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

Abstract

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.

Preoperative atrial fibrillation/flutter impact on risk-adjusted repeat aortic intervention patients

“…For 30-day readmission, cerebrovascular disease was predictive while viv-TAVR was protective compared to r-SAVR. In contrast, first-time SAVR and TAVR were shown to have similar 30-day readmission rates in prior reports [34][35][36] . Other risk factors associated with 30-day readmission have previously been described in the literature, such as female sex, age, and chronic kidney disease in first-time SAVR patients [21] , and CHF, chronic obstructive pulmonary disease, pacemaker, diabetes, renal failure, and anemia in first-time TAVR patients [22,[37][38][39] .…”

Comparison of outcome prediction models post-stroke for a population-based registry with clinical variables collected at admission vs. discharge

“…For 30-day readmission, cerebrovascular disease was predictive while viv-TAVR was protective compared to r-SAVR. In contrast, first-time SAVR and TAVR were shown to have similar 30-day readmission rates in prior reports [34][35][36] . Other risk factors associated with 30-day readmission have previously been described in the literature, such as female sex, age, and chronic kidney disease in first-time SAVR patients [21] , and CHF, chronic obstructive pulmonary disease, pacemaker, diabetes, renal failure, and anemia in first-time TAVR patients [22,[37][38][39] .…”