Interstitial lung abnormality is prevalent and associated with worse outcome in patients undergoing transcatheter aortic valve replacement

Kadoch, Michel; Kitich, Aleksandar; Alqalyoobi, Shehabaldin; LaFond, Elyse; Foster, Elena; Juarez, Maya; Mendez, Cesar; Smith, Thomas W.; Wong, Garrett B.; Boyd, W. Douglas; Southard, Jeffrey; Oldham, Justin M.

doi:10.1016/j.rmed.2018.02.017

Cited by 15 publications

(14 citation statements)

References 36 publications

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“…4,21 Furthermore, patients with ILA appear to have a worse prognosis than those without. 4,7 A recent study examining lung cancer resection specimens identified histopathologic findings of subpleural fibrosis and fibroblastic foci in subjects with radiological ILA. 22 These findings add weight to the possibility that minor ILA represent pre-clinical fibrotic lung disease.…”

Section: Discussionmentioning

confidence: 99%

“…Although the significance of ILA is not clearly defined, studies have found associated decrements in exercise capacity, reduced health and functional status, decline in lung function and increased risk of all-cause mortality and pulmonary fibrosis specific mortality. [4][5][6][7][8][9] Detection of ILA in populations receiving CT scans for other reasons may provide much needed insights into the natural history of fibrotic lung disease and inform the discussion about indications for treatment.…”

Section: Introductionmentioning

confidence: 99%

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Interstitial lung abnormalities in the Queensland Lung Cancer Screening Study: prevalence and progression over 2 years of surveillance

Mackintosh

Marshall

Slaughter

et al. 2019

Internal Medicine Journal

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Background We report the prevalence and progression of incidentally detected interstitial lung abnormalities (ILA) in the Queensland Lung Cancer Screening Study cohort. Methods About 256 volunteers aged 60–74, with ≥30 pack years smoking history and forced expiratory volume in 1 s (FEV1) ≥50% predicted underwent low‐dose computed tomography (CT) chest screening. Electronic search of baseline (T0) and 2‐year follow‐up (T2) CT reports identified candidate cases using Fleischner Society interstitial terminology. Candidate CT were reviewed in a randomised order by two experienced radiologists and a senior respiratory medicine trainee blinded to the existing reports. Scans were evaluated for the presence and extent of ILA using an in‐house score, and graded for progression. Results ILA were detected in 20/256 baseline cases (7.8%) with no incident cases detected at T2 surveillance imaging. Of these 20 cases, 9 (45%) had reticulation, 18 (90%) had ground glass change, 1 had traction bronchiectasis and 1 had randomly distributed nodularity. Seven cases with ground glass changes also had areas of reticulation, and only two had reticulation alone. All ILA were graded as minor except for traction bronchiectasis, which was moderate. Only one case progressed on T2 imaging. ILA were associated with the presence of auscultatory crackles (50% vs 11.6%, P = 0.001) and a lesser degree of emphysema (mean % volumetric emphysema 6.7% vs 9.8%, P = 0.009). No relationship was observed between baseline and serial lung function parameters. Conclusion ILA are frequent incidental findings in lung cancer screening. In the majority of cases these abnormalities do not appear to change significantly over a 2‐year period of surveillance.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Interstitial lung abnormalities in the Queensland Lung Cancer Screening Study: prevalence and progression over 2 years of surveillance

Mackintosh

Marshall

Slaughter

et al. 2019

Internal Medicine Journal

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“…According to one singlecenter study, which assessed pre-TAVR high-resolution computed tomography scans in 623 patients who underwent TAVR, interstitial lung abnormality (which also included a quarter of patients with a diagnosis of IPF) was prevalent in 14.7% of the cases and was an independent predictor of mortality in patients undergoing TAVR. 17 In contrast, a recent study utilizing the Nationwide Inpatient Sample database from 2011 to 2014 found that respiratory complications such as need for tracheostomy (0.8% vs 5.8%), acute respiratory failure (16.4% vs 23.7%), reintubation (6.5% vs 10%), and pneumonia (4.5% vs 10.1%) were significantly less frequent with TAVR vs SAVR for COPD patients. 18 Extrapolating these findings to our study, we found that in ILD patients, TAVR resulted in a superior perioperative outcome from a respiratory standpoint, resulting in shorter ventilation times (approximately 3 hours less), less ICU requirement (less than half the time), and clinically lower rates of reintubation (1.9% vs 2.7%) and prolonged ventilation (3.8% vs 8.1%).…”

Section: Discussionmentioning

confidence: 91%

“…Furthermore, there are no contemporary studies that have specifically examined the impact of ILD and IPF in patients with AS per se, which is important because choosing a particular approach (either SAVR or TAVR) remains one of the biggest challenges for clinicians and an impetus for this study. According to one single‐center study, which assessed pre‐TAVR high‐resolution computed tomography scans in 623 patients who underwent TAVR, interstitial lung abnormality (which also included a quarter of patients with a diagnosis of IPF) was prevalent in 14.7% of the cases and was an independent predictor of mortality in patients undergoing TAVR . In contrast, a recent study utilizing the Nationwide Inpatient Sample database from 2011 to 2014 found that respiratory complications such as need for tracheostomy (0.8% vs 5.8%), acute respiratory failure (16.4% vs 23.7%), reintubation (6.5% vs 10%), and pneumonia (4.5% vs 10.1%) were significantly less frequent with TAVR vs SAVR for COPD patients .…”

Section: Discussionmentioning

confidence: 99%

Transcatheter vs surgical aortic valve replacement in patients with interstitial lung disease

et al. 2020

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Background Patients with underlying interstitial lung disease (ILD) who undergo cardiac surgery are at high risk of postoperative pulmonary complications. It remains unclear if transcatheter aortic valve replacement (TAVR) offers any benefit over surgical aortic valve replacement (SAVR) in ILD patients with severe aortic stenosis. Methods All adult patients with a diagnosis of ILD who underwent either a TAVR or isolated SAVR between January 2002 and December 2017 were retrospectively reviewed. Operative mortality, 30‐day readmissions, and adjusted 1‐year survival were compared between the two cohorts. Results The overall cohort included 52 TAVR and 74 SAVR patients. While TAVR patients were significantly older (77.2 vs 72.9 years) with higher Society of Thoracic Surgeons predicted risk of mortality (STS‐PROM) scores compared with SAVR patients (6.29 vs 4.49; all P < .02), operative mortality was similar (5.8% vs 4.1%; P = .45). Rates of postoperative stroke, permanent pacemaker implantation, reintubation, and 30‐day readmissions did not differ between the two groups (all P > .46). However, TAVR was associated with significantly shorter hospital and intensive care unit (ICU) length of stay, shorter ventilation times, and less requirement for ICU admission (all P < .05). Thirty‐day readmissions and adjusted 1‐year survival were also similar between the two groups (hazard ratio for TAVR vs SAVR = 1.34; 95% CI: 0.7‐2.6). Conclusions Among ILD patients with symptomatic aortic stenosis, TAVR was associated with comparable operative and risk‐adjusted 1‐year survival to SAVR. TAVR patients also had shorter ventilator times, ICU and hospital stay despite being at higher risk. Together, our findings suggest that TAVR may be a better option in this unique cohort.

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“…The incidence of periprocedural IPF exacerbation was reported to be 0.4% among patients undergoing TAVI [4]. It is important to focus on specific populations with a baseline interstitial lung abnormality, which was found in 14.7% of those referred for TAVI [5]. These data suggest that IPF exacerbation will occur in 2-3% of TAVI cases with a baseline interstitial lung abnormality.…”

Section: Discussionmentioning

confidence: 95%

Critical exacerbation of idiopathic pulmonary fibrosis after transcatheter aortic valve implantation: Need for multidisciplinary care beyond “heart team”

Sugizaki

Mori

Nagamatsu

et al. 2018

Journal of Cardiology Cases

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An 82-year-old man with severe aortic stenosis and idiopathic pulmonary fibrosis (IPF) underwent transcatheter aortic valve implantation (TAVI) under general anesthesia. However, following a successful TAVI procedure, he developed progressive respiratory failure because of the exacerbation of IPF. Despite the use of immunosuppressants, the patient could not be saved and he died of respiratory failure. Although TAVI is a less invasive procedure compared to conventional surgical aortic valve replacement, it is currently selected for management of severely ill, frail, and elderly patients. This case highlights the potential risk of IPF exacerbation following a TAVI procedure performed under general anesthesia.

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Interstitial lung abnormality is prevalent and associated with worse outcome in patients undergoing transcatheter aortic valve replacement

Cited by 15 publications

References 36 publications

Interstitial lung abnormalities in the Queensland Lung Cancer Screening Study: prevalence and progression over 2 years of surveillance

Interstitial lung abnormalities in the Queensland Lung Cancer Screening Study: prevalence and progression over 2 years of surveillance

Transcatheter vs surgical aortic valve replacement in patients with interstitial lung disease

Critical exacerbation of idiopathic pulmonary fibrosis after transcatheter aortic valve implantation: Need for multidisciplinary care beyond “heart team”

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