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Surgical Aortic Valve Replacement Following Declined Transcatheter Aortic Valve Implantation
Session:
Prémio Manuel Machado Macedo em Cirurgia Cardíaca
Speaker:
Pedro Félix
Congress:
CPC 2024
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
26. Cardiovascular Surgery
Subtheme:
26.11 Cardiovascular Surgery - Other
Session Type:
Prémios, Registos e Sessões Especiais
FP Number:
---
Authors:
Pedro Félix; Inês Rodrigues; Tiago Mendonça; Duarte Cacela; Rui Ferreira; Valdemar Marques Gomes; Pedro Coelho; Hagen Kahlbau
Abstract
<p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Aortic stenosis had a paradigm shift in treatment following the advent of transcatheter aortic valve implantation (TAVI). The number of TAVI procedures has been steadily increasing, surpassing in some centers the number of surgical aortic valve replacement (SAVR). The choice of intervention involves in some cases a multidisciplinary approach, with the Heart Team having a central role in this discussion. Patients with high and intermediate surgical risk are considered for TAVI. Those with contraindications to this approach are subsequently discussed for surgery. Outcomes of patients submitted to surgery after being refused for TAVI remain an area of scientific interest.</span></span></span></p> <p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Our goal was to study the subpopulation of patients that underwent SAVR after being refused for TAVI, regarding cause for refusal, surgical risk, complications and outcomes.</span></span></span></p> <p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">We studied retrospectively all patients in a single center submitted to surgery after being initially evaluated for TAVI in the outpatient clinic. Data collection was limited to patient records previously documented. Our study period ranges from the beginning of this program in April 2017, to September 2023.</span></span></span></p> <p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">A total of 61 patients were initially included. The most common reason to propose to surgery was low frailty (57%), followed by valve anatomy factors that contraindicated TAVI (16%), concurrent cardiac conditions (7%), vascular access contraindications for transfemoral TAVI (5%), and electrocardiographic anomalies (4%). The remaining cases did not have a clearly documented reason for refusal. We performed an analysis of the sub-population of patients with contraindications for TAVI (20/61). We observed a median age of 79 years, median EuroSCORE II of 1,98%, and median waiting time for surgery of 161 days. Surgery had no major complications in the vast majority of cases, with a median cross clamp time of 75 (± 18.5) minutes, and with 10% of cases via upper hemisternotomy. There were no re-interventions during hospital stay. Post-operative complications included 5% stroke, 10% atrial fibrillation, 10% pacemaker implantation, and no in-hospital mortality. Median post-operative hospital stay was 10 days. Median transvalvular mean gradient was 10 (± 7.5) mm Hg. There was 1 case of mild and 1 case of moderate periprosthetic leak.</span></span></span></p> <p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">We conclude that SAVR may be considered a relatively safe option with good results in high-risk patients previously refused for TAVI, after careful selection in multidisciplinary discussion.</span></span></span></p>
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