Preoperative pulmonary function tests predict mortality after surgical or transcatheter aortic valve replacement Read at the 95th Annual Meeting of the American Association for Thoracic Surgery, Seattle, Washington, April 25-29, 2015.

Matthew C. Henn, Alan Zajarias, Brian R. Lindman, Jason W. Greenberg, Spencer J. Melby, Nishath Quader, Anna M. Vatterott, Cassandra Lawler, Marci S. Damiano, Eric Novak, John M. Lasala, Marc R. Moon, Jennifer Lawton, Ralph J. Damiano, Hersh S. Maniar

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)578-586e2
JournalJournal of Thoracic and Cardiovascular Surgery
Volume151
Issue number2
DOIs
StatePublished - Feb 1 2016
Externally publishedYes

Fingerprint

Respiratory Function Tests
Lung Diseases
Mortality
Aortic Valve
Aortic Valve Stenosis
Transcatheter Aortic Valve Replacement
Smoking
Social Adjustment
Bronchodilator Agents
Surgical Instruments

Keywords

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

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Preoperative pulmonary function tests predict mortality after surgical or transcatheter aortic valve replacement Read at the 95th Annual Meeting of the American Association for Thoracic Surgery, Seattle, Washington, April 25-29, 2015. / Henn, Matthew C.; Zajarias, Alan; Lindman, Brian R.; Greenberg, Jason W.; Melby, Spencer J.; Quader, Nishath; Vatterott, Anna M.; Lawler, Cassandra; Damiano, Marci S.; Novak, Eric; Lasala, John M.; Moon, Marc R.; Lawton, Jennifer; Damiano, Ralph J.; Maniar, Hersh S.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 151, No. 2, 01.02.2016, p. 578-586e2.

Research output: Contribution to journalArticle

Henn, Matthew C. ; Zajarias, Alan ; Lindman, Brian R. ; Greenberg, Jason W. ; Melby, Spencer J. ; Quader, Nishath ; Vatterott, Anna M. ; Lawler, Cassandra ; Damiano, Marci S. ; Novak, Eric ; Lasala, John M. ; Moon, Marc R. ; Lawton, Jennifer ; Damiano, Ralph J. ; Maniar, Hersh S. / Preoperative pulmonary function tests predict mortality after surgical or transcatheter aortic valve replacement Read at the 95th Annual Meeting of the American Association for Thoracic Surgery, Seattle, Washington, April 25-29, 2015. In: Journal of Thoracic and Cardiovascular Surgery. 2016 ; Vol. 151, No. 2. pp. 578-586e2.
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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.",
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AU - Henn, Matthew C.

AU - Zajarias, Alan

AU - Lindman, Brian R.

AU - Greenberg, Jason W.

AU - Melby, Spencer J.

AU - Quader, Nishath

AU - Vatterott, Anna M.

AU - Lawler, Cassandra

AU - Damiano, Marci S.

AU - Novak, Eric

AU - Lasala, John M.

AU - Moon, Marc R.

AU - Lawton, Jennifer

AU - Damiano, Ralph J.

AU - Maniar, Hersh S.

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N2 - 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.

AB - 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.

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KW - aortic valve replacement

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KW - pulmonary function tests

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