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The Journal of Cardiovascular Surgery 2019 June;60(3):413-21

DOI: 10.23736/S0021-9509.19.10747-1

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Chronic obstructive pulmonary disease is not associated with worse in-hospital outcomes after surgical aortic valve replacement in Spain (2001-2015)

Javier DE MIGUEL-DÍEZ 1, Ana LÓPEZ-DE-ANDRÉS 2 , Valentín HERNÁNDEZ-BARRERA 2, José M. DE MIGUEL-YANES 3, Manuel MÉNDEZ-BAILÓN 4, Nuria MUÑOZ-RIVAS 5, Rodrigo JIMÉNEZ-GARCÍA 2

1 Respiratory Department, Faculty of Medicine, Gregorio Marañón University Hospital, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; 2 Unit of Preventive Medicine and Public Health Teaching and Research, Faculty of Health Sciences, Rey Juan Carlos University, Alcorcón, Madrid, Spain; 3 Department of Internal Medicine, Faculty of Medicine, Gregorio Marañón University Hospital, Universidad Complutense de Madrid (UCM), Madrid, Spain; 4 Department of Internal Medicine, Faculty of Medicine, San Carlos University Hospital, Universidad Complutense de Madrid (UCM), Madrid, Spain; 5 Department of Medicine, Infanta Leonor University Hospital, Madrid, Spain



BACKGROUND: The aims of this study were: 1) to examine incidence, characteristics and in-hospital outcomes of surgical aortic valve replacement (SAVR) among patients with or without COPD; 2) to compare both groups matched by sex, age, year hospitalized for SAVR and implanted valve type; and 3) to identify factors associated with in-hospital mortality (IHM) among chronic obstructive pulmonary disease (COPD) patients.
METHODS: We used the Spanish National Hospital Discharge Database for patients aged ≥40 years from 2001 to 2015. We selected patients whose medical procedures included SAVR. We grouped hospitalizations by COPD status. Main outcomes were incidences and IHM. Covariates included comorbidities and concomitant procedures.
RESULTS: We identified 78,223 hospitalizations with SAVR and COPD accounted for 9.14% (6028 men and 1125 women). Incidence of hospitalizations for SAVR increased overtime in patients without COPD, but not in COPD sufferers. COPD patients were more likely to receive bioprosthetic valves than those without COPD. The proportion of mechanical valves implanted decreased as the bioprosthetic valves increased overtime in both groups. Crude IHM was 6.77% for COPD patients and 6.48% for non-COPD (P=0.17). IHM decreased significantly over time in both groups of patients. After matching no differences were found in IHM between COPD and matched not-COPD patients who received a mechanical or bioprosthetic SAVR. Among COPD patients, IHM was associated with older age, more comorbidities and concomitant coronary artery bypass graft.
CONCLUSIONS: Our analysis suggest that COPD per se should not represent a contraindication to SAVR. No differences were found for IHM between patients with and without COPD beside the type of valve used.


KEY WORDS: Pulmonary disease, chronic obstructive; Aortic valve; Hospital mortality

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