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Impact of Concomitant Pulmonary Disease on Outcomes of Patients Undergoing Transcatheter Aortic Valve Replacement
Kelly Sutter, Rohan Menon, Lisa Walsh, Daniel Choudhary, Wilson Szeto, Saif Anwaruddin, Prashanth Vallabhajosyula, Howard Herrmann, Joseph Bavaria, Nimesh Desai
University of Pennsylvania, Philadelphia, PA, USA.

OBJECTIVE: Transcatheter Aortic Valve Replacmeent (TAVR) is emerging as a viable treatment option for severe aortic stenosis (AS) in patients with significant co-morbidities. The purpose of this study is to determine the outcomes of patients with AS and COPD.
METHODS: Between November 2007 and June 2012, 266 patients underwent TAVR. All patients received a preoperative echocardiogram, heart catheterization, PFTs, and a 6-minute walk test. 205 patients had no significant COPD (STS definition: non or mild pulmonary disease) and 61 patients had significant COPD (STS definition: moderate to severe pulmonary disease).
RESULTS: 1-year data revealed 80% and 92% survival rates (p=0.28) of patients without significant COPD and those with significant COPD respectively. 1-year data also indicated that 9% of patients without COPD and 15% of patients with significant COPD were classified as NYHA III/IV (p=0.27). From baseline to 1-year, patients without significant COPD showed improvements on their 6-minute walk tests by 72.28 meters (54%), while patients with significant COPD showed improvements by 50.50 meters (42%)(p=0.045). 1-year echocardiograms display improvements in both groups: ejection fraction (%) from 57.5 to 61.2 and from 57.1 to 61.7 (p=0.37); mean gradients (mmHg) from 48.1 to 10.8 and 48.0 to 13.1 (p=0.27); and peak gradients (mmHg) from 79.8 to 21.1 and 82.2 to 25.6 (p=0.58), for patients without significant COPD and patients with significant COPD respectively.
CONCLUSIONS: Early clinical and echocardiographic results demonstrate TAVR as a viable option for high-risk patients with severe aortic stenosis and COPD.

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