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TAVI vs Ballon Aortic Valvuloplasty in Acute Decompensated Aortic Stenosis
Session:
Comunicações Orais - Sessão 03 - Válvula aórtica percutânea
Speaker:
André Lobo
Congress:
CPC 2024
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:
Andre Lobo; Rafael Teixeira; Marta Catarina Almeida; Fábio Nunes; Marta Leite; Inês Neves; Inês Rodrigues; António Gonçalves; Pedro Braga; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Introduction: Transcatheter aortic valve implantation (TAVI) has emerged as a preferred treatment for severe aortic stenosis across a spectrum of surgical risks, potentially diminishing the role of balloon aortic valvuloplasty (BAV) as a transient solution or a bridge to definitive intervention. With advancements in TAVI technology and expertise, patients, even with unstable conditions, are increasingly receiving direct, definitive TAVI instead of undergoing multiple procedures. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Aims: Assess if immediate TAVI is safer and more effective than BAV followed by elective aortic valve replacement (AVR) in acute decompensated severe aortic stenosis.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods: Retrospective single-center cohort analysis of consecutive patients who received either urgent or emergency BAV as a bridge to AVR or direct TAVI to manage acute decompensated severe aortic stenosis from May 2012 to May 2023. The primary outcomes were mortality rates at 30 days and one year.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results: 258 cases of urgent or emergent percutaneous aortic valvuloplasty were evaluated. BAV was performed in 47 patients, whereas 211 received direct TAVI. A higher proportion of the BAV group (36%) was treated due to cardiogenic shock as the primary indication, compared with 11% in the TAVI group (p<0.001). Demographic parameters and comorbid condition profiles were equivalently balanced across both groups. The median age was 81 years (IQR: 74-85, p= 0.40), and males constituted 56% of the patient population (p= 0.72). Most patients (65%) presented with left ventricular systolic dysfunction. The reduction in peak aortic valve gradient was significantly more pronounced in the TAVI group (-56±25 mmHg) compared to the BAV group (-27±19 mmHg, p< 0.001). TAVI recipients had a higher incidence of VARC-2 minor and major bleeding events (26% versus. 6% for BAV, p<0.001), and a greater occurrence of advanced AV block needing temporary pacing (19% vs. 9% for BAV, p= 0.02). Thirty-day survival rates favored the TAVI group (93%) over BAV (86%). This trend persisted at the one-year mark, with survival rates of 84% for TAVI and 70% for BAV. Furthermore, the one-year hazard ratio for mortality among patients undergoing BAV was 2.01 (95% confidence interval: 1.34–3.01, p< 0.001). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusion: The data from this retrospective analysis indicate that for patients with decompensated severe aortic stenosis, immediate TAVI may confer a mortality benefit over BAV followed by elective procedures. Despite a higher rate of procedural complications, the direct TAVI approach was associated with better survival rates at both 30 days and one year. These outcomes suggest a potential benefit of the immediate strategy in the general management of acute decompensated severe aortic stenosis. However further prospective analysis is warranted to evaluate the role of BAV in the setting of cardiogenic shock and instability.</span></span></p>
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