SPC365

Outcomes of valve-in-valve and valve-in-ring procedures following 1.6 years of follow-up

Session: Sessão de Posters 52 - Intervenção na doença valvular
Speaker: Gonçalo Terleira Batista

Congress: CPC 2024
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Cartazes
FP Number: ---
Authors: Gonçalo Terleira Batista; Mafalda Griné; Tatiana Pereira Dos Santos; Mariana Rodrigues Simões; Ana L Silva; Tomás Carlos; Joana Guimarães; Rafaela Fernandes; Manuel Santos; Joana Delgado Silva; Marco Costa; Lino Gonçalves

<p><span style="font-size:12pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Background: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Valvular bioprosthesis are prone to degeneration, often needing high-risk surgery. Valve-in-valve (ViV) and valve-in-ring (ViR) procedures offer increasingly common and viable alternatives.</span></span></span></p>

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<p><span style="font-size:12pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Purpose: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">To assess outcomes of ViV and ViR procedures, including factors predicting survival.</span></span></span></p>

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<p><span style="font-size:12pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Methods: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">This retrospective study, carried out at a tertiary center, followed 24 patients after ViV and ViR procedures between August 2020 and August 2023. Baseline and follow-up data were collected from hospital and primary care center records.</span></span></span></p>

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<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Following this, we explored the correlation with mortality using bivariate analysis, followed by binary logistic regression and Cox Regression. The multivariate analysis considered various factors, namely gender, diabetes, hypertension, dyslipidemia, tobacco use, body mass index, post-procedural myocardial injury, heart failure, type of procedure and valve, prior myocardial infarction or stroke and pre/post-procedure valvular mean gradients and ejection fraction.&nbsp;</span></span></span></p>

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<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Bivariate analysis employed Chi-square/Fisher tests for categorical variables and parametric/non-parametric tests based on the normal distribution of continuous variables. Statistical significance was set at p &lt; 0.05.</span></span></span></p>

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<p><span style="font-size:12pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Results: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Over a mean follow-up of 1.6 years, we monitored 24 patients who underwent ViV or ViR procedures, with 71% being aortic ViV, 8% mitral ViV, 4% tricuspid ViV and 29% mitral ViR. The median age at implantation was 80 years, with 42% being male, 58% hypertensive, 21% diabetic and 50% having dyslipidemia. During follow-up, 75% were on anticoagulants, while 25% were on antiplatelets. Additionally, four patients died during follow-up, and three experienced procedure-related complications.</span></span></span></p>

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<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">The absence of anticoagulation post-procedure was associated with increased mortality, both in bivariate analysis and after adjusting for potential confounders (adjusted: p=0.035; OR: 16, 95% CI: 1.22-210.6). This association was further reinforced by Cox regression analysis (p=0.049, HR 11.8, 95% CI: 1.01-137.6).</span></span></span></p>

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<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">No other variable demonstrated a significant adjusted association with survival.</span></span></span></p>

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<p><span style="font-size:12pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong></span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">The enduring benefits and safety of ViV and ViR procedures are evident in mid-term outcomes. While the weak association between survival and the absence of anticoagulation post-procedure requires further validation and analysis with larger cohorts, this finding remains noteworthy in the context of existing literature.</span></span></span></p>