Danny Dvir1, Ron Waksman2, Israel M Barbash1, Susheel K Kodali3, Lars G Svensson4, E Murat Tuzcu4, Ke Xu3, Sa'ar Minha1, Maria C Alu3, Wilson Y Szeto5, Vinod H Thourani6, Raj Makkar7, Samir Kapadia4, Lowell F Satler1, John G Webb8, Martin B Leon3, Augusto D Pichard1. 1. MedStar Washington Hospital Center, Washington, DC. 2. MedStar Washington Hospital Center, Washington, DC. Electronic address: ron.waksman@medstar.net. 3. Center for Interventional Vascular Therapy, Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York. 4. Sones Cardiac Catheterization Laboratory, Cleveland Clinic Foundation, Cleveland, Ohio. 5. Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. 6. Cardiac Surgery, Emory University School of Medicine, Atlanta, Georgia. 7. Cardiovascular Interventional Center, Cedars-Sinai Heart Institute, Los Angeles, California. 8. Interventional Cardiology and Cardiac Catheterization Laboratories Martin B. Leon, Center for Interventional Vascular Therapy, St. Paul's Hospital, Vancouver, British Columbia, Canada.
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 undergoingtranscatheter 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 undergoingTAVR 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).
RCT Entities:
OBJECTIVES: The study aimed to evaluate the impact of chronic lung disease (CLD) on outcomes of severe aortic stenosispatients 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).
Authors: Matthew C Henn; Alan Zajarias; Brian R Lindman; Jason W Greenberg; Spencer J Melby; Nishath Quader; Anna M Vatterott; Cassandra Lawler; Marci S Damiano; Eric Novak; John M Lasala; Marc R Moon; Jennifer S Lawton; Ralph J Damiano; Hersh S Maniar Journal: J Thorac Cardiovasc Surg Date: 2015-10-27 Impact factor: 5.209
Authors: Cheng Ting Lin; Matthew J Czarny; Amira Hussien; Rani K Hasan; Brian T Garibaldi; Elliot K Fishman; Jon R Resar; Stefan Loy Zimmerman Journal: Radiol Cardiothorac Imaging Date: 2020-04-30
Authors: Brian R Lindman; Marie-Annick Clavel; Patrick Mathieu; Bernard Iung; Patrizio Lancellotti; Catherine M Otto; Philippe Pibarot Journal: Nat Rev Dis Primers Date: 2016-03-03 Impact factor: 52.329
Authors: Dae Hyun Kim; Caroline A Kim; Sebastian Placide; Lewis A Lipsitz; Edward R Marcantonio Journal: Ann Intern Med Date: 2016-08-23 Impact factor: 25.391