TAVR better, cheaper than SAVR for patients with COPD

Transcatheter aortic valve replacement (TAVR) was associated with lower in-hospital mortality and significantly fewer respiratory complications than surgery for patients with chronic obstructive pulmonary disease (COPD), according to study published April 1 in the Journal of the American Heart Association.

Using the National Inpatient Sample from 2011 through 2014, researchers propensity-matched about 1,200 patients receiving TAVR to the same number receiving surgical aortic valve replacement (SAVR). Respiratory-related complications were lower across the board for TAVR:

  • Tracheostomy, 0.8 percent versus 5.8 percent (odds ratio: 0.14)
  • Reintubation, 6.5 percent versus 10.0 percent (OR: 0.49)
  • Acute respiratory failure, 16.4 percent versus 23.7 percent (OR: 0.63)
  • Pneumonia, 4.5 percent versus 10.1 percent (OR: 0.41)

In-hospital mortality occurred in 3.3 percent of TAVR patients versus 4.2 percent of those undergoing SAVR, while rates of acute myocardial infarction (2.4 percent versus 8.4 percent) were also lower. Also, hospital stays were more than five days shorter on average with TAVR and cost $56,099 versus $63,146.

“Symptomatic, severe aortic stenosis patients with chronic obstructive pulmonary disease should strongly be considered for transcatheter rather than surgical aortic valve replacement given the significantly lower in‐hospital mortality rates and respiratory‐related complications,” wrote the authors, including lead researcher Tomo Ando, MD, a cardiologist with Detroit Medical Center.

Further study is warranted to further investigate whether different stages of chronic obstructive pulmonary disease similarly benefit from transcatheter compared with surgical aortic valve replacement strategy.”

The researchers pointed out SAVR normally requires longer durations of mechanical ventilation, which may explain some of the increased respiratory risk. In addition, “open cardiac surgery would likely cause more pain and hence increased use of analgesia, including opiates,” they wrote.

“These medications could suppress the respiratory drive and may result in respiratory failure, atelectasis, or aspiration pneumonia, therefore causing adverse respiratory complications.”

Ando et al. noted they only included patients in their analysis who underwent TAVR via the transarterial approach, not the more invasive transapical method. A minimalist TAVR approach which uses only local anesthesia and conscious sedation might further reduce respiratory complications, costs and lengths of stay, the researchers said.