Anas A. Alharbi, MD, Cardiology Fellow, Department of Medicine, West Virginia University speaks about Outcomes and Contemporary Trends in Surgical vs Transcatheter Aortic Valve Replacement in Patients with Chronic Obstructive Pulmonary Disease.
Link to Article:
Chronic obstructive pulmonary disease (COPD) is a frequent complication among aortic valve replacement patients. The goal of this study is to look at the trends and outcomes of COPD patients who have significant aortic stenosis and are having either transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR).
We used the International Classification of Diseases, 9th and 10th Revision Clinical Modifications to search the National Inpatient Sample database from January 2012 to December 2017 for all patients with COPD aged 50 years or older who had TAVR or SAVR for aortic stenosis. A 1:1 propensity-matched analysis was used to control for possible bias. For the determinants of death in the cohort, logistic regression was employed. For trend analysis, linear regression was employed.
40,080 of the 95,555 patients were treated with TAVR, whereas 49,985 were treated with SAVR. The SAVR group had a higher in-hospital mortality rate than the TAVR group (4.6 percent vs. 2.5 percent; p 0.001) in the propensity-matched cohorts. The SAVR group had more respiratory problems (7.5 percent vs. 3.7 percent; p 0.001), although they were less likely to have a permanent pacemaker (5.3 percent vs. 10.8 percent, p 0.001). When comparing TAVR to SAVR, the length of stay (11.8 days [SD, 8.8] vs. 6.4 days [SD, 6.8]) and cost of stay ($244,657 [SD, $183,333] vs. $229,524 [SD, $146,994]) were in favor of TAVR. In-hospital mortality in the TAVR group was decreased from 4.8 percent to 1.5 percent during the trial period.
When compared to SAVR, TAVR had better in-hospital outcomes in COPD patients.