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Challenges and Outcomes of Aortic Valve Intervention: Insights from a Single-Center Study on Severe High-Gradient Aortic Stenosis
Session:
SESSÃO DE POSTERS 34 - TAVI 2
Speaker:
Mariana Duarte Almeida
Congress:
CPC 2025
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
26. Cardiovascular Surgery
Subtheme:
26.2 Cardiovascular Surgery – Valves
Session Type:
Cartazes
FP Number:
---
Authors:
Mariana Duarte Almeida; Oliver Correia Kungel; Francisco Rodrigues Santos; João Gouveia Fiuza; Gonçalo Marques Ferreira; Nuno Craveiro
Abstract
<p><span style="font-size:12px">Introduction: Severe high-gradient aortic stenosis (AS) is a life-threatening condition associated with a life expectancy of less than 2 years if symptomatic and untreated. </span><span style="font-size:12px"><span style="font-family:Aptos,sans-serif"><span style="color:#000000">Treatment options include surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). However, a growing disparity between the number of pts requiring intervention and healthcare system capacity has led to prolonged waiting lists. The Portuguese Society of Cardiology recommends that high-priority pts undergo intervention within 2 weeks of being added to the surgical list and priority pts within 6 weeks.</span></span></span></p> <p style="text-align:start"><span style="font-size:12px"><span style="font-family:Aptos,sans-serif"><span style="color:#000000">Purpose: This study aimed to characterize pts referred for aortic valve intervention at our center, analyze the referral process, and outcomes of pts on the waiting list.</span></span></span></p> <p style="text-align:start"><span style="font-size:12px"><span style="font-family:Aptos,sans-serif"><span style="color:#000000">Methods: Pts who underwent transthoracic echocardiography between January and September 2022 with documented severe high-gradient AS and referred for intervention were included. Demographic and clinical data were collected. Adverse outcomes were defined as all-cause mortality, unplanned hospitalizations, or emergency visits due to significant cardiovascular symptoms or events within 1 year after the initial evaluation or until the intervention, if performed within 1 year. Group-wise comparisons were performed using Independent t-tests.</span></span></span></p> <p style="text-align:start"><span style="font-size:12px"><span style="font-family:Aptos,sans-serif"><span style="color:#000000">Results: Of 85 identified pts, 65 were referred for intervention, of those 50.8% females, with a mean age of 74.4 ± 8.3 years (58–89). Among these, 50.8% underwent SAVR, 29.2% underwent TAVI, 12.3% remained on the waiting list at december 15th 2024, 3.1% died while awaiting intervention, 3.1% declined intervention, and 1.5% was deemed unsuitable for interventional treatment. </span></span>Twenty patients (32.8%) initially proposed for SAVR were later redirected to TAVI by the surgical team. </span><span style="font-size:12px"><span style="font-family:Aptos,sans-serif"><span style="color:#000000">The mean time from the first surgical evaluation to intervention was 9.3 ± 6.5 months (1-30). Time to intervention was significantly longer for TAVI compared to SAVR (13.0 ± 8.7 vs. 7.4 ± 4.0 months, p=0.001) and for pts whose initial treatment strategy was modified to TAVI compared to those whose initial strategy was followed (16.0 ± 7.9 vs. 7.2 ± 4.2 months, p<0.001). Adverse outcomes occurred in 23.1% of pts during follow-up. Although time to intervention was longer for pts with adverse outcomes (9.6 ± 5.8 months) than for those without (9.2 ± 6.7 months), this difference was not significant (p=0.432).</span></span></span></p> <p style="text-align:start"><span style="font-size:12px"><span style="font-family:Aptos,sans-serif"><span style="color:#000000">Conclusion: Waiting times for valve intervention in severe AS at our center far exceed the recommendations of scientific societies, highlighting the need for optimization of patient pathways and priorization, particularly for TAVI. Despite the high rate of adverse outcomes, longer waiting times were not significantly associated with increased events. This study underscores the importance of adequate referral and multidisciplinary discussion to address delays caused by changes in therapeutic strategy.</span></span></span></p>
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