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Impact of TAVI referral reasons on morbimortality during hospitalization and follow-up
Session:
Posters 3 - Écran 04 - Cardiologia de Intervenção
Speaker:
Sofia Torres
Congress:
CPC 2018
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Posters
FP Number:
---
Authors:
Sofia Torres; Alzira Nunes; Paulo Araújo; Marta Braga; Roberto Pinto; Joana Duarte Rodrigues; Rui Rodrigues; JOAO SILVA; Domingos Magalhães; Mariana Vasconcelos; Pedro Bernardo Almeida; Maria Júlia Maciel Barbosa
Abstract
<p><strong>Introduction </strong>Transcatheter aortic valve implantation (TAVI) has emerged as a safe alternative to surgical aortic valve replacement (SAVR) for prohibitive or high-risk surgical patients (pts) with severe aortic stenosis. There are several reasons for referring patients for TAVI, which are often interconnected and related to the advance aged group of patients in which this valvulopathy is commonly diagnosed.</p> <p><strong>Purpose </strong>To describe the main reasons for referring a patient for TAVI instead of conventional surgery, and to assess their impact on morbimortality during hospitalization and follow-up.</p> <p><strong>Methods </strong>We retrospectively evaluated pts who were submitted to TAVI in our tertiary care center between October 2014 and December 2016. Clinical and laboratorial data were evaluated.</p> <p><strong>Results </strong>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 main reasons for referral for TAVI were: porcelain aorta (PA) (n= 47; 52.8%); severe pulmonary disease (PD) (n= 6; 6.7%); frailty (Fr) (n= 5; 5.6%); prior cardiac surgery (CS) (n= 4; 4.5%); high surgical risk based on other major comorbidities (HSR) (n=27; 30.3%).</p> <p>During hospitalization, the median stay was similar (PA – 8 days; HSR – 12; PD – 10; Fr – 14; CS – 11; p= 0.60). The incidence of complications was higher in the Fr group (100%), compared to the remain (PA – 63.8%; HSR – 74.1%; PD – 33.3%; CS – 50%), although not significant (p=0.10). Only one patient had in-hospital mortality (HSR).</p> <p>Pts were followed up in cardiology appointments during a mean time of 386±93 days. During this period, pts with PD had significantly higher rates of NYHA class ≥ II: 100% (PA – 34.9%; HSR – 40.9%; Fr – 25.0%; CS –25.0%) (p<0.01). Hospitalization rates were similar between groups (PA – 23.9%; HSR – 30.8%; PD – 33.3%; Fr – 20%; CS – 75%; p=0.29). All-cause mortality was higher in the PD (16.7%) and HSR (15.4%) groups (PA – 2.2%; Fr – 0%; CS – 0%), but cardiovascular deaths occurred only in the HSR group (11.5%).</p> <p><strong>Conclusion: </strong>Based on our results, the presence of severe pulmonary disease has a negative impact on patient outcome after TAVI, as seen by the higher rates of NYHA class ≥ II on follow-up and higher all-cause mortality. On the other hand, cardiovascular mortality was verified in pts referred for TAVI due to high surgical risk based on other major comorbidities.</p>
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