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Overcoming age borders: TAVI for nonagenarians – a single center experience
Session:
Comunicações Orais - Sessão 23 - Intervenção Valvular Aórtica Percutânea
Speaker:
Mariana Sousa Paiva
Congress:
CPC 2023
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.4 Valvular Heart Disease – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Mariana Sousa Paiva; Daniel A. Gomes; Afonso Félix de Oliveira; Francisco Albuquerque; Mariana Gonçalves; João Brito; Luís Raposo; Henrique Mesquita Gabriel; Tiago Nolasco; Pedro Araújo Gonçalves; Jorge Ferreira; Rui Campante Teles; Manuel Sousa Almeida
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:#212529">Introduction</span></span></span></strong><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:#212529">:</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:#212529">Transcatheter aortic valve implantation (TAVI) is now recommended as the standard treatment for the elderly with severe aortic stenosis (AS). Nonetheless, there is scarce data regarding </span></span></span><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:#212529">short- and middle-term outcomes in patients ≥90 years. </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:#212529">The aim of our study was to describe procedural characteristics and clinical outcomes of a cohort of nonagenarians submitted to TAVI at our center.</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:#212529">Methods</span></span></span></strong><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:#212529">:</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri",sans-serif">Single-center retrospective analysis on prospectively collected data of consecutive patients ≥90 years that integrated our program, undergoing <span style="color:black">TAVI from 2008 to 2021. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri",sans-serif"><span style="color:black">Successful TAVI, procedural complications, and </span></span><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:#212529">30-day/1-year mortality rates</span></span></span><span style="font-family:"Calibri",sans-serif"><span style="color:black"> were defined according to the VARC</span></span><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:#212529">-2 definition. </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:#212529">We performed a sub-group analysis by dividing the cohort in tertiles according to the date of the procedure.</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:#212529">Results:</span></span></span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri",sans-serif">Ninety patients were included with a mean age 92±2 years, 69% women, and a mean EuroSCORE II of 6±3% </span><strong><span style="font-family:"Calibri",sans-serif"><span style="color:#4472c4">– Table 1</span></span></strong><span style="font-family:"Calibri",sans-serif">. A total of 34 patients (38%) had coronary artery disease, 28 (31%) had chronic kidney disease (CKD), 12 (13%) had peripheral artery disease, and 11 (12%) had a previous stroke. At baseline, mean aortic gradient was 54±17 mmHg and 73 (81%) patients had preserved left ventricular ejection fraction.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri",sans-serif">The transfemoral approach was used in most patients (96%), and in 75 (83%) a self-expanding valve was implanted. TAVI was successfully implanted in all patients.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri",sans-serif">The median in-hospital time was 9 (IQR 5-23) days andmost common side effects were need for permanent pacemaker implantation (n=15, 17%) and access-related bleeding (BARC 2 and 3a types) in 11 (12%) patients.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:#212529">All-cause mortality at 30 days and 1 year were 7% (n = ) and 14% (n = ), respectively.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:#212529">The mean survival was 3.0±2.0 years, comparing favorably to the expected mean survival for the cohort based on life expectancy tables (weighted mean of 2.8±0.4, Portuguese National Institute of Statistics), although not reaching statistical significance. </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:#212529">Furthermore, in our sub-group analysis, we observed that 30d and 1y mortality has gradually improved over the years (p < 0.05 for the 1<sup>st</sup> vs 2<sup>nd</sup> and 3<sup>rd</sup> tertiles, see table 1).</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:#212529">Conclusion</span></span></span></strong><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:#212529">:</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri",sans-serif">In our cohort of nonagenarian patients with severe aortic stenosis, TAVI procedures were performed successfully, with low risk of severe complications, and excellent age-adjusted survival rates. These data illustrate that age alone should not discourage adequate treatment of these patients.</span></span></span></p> <p style="text-align:justify"> </p>
Slides
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