Cardiovascular Diseases and Cardiac Surgery

Overview

Juan A. Crestanello, M.D., is a cardiovascular surgeon and department chair of Cardiovascular Surgery at Mayo Clinic in Rochester, Minnesota. Dr. Crestanello, who specializes in surgery for valvular heart disease, discusses the interaction of FEV1 and NT-Pro-BNP with outcomes after transcatheter aortic valve replacement.

JUAN A. CRESTANELLO: Welcome to the Cardiovascular Surgery Series, where I discuss the latest research in cardiovascular surgery from the Mayo Clinic. I will discuss today the interaction of FEV1 and NT-Pro-BNP with outcomes after transcatheter aortic valve replacement.

Chronic Lyme disease is common in patients treated with TAVR. Relieving the aortic stenosis in patients with severe chronic Lyme disease may not provide symptomatic improvement, improvement in the quality of life, or long-term survival benefit in those patients. In this study, we use the interaction of FEV1, a marker of severity of lung disease, and NT-Pro-BNP, a marker of myocardial dysfunction, to identify patients with aortic stenosis and chronic Lyme disease who will have limited benefit from TAVR.

We analyzed 871 patients with aortic stenosis and stratified them based on a FEV1 greater or smaller than 60% of predicted and NT-Pro-BNP greater or smaller of 1,600, which was the median for the study population.

Groups A and B had mild chronic lung disease, and Group C and D had moderate or severe chronic lung disease. Patients in Group A had the lowest risk profile and the best long-term survival. On the other hand, patients in Group D had the highest risk profile and the lowest long-term survival. 13% of those patients were alive at five years, and 25% of those patients had no symptomatic improvement.

We conclude that the combination of FEV1 and NT-Pro-BNP is 35 patients in four groups with distinct risk profile and clinical outcomes. Patients with lower FEV1 and high NT-Pro-BNP had increased comorbidities, poor functional outcomes, and decreased long-term survival. These patients had limited clinical benefit from TAVR. Thank you for listening to the Cardiovascular Surgery Series.