Transcatheter Aortic Valve Replacement Improves the Quality of Life for Patients with Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease (COPD) is a common comorbidity in patients with aortic stenosis and when severe is a surgical aortic valve replacement contraindication. However, the impact of COPD in patients undergoing TAVR is unclear. This study defines TAVR risks/benefits including quality of life, morbidities, and mortality in COPD patients. All patients undergoing TAVR from August 2012 to June 2023 at a single institution were retrospectively reviewed (n = 1565). 1273 patients with preoperative pulmonary function testing were studied. FEV1/FVC and FEV1% predicted were used to separate patients into groups of COPD severity based on the GOLD (Global Initiative for Chronic Obstructive Lung Disease) criteria. Preoperative and postoperative quality of life (QoL) were measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ). Adverse outcomes and mortality at 30-days and 1-year were measured. Severe and very severe COPD patients had significantly higher rates of new onset atrial fibrillation and myocardial infarction compared to patients with no COPD or mild to moderate COPD. There were no statistically significant differences in rates of stroke, permanent pacemaker implantation, 30-day mortality, or 1-year mortality. TAVR improved QoL in all patients regardless of COPD severity or use of home oxygen. Severe COPD patients had the greatest improvement in KCCQ QoL at 30-days and 1-year post-TAVR, while very severe COPD patients had the smallest improvement in KCCQ QoL. Patients with COPD experienced an improvement in quality of life regardless of severity of COPD. Additionally, one year mortality was not significantly different between COPD severity groups. Therefore, TAVR benefits should not be withheld for COPD patients regardless of their severity.