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Background  Chronic obstructive pulmonary disease ( COPD ) patients are at increased risk of respiratory related complications after cardiac surgery. It is unclear whether transcatheter aortic valve replacement ( TAVR ) or surgical aortic valve replacement ( SAVR ) results in favorable outcomes among  COPD  patients.    Methods and Results  Patients were identified from the Nationwide Inpatient Sample database from 2011 to 2014. Patients with age ≥60,  COPD , and either went transarterial  TAVR  or  SAVR  were included in the analysis. A 1:1 propensity‐matched cohort was created to examine the outcomes. A matched pair of 1210  TAVR  and 1208  SAVR  patients was identified. Respiratory‐related complications such as tracheostomy (0.8% versus 5.8%; odds ratio [ OR ], 0.14;  P <0.001), acute respiratory failure (16.4% versus 23.7%;  OR , 0.63;  P =0.002), reintubation (6.5% versus 10.0%;  OR , 0.49;  P <0.001), and pneumonia (4.5% versus 10.1%;  OR , 0.41;  P <0.001) were significantly less frequent with  TAVR  versus  SAVR . Use of noninvasive mechanical ventilation was similar between  TAVR  and  SAVR  (4.1% versus 4.8%;  OR , 0.84;  P =0.41). Non‐respiratory‐related complications, such as in‐hospital mortality (3.3% versus 4.2%;  OR , 0.64;  P =0.035), bleeding requiring transfusion (9.9% versus 21.7%;  OR , 0.38;  P <0.001), acute kidney injury (17.7% versus 25.3%;  OR , 0.63;  P <0.001), and acute myocardial infarction (2.4% versus 8.4%;  OR , 0.19;  P <0.001), were significantly less frequent with  TAVR  than  SAVR . Cost ($56 099 versus $63 146;  P <0.001) and hospital stay (mean, 7.7 versus 13.0 days;  P <0.001) were also more favorable with  TAVR  than  SAVR .    Conclusions   TAVR  portended significantly fewer respiratory‐related complications compared with  SAVR  in  COPD  patients.  TAVR  may be a preferable mode of aortic valve replacement in  COPD  patients.

journal of the american heart association

Is Transcatheter Aortic Valve Replacement Better Than Surgical Aortic Valve Replacement in Patients With Chronic Obstructive Pulmonary Disease? A Nationwide Inpatient Sample Analysis