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

被引：96

作者：

Dvir, Danny ^{[1
]}

Waksman, Ron ^{[1
]}

Barbash, Israel M. ^{[1
]}

Kodali, Susheel K. ^{[2
,3
]}

Svensson, Lars G. ^{[4
]}

Tuzcu, E. Murat ^{[4
]}

Xu, Ke ^{[2
,3
]}

Minha, Sa'ar ^{[1
]}

Alu, Maria C. ^{[2
,3
]}

Szeto, Wilson Y. ^{[5
]}

Thourani, Vinod H. ^{[6
]}

Makkar, Raj ^{[7
]}

Kapadia, Samir ^{[4
]}

Satler, Lowell F. ^{[1
]}

Webb, John G. ^{[8
]}

Leon, Martin B. ^{[2
,3
]}

Pichard, Augusto D. ^{[1
]}

机构：

[1] MedStar Washington Hosp Ctr, Washington, DC 20010 USA

[2] Columbia Univ, Med Ctr, Ctr Intervent Vasc Therapy, New York, NY USA

[3] Cardiovasc Res Fdn, New York, NY USA

[4] Cleveland Clin Fdn, Sones Cardiac Catheterizat Lab, Cleveland, OH 44195 USA

[5] Hosp Univ Penn, Div Cardiovasc Surg, Philadelphia, PA 19104 USA

[6] Emory Univ, Sch Med, Atlanta, GA USA

[7] Cedars Sinai Heart Inst, Cardiovasc Intervent Ctr, Los Angeles, CA USA

[8] St Pauls Hosp, Ctr Intervent Vasc Therapy, Intervent Cardiol & Cardiac Catheterizat Labs Mar, Vancouver, BC V6Z 1Y6, Canada

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2014年 / 63卷 / 03期

关键词：

aortic stenosis; pulmonary disease; transcatheter aortic valve replacement; HIGH-RISK PATIENTS; OBSTRUCTIVE PULMONARY-DISEASE; 6-MINUTE WALK TEST; EDWARDS SAPIEN; EUROPEAN REGISTRY; EXERCISE CAPACITY; HEART-FAILURE; IMPLANTATION; MORTALITY; PREDICTORS;

D O I：

10.1016/j.jacc.2013.09.024

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

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) (1 Am Coll Cardiol 2014;63:269-79) 2014 (C) by the American College of Cardiology Foundation

引用

页码：269 / 279

页数：11

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