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Risk of aortic valve replacement in patients with aortic stenosis and chronic obstructive pulmonary disease.
- Source :
-
The Journal of heart valve disease [J Heart Valve Dis] 2012 May; Vol. 21 (3), pp. 314-9. - Publication Year :
- 2012
-
Abstract
- Background and Aim of the Study: Patients with aortic stenosis (AS) and chronic obstructive pulmonary disease (COPD) have been considered at high risk for aortic valve replacement (AVR), which results in some patients being denied this life-saving operation. Hence, the study aim was to assess the operative, 30-day, and long-term mortality in individuals with COPD undergoing AVR for AS in the modern surgical era.<br />Methods: This retrospective cohort of patients had documented COPD (FEV1/FVC < 70%), and underwent isolated AVR for severe AS between 1993 and 2007 at the Mayo Clinic in Rochester, MN.<br />Results: Of the 68 patients who met the study criteria, 27 had mild/moderate COPD (FEV1 > 50%), 35 had severe COPD (FEV1 30-50%), and six had very severe COPD (FEV1 < 30%). The overall operative and 30-day mortality was 4.8%. More severe COPD was associated with a longer stay in the intensive care unit (42 h for mild/moderate versus 115 h for severe/very severe: p = 0.02), but did not influence the operative or 30-day mortalities. Female gender was associated with an increased length of hospital stay. Long-term mortality was significantly higher in patients with a history of cerebrovascular disease (HR 4.3, p < 0.001), NYHA class III or IV heart failure (class III HR 2.79, p = 0.05; class IV HR 3.97, p = 0.03), and increased age (HR 1.06, p = 0.003). The severity of COPD was an independent risk factor for long-term mortality.<br />Conclusion: Patients with severe AS and COPD are at an acceptable risk for AVR (30-day mortality < 5%). The severity of COPD is not associated with an increased in-hospital or 30-day mortality, but does influence long-term mortality.
- Subjects :
- Aged
Aged, 80 and over
Aortic Valve diagnostic imaging
Aortic Valve physiopathology
Echocardiography methods
Female
Heart Failure diagnosis
Heart Failure etiology
Heart Failure physiopathology
Humans
Length of Stay statistics & numerical data
Male
Middle Aged
Outcome Assessment, Health Care
Respiratory Function Tests methods
Retrospective Studies
Risk Adjustment
Risk Factors
Severity of Illness Index
Survival Rate
Time
Aortic Valve surgery
Aortic Valve Stenosis complications
Aortic Valve Stenosis diagnosis
Aortic Valve Stenosis mortality
Aortic Valve Stenosis physiopathology
Aortic Valve Stenosis surgery
Heart Valve Prosthesis Implantation adverse effects
Heart Valve Prosthesis Implantation methods
Heart Valve Prosthesis Implantation mortality
Pulmonary Disease, Chronic Obstructive complications
Pulmonary Disease, Chronic Obstructive diagnosis
Pulmonary Disease, Chronic Obstructive physiopathology
Subjects
Details
- Language :
- English
- ISSN :
- 0966-8519
- Volume :
- 21
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- The Journal of heart valve disease
- Publication Type :
- Academic Journal
- Accession number :
- 22808831