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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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Impact of severe aortic stenosis treatment strategy in low-risk patients: a propensity matched analysis of surgical aortic valve replacement versus transcatheter aortic valve implantation
Session:
CO1 - Cardiologia de Intervenção
Speaker:
Catarina Brízido
Congress:
CPC 2019
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Catarina Brízido; Márcio Madeira; João Brito; Mariana Gonçalves; João Carmo; Rui Campante Teles; Tiago Nolasco; José Pedro Neves; Manuel Almeida; Miguel Mendes
Abstract
<p><u>Introduction</u>:</p> <p>Recent studies suggest that transcatheter aortic valve implantation (TAVI) benefits might extend to lower risk populations. Our goal was to compare the impact of treatment strategy selection in a low-risk severe aortic stenosis (AS) population.</p> <p><u>Methods</u>:</p> <p>Single-center retrospective study which screened patients undergoing intervention from June/2009 to July/2016 (682 isolated aortic valve replacement (AVR) patients)) and from June/2009 to July/2017 (400 TAVI patients). Low-risk was defined as EuroScore II (ESII) < 4% for single non-CABG procedure. After excluding patients with ESII ≥ 4%, previous cardiac surgery and/or undergoing pre-treatment percutaneous coronary intervention, 544 AVR and 119 TAVI patients were included.</p> <p>TAVI patients were propensity score paired in a 1:1 ratio with a group of AVR patients, matched by age, NYHA class, DM, COPD, AF, creatinine clearance and LVEF < 50% (mean standardized difference <10% for matching variables). Outcomes were adjudicated according to VARC2 criteria.</p> <p><u>Results</u></p> <p>A total of 158 patients (79 AVR and 79 TAVI) were analyzed (mean age 79 ± 6 years, 79 men). The 30-day mortality was 2.5% (n=2 in each group) and there were no differences in in-hospital complications. At median follow-up of 3.8 years (IQR 2.1-6.1), 67 deaths occurred – 39 on the AVR group and 28 on the TAVI group, and treatment strategy did not influence all-cause mortality (HR 0.97, 95%CI 0.60-1.60, log rank p=0.92) – figure 1. By multivariate analysis, need for dialysis during hospitalization remained the only independent predictor of all-cause mortality (adjusted HR 6.40, 95%CI 1.57-28.14, p=0.01).</p> <p><u>Conclusion</u>:</p> <p>In this low-risk AVR population, treatment strategy did not influence mortality neither complications. These results suggest that both options are safe for low-risk patients, even though Heart Team remains essential to contemplate other variables that might alter patient management.</p>
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