Abstract 2975: Severe Aortic Stenosis and Chronic Obstructive Pulmonary Disease: What is the Risk of Aortic Valve Replacement in the Modern Surgical Era?
Background: Patients with aortic stenosis (AS) and chronic obstructive pulmonary disease (COPD) have been considered high risk for aortic valve replacement (AVR), which results in some patients being denied this life-saving operation. Therefore, the purpose of this study is to assess the operative, 30 day, and long term mortality in individuals with COPD undergoing AVR for AS in the modern surgical era.
Methods: This was a retrospective cohort study of patients who had documented COPD (FEV1/FVC <70%) and underwent isolated AVR for severe AS between 1993 and 2006 at the Mayo Clinic in Rochester MN.
Results: Of the 63 patients who met criteria, 25 had mild/moderate COPD (FEV1 >50%), 32 had severe (FEV1 30–50%), and 6 had very severe (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 hrs for mild/moderate vs 115 hrs for severe/very severe: p=0.02) but did not influence operative or 30 day mortality. Long term mortality was significantly higher in patients with a history of cerebral vascular disease (HR 4.3, p<0.001), Class 3 or 4 New York Heart Association heart failure (Class 3 HR 2.79 p=0.05) (Class 4 HR 3.97 p=0.03), and increased age (HR 1.06, p=0.003). Severity of COPD was an independent risk factor for long term mortality (Figure 1⇓).
Conclusions: 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 increased 30 day mortality but does influence long term mortality.