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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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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 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]
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Metadata
- 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
- ORCID
- 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
- bronze
- doi.org
- Licence
- 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 › Cardiology and Cardiovascular Medicine › Aortic Disease and Treatment Approaches
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › 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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