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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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A. Basics
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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
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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
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Mid and long-term Survival predictive factors after Transcatheter Aortic Valve Implantation
Session:
CO8 - Doença Valvular
Speaker:
Tânia Branco Mano
Congress:
CPC 2019
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.4 Valvular Heart Disease – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Tânia Branco Mano; Lino Patrício ; Dra. Inês Rodrigues; Tiago Mendonça; Ana Abreu; Duarte Cacela; Ruben Ramos; Hagen Kahlbau; Isabel Fragata; Rui Cruz Ferreira; José Fragata
Abstract
<p>Background: Transcatheter aortic valve implantation (TAVI) has expanded exponentially becoming a therapeutic option for intermediate and high-risk aortic stenosis patients. However, inoperable and high risk patients are still challenging regarding evaluation of TAVI prognostic impact.</p> <p>Objetives: Investigate the predictive factors for survival and survival free of events after TAVI.</p> <p>Methods: Retrospective analysis of consecutive patients (pts) with severe aortic stenosis who underwent TAVI between December 2009 and June 2018 in a single center. Survival and survival free of events at 1month, 1 year after TAVI or last follow-up (FU) were analyzed.</p> <p>Results: 298 pts: mean age 82±6 years,43% male ,mean EuroscoreII 7.4±7 and STSscore 6.6±4.8, 73% in III-IV New York Heart Association Class, 22% with left ventricular ejection fraction (LVEF) <50%. Survival rate during the FU (mean 2.1±1.7years) were 93.6%, 83.9%, 73% and 67.6%, respectively at 1 month, 1,2 and 3 years(Graphic 1a). In univariate analysis, atrial fibrillation (AF)(OR1.866; p=0.003), pulmonary systolic arterial pressure (PSAP)(HZ1.028;p=0.007), right ventricular dysfunction (OR 2.655;p=0.012), anemia (HZ1.706;p=0.016), coronary percutaneous intervention (CPI)(OR1.696;p=0.017), peripheral vascular disease (OR1.731;p=0.018), acute kidney injury (OD 7.792; p=0.02), hypoalbuminemia (HZ 0.890; p=0.029), pulmonary disease (OR 1.635; p=0.030) and higher brain natriuretic peptic (BNP) (HZ 1.001,p=0.039) were predictors of non-survival. In multivariate analysis the predictors were AF (OR2.285, p=0.005), CPI (OR2.308,p=0.006) and lower glomerular filtration rate (GFR)(HZ0.914,p=0.008).In ROC curve analysis, PSAP (AUC0.732,p<0.0001), BNP (AUC0.680,p=0.008), hemoglobin (AUC0.649, p<0.0001), Euroscore II (AUC 0.615,p=0.002), STS score (AUC0.590,p=0.015) and hospitalization length (AUC 0.582,p=0.026) had the strongest impact. The survival free-event rate were 81.4%, 66% and 58.9% at 1, 2 and 3 years (Graphic 1b). In univariate analysis the predictors of events were at 1year and last FU: hospitalization length (p<0.0001;p=0.001), LVEF<40%(p=0.001;p=0.021), anemia(p=0.009;p=0.005), Euroscore II (p=0.023; p=0.005), STS score (p=0.013;p=0.045), lower GFR (p=0.029;p=0.027) and RV dysfunction (p=0.048;p=0.001). In multivariate analysis the predictors of non-survival free events were LVEF<50% (1year OR 2.865 p=0.006;FU:OR 2.493 p=0.014) and hospitalization length (1year: HZ 1.019 p=0.014; FU: 1.104 p=0.027). In ROC curve analysis, hemoglobin level (AUC 0.917, p=0.015) and GFR (AUC 0.875, p=0.29) had the strongest impact on events</p> <p>Conclusion: Favorable long-term outcome after TAVI was demonstrated. Several factors can negatively influence prognosis, mainly atrial fibrillation, coronary artery disease and renal failure. </p>
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