Risk of Respiratory Complications, but Not Death, Is Higher for Patients With COPD Who Receive TAVI

Researchers found that patients with chronic obstructive pulmonary disease (COPD) receiving a transcatheter aortic valve insertion (TAVI) had an increased risk of developing in-hospital respiratory complications and pneumonia compared with patients without COPD.

However, the risks of in-hospital mortality, length of hospital stay, and nonrespiratory postoperative complications did not increase among patients with COPD compared with patients without COPD, according to the study published in Clinical Cardiology.

Aortic stenosis is a common heart-related comorbidity associated with COPD. Additionally, respiratory complications can increase risks of postoperative morbidity and mortality in patients undergoing surgical treatments for aortic stenosis.

For aortic stenosis, valve replacement is often considered the primary treatment because of the increased left ventricular pressure needed to maintain proper cardiac output.

Comorbid COPD has been shown to be associated with morbidity and mortality after open-chest heart surgery, and COPD can often contribute to a high preoperative risk score during presurgical assessments for patients with severe aortic stenosis, possibly influencing doctors to choose TAVI as a less invasive alternative to surgical aortic valve replacement (SAVR). One study had shown that between 28% and 43% of patients undergoing TAVI had COPD.

However, risks associated with TAVI have not been studied at great length, and previous research has produced conflicting results about whether TAVI is safer than valve replacement surgeries in patients with COPD.

Investigators used data entered from 2011 to 2014 from the Healthcare Cost and Utilization Project’s National Inpatient Sample database and included in their analysis hospitalized patients who were 18 years or older and underwent TAVI. The final cohort included 8466 patients, 2529 (29.8%) of whom had COPD.

“An important strength of the present study is that the cohort includes the largest number of patients [in] such a study, selected from all geographical regions in the US and covering hospital admissions over a 4-year period,” wrote the investigators.

Overall, the hospital mortality rate was 4.2% and the overall mean (SD) length of hospital stay was 8.06 (0.12) days. The in-hospital mortality rate and the length of hospital stay were similar between patients with COPD and patients without COPD.

In contrast, the prevalence of respiratory complications or pneumonia (20.9% vs 15.5%), infection or sepsis (2.2% vs 3%), and device complications (2.1% vs 3.0%) differed between patients with COPD and their non-COPD counterparts.

Investigators said that although prior research has shown that respiratory-related complications was significantly less frequent for patients with COPD receiving TAVI as opposed to SAVR, the present study still demonstrated that risks were significantly higher among patients with COPD compared to patients without COPD.

After reviewing the findings of previous studies and comparing them with their results, the investigators suggested “that COPD patients who undergo TAVI are at no greater risk of poor in-hospital outcomes than those undergoing SAVR.”

Researchers also proposed that the use of minimalist transcatheter aortic valve replacement (TAVR), which requires minimal sedation instead of general anesthesia, could improve in-hospital outcomes of patients with COPD. Although TAVR was not included in the present research, the investigators noted that this approach has been shown to result in lower health care resource utilization and increased 1-year survival in patients with high surgical risks as a result of severe COPD and thus “it is an especially appropriate option.”

Reference

Xiao F, Yang Y, Fan R. Effects of COPD on in-hospital outcomes of transcatheter aortic valve implantation: results from the National Inpatient Sample database. Clin Cardiol. 2020;43(12):1524-1533. doi:10.1002/clc.23475