Impact of chronic lung disease on quality-of-life outcomes in patients undergoing transcatheter aortic valve replacement.
TAVR
aortic stenosis
pulmonary function testing
quality-of-life
Journal
Journal of cardiac surgery
ISSN: 1540-8191
Titre abrégé: J Card Surg
Pays: United States
ID NLM: 8908809
Informations de publication
Date de publication:
Feb 2021
Feb 2021
Historique:
received:
10
10
2020
accepted:
09
11
2020
pubmed:
7
1
2021
medline:
15
5
2021
entrez:
6
1
2021
Statut:
ppublish
Résumé
As the symptoms for both chronic lung disease (CLD) and aortic stenosis (AS) frequently overlap, it may be challenging to determine the degree of symptomatic improvement expected for a patient with CLD after correction of AS. Our aim was to determine if patients with CLD have the same degree of quality-of-life improvement following transcatheter aortic valve replacement (TAVR) as patients without CLD. A retrospective review of 238 TAVR patients from January 2017 to November 2018 who underwent preoperative pulmonary function tests and completed 30-day follow-up was performed. Patients were identified as having CLD with FEV1 more than 75% predicted. Postoperative outcomes and changes in Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) were compared between groups. Of the 238 patients identified, 143 (60.0%) had CLD, 50 (35.0%) of whom had an obstructive disease pattern. Patients with CLD were more likely to be male, had higher rates of peripheral artery disease, and had lower baseline ejection fraction. There was no difference in STS Predicted Risk of Mortality, but patients with CLD were more likely to be designated as high-risk by surgeon evaluation. While initial and follow-up KCCQ-12 was lower for patients with CLD, there was no significant difference in degree of improvement (p = .900). When comparing patients with obstructive lung disease (FEV1/FVC < 0.70) to those without CLD, there was also no significant difference in the change of quality of life (p = .720). Although patients with concomitant severe AS and CLD have reduced baseline quality of life compared to patients without CLD, they experience a comparable degree of improvement following TAVR.
Sections du résumé
BACKGROUND
BACKGROUND
As the symptoms for both chronic lung disease (CLD) and aortic stenosis (AS) frequently overlap, it may be challenging to determine the degree of symptomatic improvement expected for a patient with CLD after correction of AS. Our aim was to determine if patients with CLD have the same degree of quality-of-life improvement following transcatheter aortic valve replacement (TAVR) as patients without CLD.
METHODS
METHODS
A retrospective review of 238 TAVR patients from January 2017 to November 2018 who underwent preoperative pulmonary function tests and completed 30-day follow-up was performed. Patients were identified as having CLD with FEV1 more than 75% predicted. Postoperative outcomes and changes in Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) were compared between groups.
RESULTS
RESULTS
Of the 238 patients identified, 143 (60.0%) had CLD, 50 (35.0%) of whom had an obstructive disease pattern. Patients with CLD were more likely to be male, had higher rates of peripheral artery disease, and had lower baseline ejection fraction. There was no difference in STS Predicted Risk of Mortality, but patients with CLD were more likely to be designated as high-risk by surgeon evaluation. While initial and follow-up KCCQ-12 was lower for patients with CLD, there was no significant difference in degree of improvement (p = .900). When comparing patients with obstructive lung disease (FEV1/FVC < 0.70) to those without CLD, there was also no significant difference in the change of quality of life (p = .720).
CONCLUSION
CONCLUSIONS
Although patients with concomitant severe AS and CLD have reduced baseline quality of life compared to patients without CLD, they experience a comparable degree of improvement following TAVR.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
672-677Subventions
Organisme : Chander S. Iyer Cardiothoracic Research Endowment Fund
Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
Andrea R, López-Giraldo A, Falces C, et al. Lung function abnormalities are highly frequent in patients with heart failure and preserved ejection fraction. Heart Lung Circ. 2014;23(3):273-279.
Dimopoulou I, Daganou M, Tsintzas OK, Tzelepis GE. Effects of severity of long-standing congestive heart failure on pulmonary function. Respir Med. 1998;92(12):1321-1325.
Dvir D, Waksman R, Barbash IM, et al. Outcomes of patients with chronic lung disease and severe aortic stenosis treated with transcatheter versus surgical aortic valve replacement or standard therapy: insights from the PARTNER trial (placement of AoRTic TraNscathetER Valve). J Am Coll Cardiol. 2014;63(3):269-279.
El-Sobkey SB, Gomaa M. Assessment of pulmonary function tests in cardiac patients. J Saudi Heart Assoc. 2011;23(2):81-86.
Light RW, George RB. Serial pulmonary function in patients with acute heart failure. Arch Intern Med. 1983;143(3):429-433.
Henn MC, Zajarias A, Lindman BR, et al. Preoperative pulmonary function tests predict mortality after surgical or transcatheter aortic valve replacement. J Thorac Cardiovasc Surg. 2016;151(2):578-585.
Gotzmann M, Knoop H, Ewers A, Mugge A, Walther JW. Impact of lung diseases on morbidity and mortality after transcatheter aortic valve implantation: insights from spirometry and body plethysmography. Am Heart J. 2015;170(4):837-842.
Magee MJ, Herbert MA, Roper KL, et al. Pulmonary function tests overestimate chronic pulmonary disease in patients with severe aortic stenosis. Ann Thorac Surg. 2013;96(4):1329-1335.
Gilmore RC, Thourani VH, Jensen HA, et al. Transcatheter aortic valve replacement results in improvement of pulmonary function in patients with severe aortic stenosis. Ann Thorac Surg. 2015;100(6):2167-2173.
Escárcega RO, Torguson R, Tavil-Shatelyan A, et al. Impact of restrictive versus obstructive pulmonary function patterns on mortality in patients undergoing transcatheter aortic valve implantation. Cardiovasc Revasc Med. 2016;17(3):181-185.
Green CP, Porter CB, Bresnahan DR, Spertus JA. Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: a new health status measure for heart failure. J Am Coll Cardiol. 2000;35(5):1245-1255.
Spertus J, Peterson E, Conard MW, et al. Monitoring clinical changes in patients with heart failure: a comparison of methods. Am Heart J. 2005;150(4):707-715.
Yee D, Novak E, Platts A, Nassif ME, LaRue SJ, Vader JM. Comparison of the Kansas City Cardiomyopathy Questionnaire and Minnesota Living With Heart Failure Questionnaire in predicting heart failure outcomes. Am J Cardiol. 2019;123(5):807-812.