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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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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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TAVI: Is it possible to predict complications?
Session:
Posters 2 - Écran 4 - Intervenção / Cirurgia Cardíaca
Speaker:
Tiago Graça Rodrigues
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:
Tiago Graça Rodrigues; E. Infante de Oliveira; P. Carrilho Ferreira; Claudia Jorge; Miguel Nobre Menezes; Joana Rigueira; Inês Aguiar Ricardo; Rafael Santos; Helena Santiago; João Tiago; Fausto José Pinto; Pedro Canas Da Silva
Abstract
<p><strong>Introduction</strong>: Transcatheter aortic valve implantation (TAVI) is an established approach in patients (pts) with severe aortic stenosis and moderate and high surgical risk. The need for pacing, vascular complications, cerebrovascular and haemorrhage are the most frequent complications. The aim of this study was to evaluate the rate of complications and look for their predictors.</p> <p><strong>Methods</strong>: A retrospective unicentric study of consecutive pts submitted to TAVI from September 2012 to October 2018. Demographic and clinical data on the population and procedures were analyzed. It was verified the occurrence of early complications (30 days after TAVI). The chi-square test and the student T-test were used in the statistical analysis. For identification of independent predictors of complications, logistic regression analysis was performed.</p> <p><strong>Results</strong>: 440 patients (mean age 81 ± 7.1 years, 55% women) were included. 35.2% had coronary heart disease, 29% diabetes, 27.9% chronic kidney disease, 13.1% peripheral arterial disease (PAD) and 8.7% stroke / TIA. The most frequently implanted valves were Sapien® (60.2%) and CoreValve® (36.1%).</p> <p>The most frequent early complications were: bradydhythmia requiring definitive pacing (18.9%, n = 83); stroke/ TIA (3.6%, n = 16), of this, 8 patients with major stroke; haemorrhage (18.7%, n = 82) with major bleeding in 25 patients; vascular complications (17.5%, n = 77), in which 22 were major.</p> <p>The presence of diabetes (X<sup>2</sup> = 4.5, p = 0.035) and PAD (X<sup>2</sup> = 4.3, p = 0.039) showed to be associated with major stroke but not with minor stroke.</p> <p>Independent predictors of vascular complications were the presence of CAD (X<sup>2</sup> = 5.9, p = 0.015) or previous CABG (X<sup>2</sup> = 4.5, p = 0.034). Only the history of previous CABG (X<sup>2</sup> = 8.7, p = 0.003) was a predictor of major vascular complication. The presence of ≥2 angulations at the level of the femoro-inguinal arterial segment (X<sup>2</sup> = 4.0; p = 0.045) was associated with major vascular complication.</p> <p>Independent predictors of haemorrhagic complications (major or minor) were female sex (OR = 2.34, p = 0.002) as well as the use of CoreValve (OR = 1.676, p = 0.04) (vs Sapien).</p> <p><strong>Conclusions</strong>: In this population, independent predictors of vascular complications were the presence of CAD or CABG and of hemorrhagic complications the use of self-expanding valves (CoreValve). There was no relationship between vessel characteristics in angioCT and vascular complications.</p>
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