• Vincent Auffret, Victor Becerra Munoz, Aurélie Loirat, Eric Dumont, Hervé Le Breton, Jean-Michel Paradis, Daniel Doyle, Robert De Larochellière, Siamak Mohammadi, Jean-Philippe Verhoye, François Dagenais, Marc Bedossa, Dominique Boulmier, Guillaume Leurent, Lluis Asmarats, Ander Regueiro, Chekrallah Chamandi, Tania Rodriguez-Gabella, Emile Voisine, Anne-Sophie Moisan, Martin Thoenes, Mélanie Côté, Rishi Puri, Pierre Voisine, and Josep Rodés-Cabau.
• Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada; Department of Cardiology and Vascular Disease, CIC-IT 804, Rennes 1 University, Pontchaillou University Hospital, Signal and Image Processing Laboratory (LTSI), INSERM U1099, Rennes, France.
• Am. J. Cardiol. 2017 Nov 15; 120 (10): 1863-1868.

AbstractRespiratory complications are a major factor contributing to postoperative morbidity and mortality, especially in patients with chronic obstructive pulmonary disease (COPD). Our objective was to compare the rate of respiratory complications in patients with COPD with severe aortic stenosis who underwent transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR). Low-to-intermediate surgical-risk patients with moderate or severe COPD who underwent TAVI or SAVR at 2 tertiary centers were included in this study. COPD was defined by the Global Initiative for Chronic Lung Disease classification. The primary end point was the 30-day composite of respiratory mortality, prolonged ventilation (>24 hours), the need for reintubation for respiratory causes, tracheostomy, acute respiratory distress syndrome, pneumonia, or pneumothorax. The inverse probability of treatment weighting was determined to reduce baseline imbalance between the 2 groups. A total of 321 patients (mean age 72.4 ± 9.3 years old, 74.5% male, mean Society of Thoracic Surgeons predicted risk of mortality 3.8 ± 1.9%, mean forced expiratory volume 1: 59 ± 13%) were included in the analysis. TAVI was performed in 122 patients, whereas 199 underwent SAVR. There were no differences between the 2 groups regarding the composite respiratory primary end point (SAVR 10.6%, TAVR 7.4%, adjusted odds ratio 0.57, 95% confidence interval 0.20 to 1.65, p = 0.30). Transfemoral TAVI without general anesthesia (28 patients) was associated with the lowest rate of respiratory complications (3.6%). Among patients with moderate or severe COPD at low-to-intermediate surgical risk, TAVI patients had a similar rate of 30-day major pulmonary complications compared with SAVR patients despite a higher baseline risk profile. Future studies should further investigate whether TAVI is associated with reduced respiratory complications, comparing transfemoral TAVI recipients treated with local anesthesia with their SAVR counterparts.Copyright © 2017 Elsevier Inc. All rights reserved.

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