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The role of the right heart on outcomes after TAVI: analysis from a large single-center cohort
Session:
Posters (Sessão 5 - Écran 5) - Intervenção Valvular Aórtica Percutânea 2
Speaker:
Mariana Silva Brandão
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:
Pósters Electrónicos
FP Number:
---
Authors:
Mariana S. Brandão; Lígia Mendes; Sílvia O. Diaz; Diogo Santos-Ferreira; António S. Barros; Alberto Rodrigues; Pedro Braga; Francisco Sampaio; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong>: The impact of right ventricular (RV) function and RV to pulmonary artery (RV-PA) coupling on outcomes of patients with aortic stenosis undergoing transcatheter aortic valve implantation (TAVI), and the early effect of the intervention, remain partly unclear.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Aim</strong>: To evaluate the impact of right heart echocardiographic (echo) parameters on the outcome of patients undergoing TAVI.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> Retrospective analysis including consecutive patients submitted to TAVI at our center between 2007-2021. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Pre and postprocedural (≤96h) echo parameters were analyzed: tricuspid annular plane systolic excursion (TAPSE), S-wave tissue Doppler velocity of the tricuspid annulus (S'), pulmonary arterial systolic pressure (PASP). TAPSE/PASP ratio was used as a surrogate of RV-PA coupling; TAPSE/PASP ratio<0.31 defined RV uncoupling. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Primary endpoint (PE) was defined as all-cause death within 1-year after TAVI. Echo parameters were compared between patients according to the PE. Pairwise comparison of pre- and post-TAVI indexes was also performed, for the overall cohort and according to the PE. Statistical significance was considered if p<0.05.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>Of 1040 TAVI patients, 615 with complete echo data were included: median age 81 years, 53% female, left ventricular ejection fraction 55(45-60)%. Before TAVI, 60 patients (11%) presented RV dysfunction (TAPSE<17mm), and 30 (15%) RV-PA uncoupling.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A significant reduction in PASP was observed after TAVI (40 vs 36 mmHg, p<0.01).[image] TAPSE decreased post-TAVI (20.0 vs 19.5 mm, p=0.04); S’ values did not differ between evaluations (11.20 vs 11.50, p=0.08).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">1-year follow up data was available for 467 patients; the primary endpoint occurred in 37 (7.9%) patients. Patients meeting the PE had higher preprocedural PASP (42 vs 39 mmHg, p=0.036). PASP decreased after TAVI (39 vs 36 mmHg, p<0.001) in patients who survived the 1<sup>st</sup> year, but not in patients meeting the PE (p=0.82).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Postprocedural TAPSE/PASP ratio was lower in the deceased group (0.43<em> vs</em> 0.57, p=.031); persistence of RV-PA uncoupling post-TAVI was more frequent in patients who met the PE (25% <em>vs </em>8.1%, p=.047). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions: </strong>In this cohort, RV longitudinal function parameters did not improve after TAVI. Contrastingly, RV-PA coupling improved after the procedure. Persistence of RV-PA uncoupling after TAVI was more frequent in patients who died during the 1<sup>st</sup> year of follow-up.</span></span></p>
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