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J Thorac Cardiovasc Surg. 2016 Feb;151(2):578-85, 586.e1-2. doi: 10.1016/j.jtcvs.2015.10.067. Epub 2015 Oct 27.

Preoperative pulmonary function tests predict mortality after surgical or transcatheter aortic valve replacement.

Author information

1
Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Mo.
2
Cardiovascular Division, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Mo.
3
Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Mo. Electronic address: maniarh@wudosis.wustl.edu.

Abstract

OBJECTIVES:

To determine the role of preoperative pulmonary function tests (PFTs) in patients with aortic stenosis (AS) evaluated for aortic valve replacement (AVR), and to evaluate the association between lung disease and mortality in specific subgroups.

METHODS:

Between 2008 and 2013, 535 patients with preoperative PFTs underwent AVR (transcatheter AVR [TAVR], n = 246; surgical AVR [SAVR], n = 289). The severity of lung disease determined by the Society of Thoracic Surgeons (STS) definition was evaluated in those with and without a clinical suspicion for lung disease (smoking, inhaled steroids/bronchodilators, or home oxygen). The association between lung disease and 1-year mortality was evaluated.

RESULTS:

Of the 186 patients (35%) without suspected lung disease, 39 (21%) had moderate/severe lung disease by PFT analysis. Among all patients, 1-year mortality was 12% in those with no lung disease, 17% in those with no mild lung disease, 22% in those with moderate lung disease, and 31% in those with severe lung disease (P < .001, log-rank test). After adjustment, moderate/severe lung disease was associated with increased 1-year mortality (adjusted hazard ratio, 2.07; 95% confidence interval, 1.30-3.29; P = .002); this association was not altered by smoking history, suspicion of lung disease, New York Heart Association class, or AVR type (interaction P value nonsignificant for all).

CONCLUSIONS:

In patients with AS evaluated for AVR, the STS risk score is significantly influenced by the severity of lung disease, which is determined predominantly by PFT results. Even when lung disease is not suspected, PFTs are abnormal in many patients undergoing AVR. Moderate/severe lung disease, diagnosed predominantly by PFTs, is an independent predictor of mortality after SAVR or TAVR. Collectively, these findings suggest that PFTs should be a routine part of the risk stratification of patients considered for AVR.

KEYWORDS:

TAVR; aortic stenosis; aortic valve replacement; preoperative evaluation; pulmonary function tests

PMID:
26687886
PMCID:
PMC5091079
DOI:
10.1016/j.jtcvs.2015.10.067
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Statement R.J.D. has received educational funding from Edwards Lifesciences. A.Z. is a consultant for Edwards Lifesciences. B.R.L. receives grants and personal fees from Roche Diagnostics. All other authors have nothing to disclose with regard to commercial support.

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