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Aortic insufficiency in patients with aortic stenosis submitted to TAVR: does it influence the outcome?
Session:
Comunicações Orais - Sessão 23 - Intervenção Valvular Aórtica Percutânea
Speaker:
Gustavo M. Campos
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:
Gustavo M. Campos; Rita Gomes; João Rosa; Bruno Castilho; Joana Guimarães; Eric Monteiro; Diogo Fernandes; Tatiana Santos; Gonçalo Batista; Mariana Simões; Ana Luísa Silva; Joana Silva; Elizabete Jorge; Marco Costa; Luís Leite; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction: </strong>Transcatheter aortic valve replacement (TAVR) has become a mainstay therapy <span style="background-color:white"><span style="color:#333333">for high-risk patients with symptomatic severe aortic stenosis (AS).</span></span> Many of the landmark trials that studied the role of TAVR in patients with severe AS did not include subjects with <span style="background-color:white"><span style="color:#333333">mixed aortic valve disease (</span></span>MAVD), and hence it has been challenging to extrapolate the excellent outcomes of TAVR to this group of patients. The incidence of M<span style="background-color:white"><span style="color:#333333">AVD </span></span>is expected to increase because of an aging population and an associated increase in the incidence of degenerative heart valve disease. The natural course of these patients seems to be worse than those with either pure AS or AR<span style="background-color:white"><span style="color:#333333"> and prior studies evaluating the utility of TAVR in treating MAVD have had mixed results, and the outcomes remain unclear.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Objectives:</strong> In this analysis we sought to report the short-term outcomes after TAVR among patients with MAVD compared to those with pure AS.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>Single center, retrospective, observational study including patients who underwent transfemoral-access TAVR for severe valve AS. Data was collected from the electronic medical records. Patients were classified according to the nature of the valve disease: mixed aortic valve disease (MAVD), defined as severe AS and at least moderate aortic regurgitation (AR) or pure severe AS (with no or trivial AR). The primary endpoint was the composite of all-cause mortality, heart failure hospitalization or stroke.</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 244 patients (median age 83 years, 45.9% male) were included in this analysis. Among these, 62 patients (25%) had MAVD. Overall, patients with MAVD had less prevalence of diabetes mellitus, and previous percutaneous coronary intervention and showed lower left ventricular ejection fraction (LVEF); higher NTproBNP at admission and higher length of stay (table 1). <span style="background-color:white"><span style="color:#333333">The MAVD group also had a higher prevalence of post-TAVR AR (24.6% vs. 12.8%; p = 0.029), but no differences were observed in the primary endpoint, despite pure AS showing numerically higher rates of events (13.5% in pure AS group vs. 8.1% in the MAVD group, p = 0.142).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong>TAVR in MAVD is not associated with worse outcomes, despite higher prevalence of post-TAVR AR and lower LVEF. This could be explained by LV remodeling induced by concomitant AR, <span style="background-color:white"><span style="color:#333333">making it easier for these patients to tolerate post-TAVR AR.</span></span></span></span></p>
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