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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
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05. Atrial Fibrillation
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
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TAVI: Clinical predictors of mortality and impact of complications
Session:
CO8 - Doença Valvular
Speaker:
Nelson P. Cunha
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:
Nelson P. Cunha; Claudia Jorge; E. Infante de Oliveira; P. Carrilho Ferreira; Miguel Nobre Menezes; Joana Rigueira; Inês Aguiar Ricardo; Tiago Graça Rodrigues; Rafael Santos; Alexandra Lopes; Fausto José Pinto; Pedro Canas Da Silva
Abstract
<p>Introduction: The transcatheter aortic valve implantation (TAVI) is a procedure established in the severe aortic stenosis in patients (pts) of moderate / high surgical risk.</p> <p>Purpose: Determine rates of complications and mortality and to identify predictors of mortality.</p> <p>Methods: Retrospective unicentric study of consecutive pts submitted to TAVI from September 2012 to October 2018. Analyzed demographic, clinical and procedural characteristics. Mortality rate (MR) and the occurrence of early complications (EC) at 30 days and late (LC) (30th day-1st year) were evaluated. We used the chi-square and T-student tests and for determination of predictors, Cox regression analysis was performed.</p> <p>Results: Included 440 pts (55% women, 81 ± 7.1 years), with Euroscore II average of 4.33 ± 3.8% and STS 6.38 ± 5.34%. 35.2% pts had coronary heart disease, diabetes 29%, chronic kidney disease (CKD) 27.9%, peripheral arterial disease (PAD) 13.1% and a history of stroke / TIA 8.7%. MR <30 days was 4.4% (n = 19, 5 intra-procedure deaths); > 30 days and 1 year 10% (n = 44); > 1 year of 29% (n = 129, 9.1% for cardiovascular cause) during a mean follow-up of 660 ± 692 days.</p> <p>The baseline parameters associated with a higher MR were the presence of PAD (X<sup>2</sup> = 6.7, p = 0.012), CKD (X<sup>2</sup> = 10.7;p = 0.001), creatinine (Cr) (1.43 vs 1.25, p = 0.039), NT-proBNP (8150 vs 4384, p = 0.006), quantification of valvular calcium by angioCT (p <0.05), 3mensio (1159 vs 963, p = 0.017)) and Euroscore II and STS (5.16 vs. 4.26%, p = 0.023 and 7.27 vs 5.99%, p = 0.025 respectively). The only independent predictor of mortality was NT-proBNP (p = 0.007, HR 1.15, 95% CI 1.038-1.272), losing statistical significance when adjusted for age, gender, Cr and body mass index (BMI).</p> <p>The most frequent EC were bradydhythmia with implantation of definitive pacing (18.9%, n = 83); stroke / TIA (3.6%, n = 16, major stroke at 8 pts); hemorrhage (18.7%, n = 82, major in 25 pts) and vascular complications (17.5%, n = 77, major in 22 pts).</p> <p>Mortality was associated with acute kidney injury AKIN = 2 (X<sup>2</sup> = 14.7, p = 0.001) or RIFLE=2 (X<sup>2</sup> = 10.3, p = 0.016), major hemorrhage (X<sup>2</sup> = 5.5, p = 0.019), total stroke (X<sup>2</sup> = 8.9, p = 0.003) and major stroke (X<sup>2 </sup>= 19.6, p <0.001). The LC associated with mortality were = moderate mitral regurgitantion (X<sup>2</sup> = 5.4, p = 0.016), hospital readmission (X<sup>2</sup> = 4.4, p = 0.036), and stroke (X<sup>2</sup> = 22.9; p <0.001), with major stroke (p <0.001) being the only independent predictor of mortality.</p> <p>Conclusion: MR in this sample resembled those described in the literature, with PAD, CKD, Cr, NT-proBNP and qVCa associated with higher MR. NT-proBNP was the only predictor of mortality, suggesting a possible benefit in the compensation of heart failure pre-procedure. The rate of complications was lower than that described in the literature, with major stroke the only single independent predictor of mortality, suggesting a need to adopt preventive measures in selected cases with possible impact on survival.</p>
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