Document Detail

Outcomes of Patients with Chronic Lung Disease and Severe Aortic Stenosis Treated with Transcatheter- versus Surgical Aortic Valve Replacement or Standard Therapy: Insights from the PARTNER Trial.
MedLine Citation:
PMID:  24140659     Owner:  NLM     Status:  Publisher    
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 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, 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-minute walk test <50 m) (hazard ratio, 1.67, p=0.0009) and oxygen-dependency (hazard ratio, 1.44, p=0.02).
CONCLUSIONS: Although patients with CLD undergoing TAVR had worse outcomes, TAVR was better in these patients than was standard therapy and was similar to SAVR. However, CLD patients who were either poorly mobile or oxygen-dependent had poor outcomes.
Danny Dvir; Ron Waksman; Israel M Barbash; Susheel K Kodali; Lars Svensson; E Murat Tuzcu; Ke Xu; Sa'ar Minha; Maria C Alu; Wilson Y Szeto; Vinod Thourani; Raj Makkar; Samir Kapadia; Lowell F Satler; John G Webb; Martin B Leon; Augusto D Pichard
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-10-1
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  -     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2013 Oct 
Date Detail:
Created Date:  2013-10-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
MedStar Washington Hospital Center, Washington, DC.
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