small aortic annulus and low-flow, low-gradient aortic stenosis.

    “Results from some recent studies suggest that TAVR might be preferable to surgical AVR in patients with diabetes, chronic obstructive pulmonary disease, pulmonary hypertension, small aortic annulus and low-flow, low-gradient AS262–266.”

    From Calcific aortic stenosis (2016) · cites this paper as [264]

    The TAVR VERSUS SAVR section (page not provided) reports fewer major bleeding events with TAVR and a nonsignificant six-month trend favoring transfemoral TAVR in patients with chronic lung disease. But it finds no significant long-term survival difference, and the Conclusions say TAVR was similar to SAVR—not preferable. This paper addresses chronic lung disease rather than separately establishing a preference for TAVR in the other listed subgroups. (LLM, conf=0.87)

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Research works printed but not linked: 2

  1. [38]38. de Arenaza DP, Pepper J, Lees B, et al. Preoperative 6MWT adds prognostic information to Euroscore in patients undergoing AVR. Heart 2010;96:113-7.
  2. [43]43. Dvir et al. JACC Vol. 63, No. 3, 2014 TAVR in Patients With Chronic Lung Disease January 28, 2014:269-79

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Authors
Dvir, D., Waksman, R., Barbash, I. M., Kodali, S. K., Svensson, L. G., Tuzcu, E. M., Xu, K., Minha, S., Alu, M. C., Szeto, W. Y., Thourani, V. H., Makkar, R., Kapadia, S., Satler, L. F., Webb, J. G., Leon, M. B., & Pichard, A. D.
Affiliations
  • MedStar Washington Hospital Center (US)
  • Columbia University Irving Medical Center (US)
  • Cleveland Clinic (US)
  • Hospital of the University of Pennsylvania (US)
  • Emory University (US)
  • Cedars-Sinai Medical Center (US)
  • St. Paul's Hospital (CA)
Corresponding author
Waksman, Ron
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2014-01
Volume
63
Issue
3
Pages
269-279
ISSN
0735-1097 (ISSN-L)
OpenAlex
W195442482
Cited by
112
References
63
Citations by year
2026: 3 · 2025: 5 · 2024: 2 · 2023: 12 · 2022: 5 · 2021: 9 · 2020: 13 · 2019: 7 · 2018: 7 · 2017: 12 · 2016: 17 · 2015: 15 · 2014: 4
FWCI
8.15
Type
journal article
Language
en
Open access
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Boston Scientific
  • Medtronic
  • Volcano
  • Eli Lilly
  • Daiichi Sankyo
  • AstraZeneca
  • Abbott Vascular
  • Edwards Lifesciences and Medtronic CardioVascular
  • Edwards Lifesciences and Sorin Medical
  • Edwards Lifesciences and St. Jude Medical
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Disease and Treatment Approaches
  • Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
Keywords
chronic lung disease, severe aortic stenosis, transcatheter aortic valve implantation, surgical aortic valve replacement, mortality, PARTNER trial, inoperable patients, 6-minute walk test, oxygen dependence, mortality risk factors
MeSH terms
Aged, 80 and over, Aortic Valve Stenosis, Cause of Death, Chronic Disease, Female, Follow-Up Studies, Cardiac Catheterization, Heart Valve Prosthesis, Humans, Lung Diseases, Male, Severity of Illness Index, United States, Survival Rate, Treatment Outcome

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