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Prognostic impact of pulmonary diseases in the results of Transcatheter Aortic Valve Implantation
Session:
Posters 3 - Écran 04 - Cardiologia de Intervenção
Speaker:
Paulo Maia Araújo
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:
Paulo Maia Araújo; Marta Braga; Sofia Torres; Alzira Nunes; Roberto Pinto; Joana Duarte Rodrigues; Rui Rodrigues; Pedro Bernardo Almeida; Manuel Campelo; JOAO SILVA; Maria Júlia Maciel Barbosa
Abstract
<p><strong>Introduction: </strong>Transcatheter aortic valve implantation (TAVI) is an effective treatment for patients (pts) with symptomatic severe aortic stenosis, considered at high surgical risk. Pulmonary disease (PD) is frequent in these pts and can have a post procedural impact on morbi/mortality.</p> <p><strong>Purpose: </strong>To evaluate the impact of PD in complications, mortality, functional capacity and improvement of symptoms after TAVI.</p> <p><strong>Methods: </strong>Retrospective analysis of pts submitted to TAVI in a tertiary care center (October 2014 to December 2016). Clinical, laboratorial and spirometric data were evaluated. All pts had symptomatic severe aortic stenosis prior to the procedure and the decision for referral for TAVI was made by a multidisciplinary <em>Heart Team</em>. PD was defined as the presence of a previous diagnosis of obstructive (COPD, asthma) and/or restrictive pulmonary disease or a significant airway obstruction/restriction in spirometry.</p> <p><strong>Results: </strong>A total of 89 pts were submitted to TAVI during the referred time period. The mean age was 80.2±7.1 years and 51.7% (n=46) were female. Seventeen pts (19.1%) had PD and in 35.3% of these, PD was the main reason for referral to TAVI, instead of surgery. PD was classified (according to the Chronic Lung Disease classification in the STS score) as: mild in 64.7%, moderate in 23.5% and severe in 11.8%. Baseline NYHA class was similar between patients with/without PD: II – 52.9% vs 59.7% ; III – 47.1% vs 37.5%; IV – 0% vs 2.8% (p=0.64). The mean EuroSCORE II was significantly higher in pts without PD (6.2% vs 3.5%; p=0.05), but the mean age was similar (PD – 77.3 y; no PD – 80.9 y; p=0.48).</p> <p>During hospitalization, the median stay was similar (PD – 15.2 vs no PD - 14.4 days; p= 0.94). The incidence of complications was tendentially higher in pts without PD (70.8% vs 47.1%), although not significant (p=0.06). Only one patient had in-hospital mortality (no PD).</p> <p>At 6-month after discharge, mean BNP was similar between groups (PD: 351 vs no PD: 395 pg/ml; p=0.67), but LVEF was significantly higher in pts with PD (64% vs 51%; p=0.05).</p> <p>At the end of a mean follow-up time of 386±93 days after discharge, PD pts referred significantly lower rates of functional capacity improvement (50.0% vs 87.5%; p<0.01) and higher rates of NYHA class ≥ 2 (85.7% vs 29.7%; p<0.01).</p> <p>Hospitalizations were tendentially higher in PD pts (47.1% vs 24.3%), although not significant (p=0.06). Cardiovascular mortality and all-causes mortality were similar (PD: 0% vs no PD: 4.3%, p=0.39; PD: 11.8% vs no PD: 5.7%, p=0.38).</p> <p><strong>Conclusion: </strong>Pts with PD have similar results in morbi-mortality during hospitalization and in mortality during follow-up. However, one year after the procedure, the PD group has a higher proportion of pts remaining symptomatic and with less improvement in functional capacity. Therefore, in this population, PD has a negative prognostic impact on morbidity after TAVI.</p>
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