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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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32. Cardiovascular Nursing
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Percutaneous vs surgical paravalvular leak: a ten years tertiary centre experience
Session:
Posters 2 - Écran 4 - Intervenção / Cirurgia Cardíaca
Speaker:
Gustavo Sá Mendes
Congress:
CPC 2019
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Posters
FP Number:
---
Authors:
Gustavo Sá Mendes; Rui Campante Teles; José Pedro Neves; Marisa Trabulo; Manuel Almeida; Regina Ribeiras; João Abecasis; Tiago Nolasco; Pedro Freitas; Márcio Madeira; Miguel Mendes
Abstract
<p><strong>Background:</strong> Paravalvular leak (PVL) presents an incidence ranging from 2-17%. Open heart surgery is considered the standard treatment and there is no consensus regarding the role of percutaneous closure of non-endocarditis PVL.</p> <p><strong>Methods: </strong>Single-centre retrospective study including consecutive patients that had their PVL closed percutaneously [P] or by surgery [S], after heart team agreement, between 2007 and 2018. The primary objective was analysing mortality and rehospitalizations. The secondary goals were evaluating a) the technical success, defined as reduction in regurgitation [at least 1 degree]; b) the clinic-laboratorial improvement, regarding the worst result between 1 month and 1 year after the procedure.</p> <p><strong>Results: </strong>In the whole of 48 procedures, 12 patients underwent percutaneous closure and 36 surgery. The mean age was 66 ± 13 years (74± 12 [P] vs 65± 13 [S] years, p = 0,026) and 56% were male. Clinical indications were heart failure in 91%, haemolytic anaemia in 42%, with a combination of both more prevalent in P group (67% vs 22%, p=0,010). The leak was moderate to severe in 61%, and there was no difference in regurgitation degree between P and S groups (83% vs 56%, p= 0,163).</p> <p>Group P had more comorbidities and higher risk (EuroScore II (13,1% [7,1 - 19,0 CI95%] vs 4,1 [2,9 - 6,5 CI 95%], p=0,003). (Table I)</p> <p>Despite an lower hospital stay in P group (6,5 [3-13] vs 22 [13-38] days, p =0,001), there were no significant differences between groups in respect to total mortality at 6 months, cardiovascular (CV) mortality and CV rehospitalization at 1 year. The technical success was inferior in group P (75% vs 97%) but clinic-laboratorial results did not differ (table 2).</p> <p><strong>Conclusion:</strong> In this high-risk population a clinical improvement can be achieved by both methods. The percutaneous technique seems more appropriate for patients with higher risk, despite the greater success of PVL closure by surgical approach.</p>
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