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Urgent vs non-urgent Transcatheter Aortic Valve Implantation outcomes
Session:
Posters - H. Interventional Cardiology and Cardiovascular Surgery
Speaker:
Alexandra Castelo
Congress:
CPC 2021
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Posters
FP Number:
---
Authors:
Alexandra Castelo; André Grazina; Tiago Mendonça; Inês Rodrigues; Pedro Garcia Brás; Vera Vaz Ferreira; Rúben Ramos; António Fiarresga; Duarte Cacela; Rui Cruz Ferreira
Abstract
<p><u>Background</u>: There are limited data about the outcomes of non-elective transcatheter aortic valve implantation (TAVI), but some studies suggest that these patients have worst results.</p> <p><u>Purpose</u>: To compare outcomes in patients submitted to urgent versus elective TAVI.</p> <p><u>Methods</u>: Retrospective analysis of consecutive patients (P) submitted to TAVI between 2018 and 2020 in a tertiary center. Baseline characteristics and outcomes after the procedure were collected. Urgent TAVI was considered when patients were not electively admitted for the procedure but required the intervention on the current admission for medical reasons and could not be sent home without a definitive procedure.</p> <p><u>Results</u>: A total of 208P (55,3% female) were included, with a mean age of 82 ± 7years. Patients submitted to urgent TAVI (57P, 27,4%) had worse baseline characteristics, with higher EuroScore risk (10,7% vs 5,4%, p <0,001), STS score (7,3% vs 4,4%, p <0,001), and natriuretic peptide B (1350 vs 728 pg/mL, p = 0,021), lower left ventricle ejection fraction (44% vs 50%, p <0,001), more diabetes (49,1% vs 33,1%, p = 0,033), peripheral artery disease (22,8% vs 4,6%, p <0,001) and worse accesses<br /> (21,2% vs 5%, p = 0,002). In univariable analysis, urgent TAVI was associated with higher intra-hospital mortality (14% vs 4%, p = 0,01), 30-days mortality (17,5% vs 4%, p = 0,001) and 30-days cardiovascular mortality (17,5% vs 3,3%, p <0,001), life-threatening bleeding (17,9% vs 4%, p =0,001), acute kidney injury (16,1% vs 4,7%, p = 0,007), vascular complications (16,1 vs 4%, p = 0,003) and longer hospital and intensive care unit stay (30 vs 12 days, p <0,001 and 6 vs 4 days, p = 0,025 respectively), but not with post-TAVI hospital stay (12 vs 10 days, p = 0,37). When adjusted to the differences in baseline characteristics, in a multivariable analysis, urgent TAVI was only associated with longer hospital stay (p <0,0001). There were no differences in outcomes between groups beyond the first 30 days after the procedure, including mortality and hospital admissions.</p> <p><u>Conclusion</u>: Patients submitted to urgent TAVI tend to have worse short-term outcomes, but this seems to be attributable to the worse baseline characteristics of these cases instead of the urgent nature of the procedure. Even with the adjustment for baseline differences, these patients have longer global hospital stays, but they don't have latter pos-TAVI discharge.</p>
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