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Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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Short and long-term clinical impact of urgent transcatheter aortic valve replacement (TAVR): a propensity-score matched single-centre study
Session:
CO 15 - Prémio Investigação Clínica
Speaker:
Cláudio Guerreiro
Congress:
CPC 2018
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.4 Valvular Heart Disease – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
CM Espada Guerreiro; João Gonçalves Almeida; Daniel Caeiro; Ana Raquel Barbosa; Tiago Dias; Pedro Gonçalves Teixeira; Marisa Passos Silva; Adelaide V. Dias; Marlene Fonseca; Bruno Melica; Alberto Rodrigues; Pedro Braga; Vasco Gama Ribeiro
Abstract
<p><strong>Introduction </strong></p> <p>High risk severe AS patients can present to the emergency department because of acute decompensated heart failure (ADHF). When resistant to medical therapy, it mandates an urgent intervention. Urgent TAVR may be a safe and efficacious approach, but data regarding long-term follow up is missing.</p> <p> </p> <p><strong>Objectives</strong></p> <p>To report our experience with urgent TAVR. To assess the short and long-term clinical impact of urgent TAVR in a propensity-matched population. </p> <p> </p> <p><strong>Methods</strong></p> <p>Retrospective study of 338 severe AS patients submitted to TAVR between 08/2007-10/2016. Urgent TAVR group was defined by: ADHF secondary to severe AS, resistant to medical therapy, with TAVR performed in the same hospital stay. Propensity score matching analyses (2:1 ratio) was performed to adjust for the following baseline variables: gender, EUROscore II, LVEF, NYHA class, coronary artery disease, carotid disease, anemia, atrial fibrillation and type of TAV. </p> <p> </p> <p><strong>Results</strong></p> <p>338 patients were enrolled (age 79.1±7.7 years; 51.5% females; mean EuroScore II 6.2±5.7%). In the majority of patients of both groups, the procedure was performed by femoral access (88%). The following devices were used: self-expandable prosthesis 60% (n=203) and balloon-expandable prosthesis 40% (n=135).</p> <p>The propensity matching analysis identified 146 matched pairs (56 urgent TAVR patients and 90 elective TAVR patients). All patients from both groups sucessfully received a TAVR device. The operators performed less predilatation in the urgent group (42.9 vs 61.9%, p=0.02), with a statistical tendency for more repositioning (5.4 vs 0%, p=0.05), without differences in post-dilatation (21.4 vs 16.9%, p=0.51). The acute device success (urgent 80.4 vs elective 76.7%, p=0.683), and safety (76.8 vs 83.3%, p=0.38) were similar. There was similar procedural mortality (1.8 vs 2.2%, p=0.85). No significant differences were found in post procedural PVL (>mild: 12 vs 10.5%, p=0.33) or in mean gradients (12.3 vs 13.1mmHg, p=0.52). There were more major vascular complications in the urgent group (16.4 vs 6.7%, p=0.02); no differences in AKI (22.6 vs 22%, p=0.92), major bleeding (11.8 vs 12.5%, p=63), cardiogenic shock (7.3 vs 6.7%, p=0.889) or stroke/TIA (8.9 vs 7.9%, p=0.82). The urgent TAVI group had significantly longer hospital stays (16 vs 9 days, p<0.01).</p> <p>30 day all-cause mortality rates were similar (7.1 vs 5.7%, p=0.72), as was cardiovascular mortality and MACE. In a median FUP period of 428 (IQR 210-910) days, overall 36.3% reached the endpoint all-cause mortality and no differences were found between the urgent and the elective matched-TAVR group (log-rank test p=0.616). </p> <p> </p> <p><strong>Conclusions</strong></p> <p>Urgent TAVR procedures were safe and effective in unstable severe aortic stenosis patients. Despite increased major vascular complications and hospitalization time, appropriately selected urgent TAVR patients had similar short and above one year safety profiles.</p>
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