Chronic Obstructive Pulmonary Disease in Patients Undergoing Transcatheter Aortic Valve Implantation

Abstract

COPD was associated with a higher rate of mortality at mid-term follow-up. Among COPD patients, a higher degree of airway obstruction and a lower exercise capacity determined a higher risk of pulmonary complications and mortality, respectively. TAVI was futile in more than one-third of the COPD patients, and a shorter distance walked at the 6MWT predicted the lack of benefit after TAVI. These results may help to improve the clinical decision-making process in this challenging group of patients.

Preoperative Frailty Assessment and Outcomes at 6 Months or Later in Older Adults Undergoing Cardiac Surgical Procedures

“…A simple assessment of mobility (administration time <1 minute), such as impaired mobility due to musculoskeletal or neurologic disorder(56) or use of assistive devices(50), and 6MWT (10 minutes) distance below various thresholds(12, 51-53) were statistically significantly associated with a 1.2- to 3.2-fold increase in mortality (Table 2). ADL dependence (5 minutes) was statistically significantly associated with mortality in 2 of the 3 studies.…”

“…(54, 55) The Clinical Frailty Scale (3 minutes), a global assessment based on medical problems, activity level, and disability, predicted mortality,(50, 60) whereas subjective assessment without such a scale did not. (12, 56, 57) A majority of studies of single-component instruments were conducted in highly representative samples, but the risk of bias was high due to determination of frailty status without using previously validated or clinical cutpoints and lack of validation (Appendix Figure 2 panel A). The overall quality of evidence was moderate for mobility, Clinical Frailty Scale, and subjective assessment, and low for disability in mortality prediction (Appendix Figure 2 panel B).…”

“…There were 3 studies that examined a composite outcome of mortality and poor functional status (Table 2). Wheelchair-bound status(15) and 6MWT distance <170m (among COPD patients)(12) were statistically significantly associated with a 2.6- to 2.8-fold risk of the composite outcome. Serum albumin was not associated with the outcome after adjusting for mobility impairment.…”

“…(15) Subjective assessment did not predict the outcome in COPD patients. (12) All 3 studies were conducted in highly representative samples, but the risk of bias was moderate due to missing outcomes and lack of validation (Appendix Figure 2 panel A). The quality of evidence was high for mobility and low for nutrition and subjective assessment (Appendix Figure 2 panel B).…”

“…(1) Due to high burden of cardiovascular disease and evolution of minimally invasive surgical techniques, this number is expected to rise. (2-4) While older patients may benefit from cardiac surgical procedures, some do not survive or experience complications,(5-10) functional decline,(11, 12) and poor quality of life. (13-15) Identifying patients who are most or least likely to benefit from surgical procedures remains a significant challenge.…”