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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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TAVI fast track protocol: a propensity matching analysis of in-hospital and post-discharge results
Session:
CO1 - Cardiologia de Intervenção
Speaker:
Afonso Félix Oliveira
Congress:
CPC 2019
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.4 Interventional Cardiology - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Afonso Félix De Oliveira; Rui Campante Teles; João Brito; Luís Raposo ; Pedro de Araújo Gonçalves; Henrique Gabriel; Mariana Gonçalves; António Tralhão; Marisa Trabulo; Jorge Santos Ferreira; Manuel Almeida; Miguel Mendes
Abstract
<p><strong>Introduction: </strong>Prolonged hospitalization after transcatheter aortic valve implantation (TAVI) may decrease autonomy and increase frailty in elderly patients. “Fast track” protocols aim to optimize resources and promote early recovery after uncomplicated transfemoral TAVI by minimizing femoral vascular access use, promoting early mobilization and using continuous remote EKG monitoring instead of formal Holter exam.</p> <p><strong>Methods:</strong> We performed a longitudinal retrospective cohort analysis of transfemoral-TAVI cases between Jan-2016 and Jun-2018. The “fast track” protocol was performed in all eligible patients after Jan-2018. Patients with major vascular/bleeding complications, invasive ventilation/general anaesthesia or valve-in-valve procedures were not eligible and were excluded. A 1:1 propensity matching analysis was performed to adjust for baseline characteristics (age, gender, EuroScore II (ESII), LVEF, previous pacemaker, valve type and NT-proBNP). The primary outcome was TAVI-to-discharge time and the secondary outcome was mortality at 30-days.</p> <p><strong>Results:</strong> 100 matched patients were included in the study. Mean age was 84 ± 0.9 years in the control group and 83 ± 0.5 years in the fast track group (p = n.s.). ESII was 5.2% ± 0.4 in the control group and 4.8% ± 0.5 in the fast track group (p = n.s.). NT-proBNP was 3283 ± 752 pg/mL in the control group and 4087 ± 926 pg/mL in the fast track group (p = n.s.). Glomerular filtration rate was also non-significant between control and fast-track group (45.8 ± 2.88 vs 46.3 ± 2.4 , p < 0.05). Pre-procedure, 16% (n = 4) in control vs 8% (n = 8) in the fast track cohort had a permanent pacemaker (p = n.s.). During hospital stay, 69% (n = 29) vs 26% (n = 12) performed an Holter exam in control and fast track group respectively (p < 0.05), while in-hospital pacemaker implantation rate was not statistically different (23.8% n = 10 vs 21.7% n = 10). The primary endpoint of TAVI-to-discharge time was significantly higher in the control group in comparison to the fast track patients (6.6 ± 0.6 vs 3.9 ± 0.3, p < 0.05). The secondary endpoint of mortality at 30-days was similar between groups, without any event recorded in either group.</p> <p><strong>Conclusions:</strong> A fast track protocol in TAVI procedures is feasible, effective and shortens hospitalization. Further investigation is needed to address long-term effects of such strategy.</p>
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