Risk of aortic valve replacement in patients with aortic stenosis and chronic obstructive pulmonary disease

Background and aim of the study: Patients with aortic stenosis (AS) and chronic obstructive pulmonary disease (COPD) have been considered at high risk for aortic valve replacement (AVR), which results in some patients being denied this life-saving operation. Hence, the study aim was 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 retrospective cohort of patients had documented COPD (FEV₁/FVC <70%), and underwent isolated AVR for severe AS between 1993 and 2007 at the Mayo Clinic in Rochester, MN. Results: Of the 68 patients who met the study criteria, 27 had mild/moderate COPD (FEV ₁ >50%), 35 had severe COPD (FEV₁ 30-50%), and six had very severe COPD (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 h for mild/moderate versus 115 h for severe/very severe: p = 0.02), but did not influence the operative or 30-day mortalities. Female gender was associated with an increased length of hospital stay. Long-term mortality was significantly higher in patients with a history of cerebrovascular disease (HR 4.3, p <0.001), NYHA class III or IV heart failure (class III HR 2.79, p = 0.05; class IV HR 3.97, p = 0.03), and increased age (HR 1.06, p = 0.003). The severity of COPD was an independent risk factor for long-term mortality. Conclusion: 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 an increased in-hospital or 30-day mortality, but does influence long-term mortality.