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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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01. History of Cardiology
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05. Atrial Fibrillation
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
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32. Cardiovascular Nursing
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Predictors of clinical outcomes following transcatheter aortic valve replacement
Session:
Posters (Sessão 5 - Écran 5) - Intervenção Valvular Aórtica Percutânea 2
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:
Pósters Electrónicos
FP Number:
---
Authors:
Gustavo M. Campos; João Rosa; Rita Gomes; Bruno Castilho; Eric Monteiro; Joana Guimarães; Diogo Fernandes; Gonçalo Costa; Rafaela Fernandes; Gil Cunha; Vanessa Lopes; Tatiana Santos; Ana Luísa Silva; Mariana Simões; Gonçalo Batista; 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>Aortic valve stenosis (AS) is one of the most common cardiovascular diseases and its prevalence is increasing associated with an ageing population. 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). As a result of evidence from the randomized controlled trials, TAVR indications have expanded to include severe AS patients with low surgical risk. Thus, given the increasing number of patients who undergo TAVR, it is important to study possible long-term complications after the procedure.</span></span> Common surgical risk scores are widely used to guide treatment options, but these models were created and validated in a standard surgical risk population. Therefore, these models do not reflect the particularities of the typical TAVR population and there is a paucity of information about predictors of both mortality and morbidity in these patients.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Objectives: </strong><span style="background-color:white"><span style="color:black">The</span></span><span style="background-color:white"><span style="color:black"> aim of this analysis was to identify predictors of adverse events in older adults undergoing TAVR.</span></span></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. The outcome was the composite of all-cause mortality, heart failure hospitalization or stroke. Univariate and multivariate Cox proportional hazard modeling was performed to identify predictors of the outcome.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong><span style="color:black">This cohort included 244 patients (median age 83 years, 45.9% male). The composite outcome was observed in </span><span style="color:black">33 (13.5%)</span><span style="color:black"> patients. In multivariate analyses, atrial fibrillation (HR 2.27; 95% CI 1.09-4.74), creatinine (HR 1.42; 95% CI 1.10-1.83) and </span><span style="color:black">hemoglobin</span><span style="color:black"> (HR 0.79; 95% CI 0.62-0.99) levels, as well as the presence of significant (moderate to severe) post-TAVR aortic regurgitation (AR) (HR 2.35; 95% CI 1.06-5.24) were identified as independent predictors of adverse events. When adjusted to confounders, no association was found between left ventricular ejection fraction and the outcomes.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong>Significant post-TAVR AR, as well as the presence of atrial fibrillation, lower hemoglobin and higher creatinine levels were associated with postoperative adverse events in older patients undergoing TAVR. </span></span></p>
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