Anesthetic Implications of Chronic Lung Disease in Patients Undergoing Transcatheter Valve Implantation

Konia, Mojca Remskar; Helmer, Gregory; Raveendran, Ganesh; Aposolidou, Ioanna

doi:10.1053/j.jvca.2016.08.016

Cited by 2 publications

(1 citation statement)

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“…Prior studies have demonstrated that LTOT is an independent predictor of adverse outcomes in patients with severe aortic stenosis (AS) who are treated with surgical aortic valve replacement (SAVR), with an increased incidence of respiratory complications, pneumonia, and short-term and long-term mortality [ 7 , 8 ]. Owing to the less invasive nature of percutaneous valve replacement with less duration of mechanical ventilation and alternative availability of a minimalist approach with use of local/regional anesthesia and conscious sedation, some reports have postulated transcatheter aortic valve replacement (TAVR) as the more optimal approach in patients with severe chronic lung disease [ 9 , 10 ]. There is controversy, however, over the risk of TAVR morbidity and mortality specifically in the LTOT patient subgroup.…”

Section: Introductionmentioning

confidence: 99%

In-Hospital and One-Year Outcomes of Transcatheter Aortic Valve Replacement in Patients Requiring Supplemental Home Oxygen Use

et al. 2023

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Background There have been limited reports with inconsistent results on the impact of long-term use of oxygen therapry (LTOT) in patients treated with transcatheter aortic valve replacement (TAVR). Methods We compared in-hospital and intermediate TAVR outcomes in 150 patients requiring LTOT (home O 2 cohort) with 2,313 non-home O 2 patients. Results Home O 2 patients were younger, and had more comorbidities including chronic obstructive pulmonary disease (COPD), diabetes, carotid artery disease, lower forced expiratory volume (FEV 1 ) (50.3±21.1% vs. 75.0±24.7%, P < 0.001), and lower diffusion capacity (DLCO, 48.6±19.2% vs. 74.6±22.4%, P < 0.001). These differences represented higher baseline Society of Thoracic Surgeons (STS) risk score (15.5±10.2% vs. 9.3±7.0%, P < 0.001) and lower pre-procedure Kansas City Cardiomyopathy Questionnaire (KCCQ-12) scores (32.5 ± 22.2 vs. 49.1 ± 25.4, P < 0.001). The home O 2 cohort required higher use of alternative TAVR vascular access (24.0% vs. 12.8%, P = 0.002) and general anesthesia (51.3% vs. 36.0%, P < 0.001). Compared to non-home O 2 patients, home O 2 patients showed increased in-hospital mortality (5.3% vs. 1.6%, P = 0.001), procedural cardiac arrest (4.7% vs. 1.0%, P < 0.001), and postoperative atrial fibrillation (4.0% vs. 1.5%, P = 0.013). At 1-year follow-up, the home O 2 cohort had a higher all-cause mortality (17.3% vs. 7.5%, P < 0.001) and lower KCCQ-12 scores (69.5 ± 23.8 vs. 82.1 ± 19.4, P < 0.001). Kaplan-Meir analysis revealed a lower survival rate in the home O 2 cohort with an overall mean (95% confidence interval (CI)) survival time of 6.2 (5.9 - 6.5) years (P < 0.001). Conclusion Home O 2 patients represent a high-risk TAVR cohort with increased in-hospital morbidity and mortality, less improvement in 1-year KCCQ-12, and increased mortality at intermediate follow-up.

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