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CPC 2018
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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
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A single centre experience with the Trifecta® bioprothesis for aortic valve replacement
Session:
Posters 1 - Écran 04 - Cirurgia Cardíaca
Speaker:
João Pedro Monteiro
Congress:
CPC 2018
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
26. Cardiovascular Surgery
Subtheme:
26.2 Cardiovascular Surgery – Valves
Session Type:
Posters
FP Number:
---
Authors:
João Pedro Monteiro; Diogo Rijo; Sara Simoes Costa; Rodolfo Pereira; Ricardo Ferraz; Luís Vouga; Miguel Guerra
Abstract
<p>Introduction and objectives</p> <p> </p> <p>Bioprosthesis are increasingly used for aortic valve replacement (AVR), as a result of increasing elderly patients, as well as, continuous improvements in durability and hemodynamic performance of pericardial prosthesis. The Trifecta<sup>®</sup> aortic prosthesis is a latest-generation trileaflet stented pericardial valve designed for supra-annular placement in the aortic position. This study establishes the safety and early clinical and hemodynamic performance of the Trifecta<sup>®</sup> valve.</p> <p> </p> <p>METHODS:</p> <p> </p> <p>We retrospectively analyzed the data of 373 consecutive patients that underwent surgical implantation of the pericardial stented aortic prosthesis (Trifecta<sup>®</sup> valve; St Jude Medical, St Paul, Minn) at our institution from March 2014 (first implant) to March 2017 (3 years). Pre-operative, operative and post-operative parameters and clinical outcomes, as well as, echocardiography data were evaluated.</p> <p> </p> <p>RESULTS:</p> <p> </p> <p>The mean age was 73,96 years ± 51. 176 patients (47,18%) were male, the mean body mass index was 28,14 ± 12 and 75 pateints (20,11%) were ³80-years old. Concomitant procedures were performed in 123 patients (32,98%). Isolated AVR was undertaken through conventional sternotomy (88,26%), partial sternotomy (10,87%) or anterior right minithoracotomy (0,87%). Prosthesis sizes implanted were: 19 mm (n=37), 21 mm (n=138), 23 mm (n=196) and 25 mm (n=2). </p> <p>The overall follow-up included 669 late patient-years. Early (≤ 30 day) mortality occurred in 20 patients (5.36%), and there were 4 late (≥ 31 days) deaths (1.07%) yielding a linearized mortality rate of 2.98% per late patient-year. For isolated AVR, mortality occurred in 12 patients (3.22%). </p> <p>The incidence of new onset atrial fibrillation/flutter was of 28.95% (n=108) and five patients (1,34%) had necessity for implantation of postoperative permanent pacemaker. Four cases (1.07%) of mediastinitis/sternal dehiscence and thirty nine cases (10.46%) of major bleeding required surgery</p> <p>There were 2 (0,54%) early thromboembolic events, including 1 (0,27%) stroke and 1 (0,27%) systemic embolic event. There were no instances of early valve thrombosis, endocarditis, or clinically significant haemolysis. There were no late thromboembolic events or valve structural deterioration. In total, there was 1 (0,27%) late valve explant due to an endocarditis. Overall, freedom from valve explant was 99,77% per late patient-year.</p> <p>At postoperative echocardiography, average mean gradients across all valve sizes was 10.63mmHg. Mean follow-up was 4± 2 months. No severe aortic regurgitation was observed.</p> <p>CONCLUSION:</p> <p>The present systematic review demonstrated that AVR with this prosthesis provided excellent early safety and hemodynamic outcomes with acceptable mean gradients. Nevertheless, their timing, pathological characteristics, and clinical presentation mandate continued follow-up.</p>
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