Impact of COPD on Outcome in Patients Undergoing Transfemoral versus Transapical TAVI

Abstract

Objective The purpose of this study was to evaluate the impact of chronic obstructive pulmonary disease (COPD) on clinical outcomes in patients referred for transfemoral (TF) as well as transapical (TA) aortic valve implantation and furthermore to delineate possible advantages of the TF access. Methods One thousand eight hundred forty-two patients undergoing transcatheter aortic valve implantation (TAVI) at two study centers were included in the present analysis. The outcome was measured and classified according to Valve Academic Research Consortium-II criteria. Kaplan–Meier estimate was used to assess long-term survival. Results The present analysis suggests that COPD has limited influence on post-procedural outcome after TAVI. Comparing the TF to TA approach, no significant difference on the impact of COPD on clinical outcomes has been found, except for longer post-procedural ventilation times in COPD patients treated via TA access (p < 0.001). Conclusions COPD in patients referred for TAVI procedure was associated with poorer overall long-term survival, thus characterizing a high-risk population for futile treatment; however, the selection of access did not result in a significant difference in most Valve Academic Research Consortium-II-defined clinical outcomes in COPD patients.

Identifying Patients without a Survival Benefit following Transfemoral and Transapical Transcatheter Aortic Valve Replacement

“…Although it is well established in the recent literature that COPD as a concomitant risk factor does not necessarily lead to a worse outcome after TA-TAVR, our study demonstrated that pronounced pulmonary oxygenation impairment resulting in home oxygen dependence is significantly associated with futile treatment after TA-TAVR [ 27 ]. However, it has to be pointed out that home oxygen dependence is a very rare clinical condition with an overall incidence of less than 2%, yet should be incorporated in the preinterventional decision making process when present.…”

Transcatheter versus Isolated Surgical Aortic Valve Replacement in Young High-Risk Patients: A Propensity Score-Matched Analysis

“…Due to existing contraindications to SAVR, 16 patients were excluded from the analysis. Of the remaining 88 patients, 42 were treated via the percutaneous transfemoral and 46 via the transapical access site as previously described [ 15 ]. Different generations of transcatheter valves developed by Edwards Lifesciences (Edwards Lifesciences, Irvine, CA, USA), Medtronic (Medtronic, Minneapolis, MN, USA), JenaValve (JenaValve Technology GmbH, Munich, Germany) and Symetis (Symetis SA, a Boston Scientific company, Ecublens, Switzerland) were used.…”

Alternative Access for TAVR: Choosing the Right Pathway

“…Other risks include damage to the mitral valve chordae that could result in acute mitral insufficiency [ 33 ]. Additionally, in patients with chronic obstructive pulmonary disease, longer postprocedural ventilation times have been noted in transapical TAVRs when compared to transfemoral approaches [ 39 ]. For these reasons, patients should be considered for this approach only if all extrathoracic options have been exhausted and there is significant calcification of the ascending aorta, precluding transaortic access.…”