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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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0 Topics
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
G. Aortic Disease, Peripheral Vascular Disease, Stroke
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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
37. Miscellanea
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Impact of paravalvular regurgitation in morbimortality of patients undergoing Transcatheter Aortic Valve Implantation
Session:
Posters 2 - Écran 07 - Doença Valvular
Speaker:
Alzira Maria Freitas Nunes
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:
Posters
FP Number:
---
Authors:
Alzira Nunes; Sofia Torres; Marta Braga; Paulo Maia Araújo; Joana Duarte Rodrigues; Roberto Pinto; Rui Rodrigues; Pedro Bernardo Almeida; Domingos Magalhães; JOAO SILVA; Maria Júlia Maciel Barbosa
Abstract
<p>Introduction: Transcatheter aortic valve implantation (TAVI) has emerged as an alternative therapeutic intervention with superior hemodynamic performance for patients with severe, symptomatic aortic stenosis who are at high risk for surgical aortic valve replacement (SAVR). Nevertheless, there are some concerns regarding safety aspects of the procedure such as paravalvular regurgitation (PVR). Although the incidence of significant PVR has declined dramatically with the advent of newer-generation prosthetic valves, mild PVR remains common and its clinical impact has been inconsistent. Purpose: To assess the impact of PVR after TAVI on morbimortality during hospitalization and follow-up. Methods: We retrospectively evaluated patients (pts) who were submitted to TAVI in a tertiary care center between October 2014 and December 2016. PVR was assessed at the end of the procedure with aortography. Clinical and laboratorial data were evaluated. Results: A total of 89 pts, of whom 51.7% (n=46) were female, with a mean age of 80.2±7.1 years, were included. All pts had symptomatic severe aortic stenosis prior to TAVI. The median EuroSCORE II was 4,5% (0.8-25.9). The implanted valves were: CoreValve Evolut – 67 pts (75.3%), CoreValve – 16 pts (18%), CoreValve Portico – 3 pts (3.4%) and LOTUS Edge Valve System – 3 pts (3.4%). The vascular access was: femoral – 84 pts (94.4%); transaortic – 2 pts (2.2%) and subclavian – 3pts (3.4%). Postprocedural PVR was present in 46 pts (51.7%), mostly of mild degree (44 pts), moderate degree in 2 pts and severe in none. There was a tendency for higher incidence of PVR in the CoreValve Portico valves (100%) comparing to the remaining: CoreValve – 62.5%; CoreValve Evolute - 47.8%; Lotus Valve – 33.3% (p=0.22). The incidence of PVR was not significantly different between the vascular accesses: femoral - 51.2%; transaortic – 50%; subclavian – 66.7% (p=0.87). Comparing pts with and without PVR, the mean of length of stay (13 vs 15 days; p=0.56) and the incidence of complications (65.2% vs 67.5%; p=0.82) were similar. Only one patient had in-hospital mortality (no PVR). One year after discharge, pts with or without PVR had similar: rates of NYHA class ≥ II (36.6% vs 43.2%; p=0.5), hospitalizations for cardiovascular (CV) causes (15.2% vs 12.2%; p=0.68) and CV mortality (4.3% vs 2.4%; p=0.63). Conclusion: Our study did not show an increase in morbimortality associated with PVR after TAVI. However, we believe that every effort should be made in order to reduce the incidence of this clinical problem.</p>
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