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Temporal trends and outcomes after TAVI: what we’ve learned over the past decade
Session:
Painel 11 - Cardiologia Intervenção 3
Speaker:
Pedro Miguel Gonçalves Teixeira
Congress:
CPC 2020
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Posters
FP Number:
---
Authors:
Pedro Gonçalves Teixeira; Ana Raquel Barbosa; Cláudio Guerreiro; João Gonçalves Almeida; Ana Mosalina; Pedro Ribeiro Queirós; Cátia Serena; Mariana Ribeiro Da Silva; Gualter Santos Silva; Mariana S. Brandão; Diogo Santos Ferreira; Ricardo Fontes-Carvalho; Adelaide V. Dias; Alberto Rodrigues; Pedro Braga
Abstract
<p>INTRODUCTION </p> <p>Over the past decade, TAVI has emerged as a valid and safe treatment option for severe symptomatic aortic stenosis, from prohibitive surgical risk patients in the early days, to those at intermediate risk in current practice. Advances in device technology, as well as growing operators’ skills, were remarkable in this short time window.</p> <p>OBJECTIVES </p> <p>The authors aim to compare early safety and success endpoints, and major clinical outcomes, between early and late periods of a twelve-year single-center experience.</p> <p>METHODS </p> <p>All patients that underwent TAVI at our centre between 2007 and 2019 were included in the analysis. Patients were divided in two groups according to the procedure date, in those representing the early experience (2007 to 2014) and those comprising a more contemporary cohort (2015 to 2019).</p> <p>RESULTS</p> <p>A total of 681 patients that underwent TAVI were enrolled, 51.6% were female, and the mean age was 79.8 ± 7.6 years, with 181 patients being treated between 2007-2014, and 500 between 2015-2019. No significant between-group differences were observed in the mortality risk prediction scores (Euroscore II x ¯ 14.0 ± 10.1% vs 13.1 ± 13.4%, p=0.92; STS score x ¯ 6.8 ± 4.6% vs 5.1 ± 5.2%, p=0.47), but contemporary patients (2015-2019) were less likely to have NYHA≥III functional class (53.7% vs 74.7%, p<0.001).</p> <p>In contemporary procedures, transfemoral access were more frequently used (96.4% vs 82.9%, p<0.001), delivery system’s caliber was significantly smaller (17.2±1.8 vs 15.3±2.3 Fr, p<0.001), and less volume of contrast agent was used (170±75 vs 153±86 ml, p=0.03).</p> <p>The composite endpoint of 30-day procedural success (VARC-2 definition) was achieved in similar rates between groups. The 30-day safety endpoint was more frequently observed in patients treated between 2015-2019 (62.7% vs 51.9%, p=0.015). This was driven by significantly less access site complications (35.4% vs 40.2%, p=0.029), acute renal injury (17.3% vs 25.8%, p= 0.025), pacemaker implantation (14.7% vs 27.0%, p=0.001), as well as ischemic stroke or TIA (4.2% vs 9.5%, p=0.016). New-onset AF (7.3% vs 15.1%, p=0.004), complete LBBB (27.3% vs 44.9%, p<0.001), and any peri-prosthetic leak (50% vs 72.9%, p<0.001), were also less frequently observed in those treated between 2015-2019.</p> <p>All-cause mortality was significantly lower in patients submitted to TAVI between 2015-2019, in a median follow-up of 24 months (Kaplan Meyer survival curve with Log Rank=0.015).</p> <p>CONCLUSION</p> <p>Technical advances and operator’s skills improvement have made the path for TAVI expansion with increasingly better safety profile, and a tremendous impact in major clinical outcomes. Contemporarily treated patients have lower procedure-related complications, such as vascular complications, AKI, pacemaker implantation, and early stroke / TIA. Our analysis suggests these patients may have lower all-cause mortality rates in a 2-year follow-up.</p>
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