Transcatheter aortic valve replacement (TAVR) can lead to significant reductions in symptoms for patients who also present with chronic obstructive pulmonary disease (COPD), according to a new study published in JACC: Cardiovascular Interventions. However, patients with more severe COPD also face a higher risk of mortality within two years of TAVR than patients with less severe COPD.
“COPD is one of the top three causes of death worldwide,” wrote first author Philipp Doldi, MSc, a specialist with Ludwig Maximilian University of Munich in Germany, and colleagues. “Therefore, it is not surprising that 16% to 43% of patients with aortic stenosis (AS) undergoing TAVR have comorbid COPD. Due to the fact that dyspnea is a cardinal symptom of both diseases, it might be challenging to assign symptoms either to AS or COPD. Thus, it remains uncertain to what extent TAVR can improve outcome and symptoms in COPD patients with different disease severity stages.”
Doldi et al. explored data from more than 3,000 TAVR patients treated at a single facility from January 2013 to November 2020. They focused on 440 TAVR patients with confirmed COPD and 423 TAVR patients without COPD.
The median age for all study participants was 79 years old. The median Society of Thoracic Surgeons score was 4.0. All patients presented with severe symptomatic AS, and 81.5% of patients presented with advanced heart failure symptoms.
Also, data from a pulmonary function test (PFT) was available for each patient. The research group reviewed each patient’s PFT, grading their symptoms according to the popular Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines.
Overall, after a median follow-up period of nearly three years, the estimated two-year survival rates were 69.2% for TAVR patients with COPD and 79.7% for TAVR patients without COPD. COPD was also identified as an independent predictor of mortality after TAVR.
Patients with more severe COPD faced a higher risk of mortality; estimated two-year survival rates were 76% for GOLD 1 patients, 73% for GOLD 2 patients, 63% for GOLD 3 patients and 44% for GOLD 4 patients.
The authors also emphasized that TAVR “significantly reduced symptoms” in both patients with and without COPD. Patients with GOLD 3 or GOLD 4 COPD had much worse symptoms at follow-up than patients with no COPD, GOLD 1 COPD or GOLD 2 COPD.
“Although TAVR can effectively reduce symptoms in COPD patients, increasing severity of COPD is associated with less symptomatic improvement,” the authors wrote. “Therefore, decision on an interventional approach should be evaluated on an individual basis in COPD patients.”
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Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.