Preoperative pulmonary function tests predict mortality after surgical or transcatheter aortic valve replacement

Area of Science:

• Cardiology
• Pulmonology
• Thoracic Surgery

Background:

• Aortic stenosis (AS) is a significant cardiovascular condition requiring aortic valve replacement (AVR).
• Preoperative risk stratification is essential for optimizing outcomes in patients undergoing AVR.
• The role of pulmonary function tests (PFTs) in evaluating lung disease severity and its impact on AVR outcomes remains under investigation.

Purpose of the Study:

• To determine the role of preoperative PFTs in patients with AS undergoing AVR.
• To evaluate the association between lung disease severity and 1-year mortality in this patient population.
• To assess whether PFTs should be routinely integrated into the risk stratification for AVR.

Main Methods:

• A cohort of 535 patients with AS who underwent AVR (TAVR or SAVR) between 2008 and 2013 were analyzed.
• Preoperative PFTs were used to assess lung disease severity based on STS definitions.
• The association between lung disease and 1-year mortality was evaluated, considering factors like smoking history and clinical suspicion of lung disease.

Main Results:

• 35% of patients without suspected lung disease exhibited moderate/severe lung disease on PFTs.
• 1-year mortality increased significantly with lung disease severity (12% no lung disease to 31% severe lung disease).
• Moderate/severe lung disease was an independent predictor of increased 1-year mortality (aHR 2.07; P = .002) regardless of AVR type or smoking history.

Conclusions:

• Pulmonary function tests are valuable for identifying lung disease in AS patients undergoing AVR, even when not clinically suspected.
• Lung disease severity, as determined by PFTs, significantly influences the STS risk score.
• Moderate/severe lung disease is an independent predictor of mortality after AVR, supporting routine PFT use in risk stratification.