Does Minimalist Transfemoral Transcatheter Aortic Valve Replacement Produce Better Survival in Patients With Severe Chronic Obstructive Pulmonary Disease?

作者：Condado Jose F; Haider Moosa N; Lerakis Stamatios; Keegan Patricia; Caughron Hope; Thourani Vinod H; Devireddy Chandan; Leshnower Bradley; Mavromatis Kreton; Sarin Eric L; Stewart James; Guyton Robert; Forcillo Jessica; Patel Ateet; Simone Amy; Block Peter C; Babaliaros Vasilis^*

来源：Catheterization and Cardiovascular Interventions, 2017, 89(4): 775-780.

DOI：10.1002/ccd.26683

• chronic obstructive pulmonary disease
• transcatheter aortic valve replacement
• minimalist
• transfemoral

Objectives: To compare outcomes after minimalist and standard transfemoral transcatheter aortic valve replacement (TF-TAVR) in patients with severe chronic obstructive pulmonary disease (COPD). Background: TF-TAVR is increasingly performed with conscious sedation and transthoracic echocardiography guidance (minimalist). The safety/efficacy of this technique in patients with severe COPD is unknown. Methods: We compared demographics, 30-day outcomes and 1-year survival of patients with severe COPD (FEV1% <= 50) who underwent minimalist vs. standard TF-TAVR between 2008 and 2015 at our institution. Results: Of 88 patients with severe COPD, 46 underwent minimalist and 42 underwent standard TF-TAVR. There were no differences on baseline characteristics, except for more history of coronary artery bypass grafting (45.5% vs. 20.6%, P = 0.03) and less history of cerebrovascular disease (16.7% vs. 45.5%, P = 0.03) in the standard TF-TAVR. Seventeen minimalist TF-TAVR patients (41.0%) were transferred directly to the general medical ward with telemetry monitoring (without ICU stay); all standard TF-TAVR patients went to the ICU. Minimalist TF-TAVR patients had shorter procedure time (97 vs. 129 min, P < 0.001), ICU time (21.8 vs. 29.8 hr, P = 0.001) and length of stay (2 vs. 5 days, P = 0.001). There were no differences in procedure complications and 30-day mortality between groups. In our multivariate analysis, minimalist TF-TAVR (HR 0.28, 95% CI 0.08-0.97) and previous coronary revascularization (HR 0.24, 95% CI 0.09-0.65) were associated with increased 1-year survival. In contrast, moderate paravalvular leak (HR 7.73, 95% CI 1.94-0.84) was associated with decreased 1-year survival. Conclusion: In patients with severe COPD, Minimalist TF-TAVR results in less resource utilization and improved 1-year survival compared to standard approach. Our findings should be validated in a larger cohort of patients with severe COPD.

• 出版日期2017-3-1