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Transcatheter aortic valve replacement (tAVR) are emerging as a viable treatment option for severe aortic stenosis in patients with significant co-morbidities.

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Presentation on theme: "Transcatheter aortic valve replacement (tAVR) are emerging as a viable treatment option for severe aortic stenosis in patients with significant co-morbidities."— Presentation transcript:

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2 Transcatheter aortic valve replacement (tAVR) are emerging as a viable treatment option for severe aortic stenosis in patients with significant co-morbidities. The purpose of this study is to determine the outcomes of high-risk patients with aortic stenosis and COPD. Between November 2007 and June 2012, 266 patients have been implanted with a TAVR at Penn as part of the PARTNER Trial. All patients undergo a complete comorbid workup, which includes echocardiogram, heart catheterization, PFTs, and a 6 minute walk test. 205 patients had no COPD *(STS definition: mild/no COPD) 61 patients had COPD *(STS definition: moderate to severe COPD) None Mild: FEV1 60% to 75% of predicted, and/or on chronic inhaled or oral bronchodilator therapy. Moderate: FEV1 50% to 59% of predicted, and/or on chronic steroid therapy aimed at lung disease. Severe: FEV1 50.

3 No COPD (n=205) COPD (n= 61) P-Value Age83.95 ± ± Male108 (53%)30 (49%)0.663 Race - white199 (97%)57 (93%)0.244 STS Score11.18 ± ± Avg BNP No COPD (n=205) COPD (n= 61) P-Value HTN187 (91%)54 (89%)0.617 CV Disease66 (32%)21 (34%)0.758 Diabetes76 (37%)19 (31%)0.448 Renal Failure20 (10%)8 (13%)0.478 Prior MI47 (23%)13 (21%)0.863 PAD95 (46%)30 (49%)0.771 No COPD (n=205) COPD (n= 61) P-Value FVC2.31 ± ± % Pred FVC93% ± 29%75% ± 32% <0.001 FEV11.72 ± ± % Pred FEV194% ± 31%66% ± 30% <0.001 FEV1/FVC0.75 ± ± 0.17 <0.001 No COPD (n=205) COPD (n= 61) P-Value PA Systolic47.75 ± ± PA Diastolic19.49 ± ± PCWP20.41 ± ± LVEDP17.91 ± ±

4 No COPD (n=205) COPD (n= 61) P-Value Class NYHA I/II2 (1%)1 (2%)0.544 NYHA III/IV203 (99%)60 (98%)0.544 Echo EF57.53 ± ± Peak79.76 ± ± Mean48.1 ± ± AI1.60 ± ± MWT Meters ± ± # of pts unable34 (17%)14 (23%) AI classified as 0 = None, +1 trace, +2 mild, +3 mod, +4 severe

5 No COPD (n=158) COPD (n= 50) P-Value Class NYHA I/II152 (96%)42 (84%) NYHA III/IV4 (4%)8 (16%) Echo EF60.42 ± ± Peak19.58 ± ± Mean10.14 ± ± AI1.35 ± ± MWT n=98n=34 Meters ± ± 74.0 < # of pts unable7 (7%)6 (18%) AI classified as 0 = None, +1 trace, +2 mild, +3 mod, +4 severe

6 No COPD (n=146) COPD (n= 47) P-Value Class NYHA I/II133 (91%)40 (85%)0.273 NYHA III/IV13 (9%)7 (15%)0.273 Echo EF61.24 ± ± Peak21.07 ± ± Mean10.83 ± ± AI1.51 ± ± MWT* n=123N=39 Meters ± ± # of pts unable13 (10.5%)8 (21%) AI classified as 0 = None, +1 trace, +2 mild, +3 mod, +4 severe

7 Both cohorts of patients with and without COPD have tolerated TAVR well without significant morbidity and improvement in NYHA class and 6 minute walks. 6 and 12 month echocardiographic and clinical data (including 6 minute walk tests and NYHA classifications) improvements demonstrate TAVR as a viable option for high-risk patients with severe aortic stenosis and COPD. Further investigation with longer follow up will be needed to target this population as we believe COPD is one of the greatest comorbidities that accompany aortic stenosis in these patients. No COPD (n=205) COPD (n= 61) P-Value 1 year Survival 80%92%0.284


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