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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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32. Cardiovascular Nursing
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Predictors of functional recovery after percutaneous aortic valve implantation – data from 459 cases
Session:
Posters (Sessão 5 - Écran 7) - Intervenção Cardíaca Coronária e Estrutural 3 - Foco na Válvula Aórtica
Speaker:
Diogo Santos Ferreira
Congress:
CPC 2022
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Diogo Santos Ferreira; Isabel Fernandes; Silva Diaz; Cláudio Guerreiro; Mariana Brandão; Mariana Ribeiro Silva; Gualter Silva; Pedro Ribeiro Queirós; Eulália Pereira; Gustavo Pires de Morais; Bruno Melica; Lino Santos; Alberto Rodrigues; Pedro Braga; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>BACKGROUND:</strong> Aortic valve stenosis is now the most common primary valve lesion requiring intervention and is frequently associated with heart failure symptoms, which can be easily assessed through New York Heart Association (NYHA) classification. Transcatheter Aortic Valve Implantation (TAVI) is an increasingly attractive solution for its treatment as a less-invasive approach, especially in a higher surgical risk subgroup of patients. However, not all patients exhibit a symptomatic improvement after the procedure.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>METHODS:</strong> A single-centre retrospective database of all consecutive TAVI procedures performed between March 2012 and December 2019 was analyzed. The primary outcome was defined as a reduction of NYHA class of at least 1 point over the six months after treatment, and the secondary outcome considered a reduction of at least 2 classes. Clinical, echocardiographic and blood-analysis data previous to TAVI were explored as potential predictors of good NYHA response, using Pearson’s Chi-squared test, Wilcoxon rank sum test and Fisher’s exact test, as appropriate. A p<0.05 was considered statistically significant.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>RESULTS:</strong> A total of 459 cases had full information regarding NYHA status both prior and 6 months after TAVI (image 1). 68% patients improved at least one NYHA class, with a less predominance of female patients on NYHA responders (48% versus 61%, p=0.009). Patients with a higher estimated surgical risk tended to exhibit a better symptomatic response after the procedure (p=0.002 for EuroSCORE II, p=0.055 and p=0.10 for STS mortality and morbimortality, respectively). Fewer patients suffered from chronic obstructive pulmonary disease (COPD) in the NYHA-responders subgroup (15% versus 25%, p=0.01). Ejection fraction (EF) was slightly lower among the patients who recovered at least one functional class (55 versus 57%, p<0.001), and there was a higher predominance of patients with reduced EF (≤40%, 22% versus 10%, p=0.028). 19% of patients improved at least 2 functional classes, and these tended to be also younger (78- versus 82-years-old, p=0.002), more frequently diabetic and dyslipidemic and with higher basal serum creatinine, despite no differences in estimated creatinine clearance.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>CONCLUSIONS: </strong>According to the present study, only about two-thirds of patients improved their NYHA class after TAVI. Basal characteristics portraying a higher periprocedural risk are associated with symptomatic improvement over follow-up, thus demanding a more careful risk-benefit consideration. The identification of accurate predictors of clinical response to treatment might better guide patient selection and expectations regarding TAVI for severe aortic stenosis.</span></span></p>
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