Is Transcatheter Aortic Valve Replacement Better than Surgical Aortic Valve Replacement in Patients with Chronic Obstructive Pulmonary Disease? A Nationwide Inpatient Sample Analysis
Tomo Ando1, Oluwole Adegbala2, Emmanuel Akintoye1, Said Ashraf3, Luis Afonso3, Theodore Schreiber3.
1Detroit Medical Center, Troy, MI, USA, 2Englewood Hospital and Medical Center, Englewood, NJ, USA, 3Detroit Medical Center, Detroit, MI, USA.
Background: Chronic obstructive pulmonary disease (COPD) patients are at increased risk of respiratory related complications after cardiac surgery. It is unclear whether transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) results in favorable outcomes in COPD patients. Methods: Patients were identified from Nationwide Inpatient Sample (NIS) database from 2011 to 2014. Patients with age ≥60, COPD, either went transarterial TAVR or SAVR were included in the analysis. Those who underwent concomitant cardiac surgery were excluded. To adjust for the difference in underlying comorbidities, a 1:1 propensity-matched cohort was created to examine the outcomes. Primary endpoints were 1: in-hospital mortality or tracheostomy and 2: major respiratory complications defined by composite of in-hospital mortality, acute respiratory failure, noninvasive mechanical ventilation or re-intubation. Results: A matched pair of 1,246 TAVR and 1,244 SAVR patients was identified. Patient characteristics were well matched between the two groups. The primary endpoint was significantly less observed in TAVR compared to SAVR patients (3.9% vs. 8.61%, OR 0.60, p<0.0001). This was mainly driven by lower event rate of tracheostomy (0.9% vs. 5.2%, OR 0.16, p<0.0001). The in-hospital mortality rate was numerically lower in TAVR compared to SAVR but did not reach statistical significance (3.3% vs. 4.2%, OR 0.77, p=0.20). Major respiratory complication was also significantly low in TAVR (21.8% vs. 31.8%, OR 0.60, p<0.0001). Each of the components of major respiratory complications was all significantly less observed in TAVR than SAVR. The use of non-invasive mechanical ventilation was similar between TAVR and SAVR (4.3% vs. 5.3%, OR 0.81, p=0.26). Cost ($55,916 vs. $63,425, p<0.0001) and hospital stay (mean 7.7 days vs. 12.9 days, p<0.0001) also favorable in TAVR than SAVR. Conclusions: TAVR portended significantly less respiratory related complications as well as certain non-respiratory related complications compared to SAVR in COPD patients. In addition, TAVR resulted in less utilization of healthcare resource. TAVR may be a preferable mode of aortic valve replacement in COPD patients.
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