2. Transcatheter aortic valve replacement (tAVR) are emerging as a viable treatment option for severe aortic stenosis in patients with significant co-morbidities. The purpose of this study is to determine the outcomes of high-risk patients with aortic stenosis and COPD. Between November 2007 and June 2012, 266 patients have been implanted with a TAVR at Penn as part of the PARTNER Trial. All patients undergo a complete comorbid workup, which includes echocardiogram, heart catheterization, PFTs, and a 6 minute walk test. 205 patients had no COPD *(STS definition: mild/no COPD) 61 patients had COPD *(STS definition: moderate to severe COPD) None Mild: FEV1 60% to 75% of predicted, and/or on chronic inhaled or oral bronchodilator therapy. Moderate: FEV1 50% to 59% of predicted, and/or on chronic steroid therapy aimed at lung disease. Severe: FEV1 50.

3. No COPD (n=205) COPD (n= 61) P-Value Age83.95 ± 6.7181.52 ± 8.10.060 Male108 (53%)30 (49%)0.663 Race - white199 (97%)57 (93%)0.244 STS Score11.18 ± 4.112.13 ± 3.790.033 Avg BNP3759.153932.740.914 No COPD (n=205) COPD (n= 61) P-Value HTN187 (91%)54 (89%)0.617 CV Disease66 (32%)21 (34%)0.758 Diabetes76 (37%)19 (31%)0.448 Renal Failure20 (10%)8 (13%)0.478 Prior MI47 (23%)13 (21%)0.863 PAD95 (46%)30 (49%)0.771 No COPD (n=205) COPD (n= 61) P-Value FVC2.31 ± 0.731.98 ± 0.810.005 % Pred FVC93% ± 29%75% ± 32% <0.001 FEV11.72 ± 0.571.29 ± 0.610.138 % Pred FEV194% ± 31%66% ± 30% <0.001 FEV1/FVC0.75 ± 0.150.67 ± 0.17 <0.001 No COPD (n=205) COPD (n= 61) P-Value PA Systolic47.75 ± 16.0350.12 ± 15.230.151 PA Diastolic19.49 ± 8.1521.98 ± 8.20.019 PCWP20.41 ± 9.9921.88 ± 7.30.096 LVEDP17.91 ± 8.2322.38 ± 7.510.001

4. No COPD (n=205) COPD (n= 61) P-Value Class NYHA I/II2 (1%)1 (2%)0.544 NYHA III/IV203 (99%)60 (98%)0.544 Echo EF57.53 ± 15.4257.06 ± 16.470.936 Peak79.76 ± 7.7382.18 ± 20.290.423 Mean48.1 ± 13.4548.00 ± 12.630.949 AI1.60 ± 1.061.21 ± 1.160.020 6MWT Meters133.84 ± 101.63119.231 ± 80.23 0.365 # of pts unable34 (17%)14 (23%) AI classified as 0 = None, +1 trace, +2 mild, +3 mod, +4 severe

5. No COPD (n=158) COPD (n= 50) P-Value Class NYHA I/II152 (96%)42 (84%)0.0016 NYHA III/IV4 (4%)8 (16%)0.0016 Echo EF60.42 ± 11.8459.22 ± 12.130.601 Peak19.58 ± 7.7322.03 ± 10.080.153 Mean10.14 ± 7.7311.55 ± 5.330.122 AI1.35 ± 1.141.13 ± 1.070.203 6MWT n=98n=34 Meters209.65 ± 110.40138.39 ± 74.0 < 0.001 # of pts unable7 (7%)6 (18%) AI classified as 0 = None, +1 trace, +2 mild, +3 mod, +4 severe

6. No COPD (n=146) COPD (n= 47) P-Value Class NYHA I/II133 (91%)40 (85%)0.273 NYHA III/IV13 (9%)7 (15%)0.273 Echo EF61.24 ± 10.7761.72 ± 11.68 0.747 Peak21.07 ± 11.0325.57 ± 10.22 0.003 Mean10.83 ± 13.2713.07 ± 5.72 0.006 AI1.51 ± 1.181.19 ± 1.54 0.106 6MWT* n=123N=39 Meters206.13 ± 115.30169.73 ± 125.910.097 # of pts unable13 (10.5%)8 (21%) AI classified as 0 = None, +1 trace, +2 mild, +3 mod, +4 severe

7. Both cohorts of patients with and without COPD have tolerated TAVR well without significant morbidity and improvement in NYHA class and 6 minute walks. 6 and 12 month echocardiographic and clinical data (including 6 minute walk tests and NYHA classifications) improvements demonstrate TAVR as a viable option for high-risk patients with severe aortic stenosis and COPD. Further investigation with longer follow up will be needed to target this population as we believe COPD is one of the greatest comorbidities that accompany aortic stenosis in these patients. No COPD (n=205) COPD (n= 61) P-Value 1 year Survival 80%92%0.284