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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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A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
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12. Coronary Artery Disease (Chronic)
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15. Valvular Heart Disease
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20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
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Aortic valve balloon valvuloplasty in patients admitted for cardiogenic shock with severe aortic stenosis: a retrospective analysis of 14 cases
Session:
Posters 5 - Écran 9 - Doença Coronária
Speaker:
Miguel Lourenço Varela
Congress:
CPC 2019
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
14. Acute Cardiac Care
Subtheme:
14.4 Acute Cardiac Care – Cardiogenic Shock
Session Type:
Posters
FP Number:
---
Authors:
Miguel Lourenço Varela; Pedro Gonçalves Teixeira; Marta Ponte; Daniel Caeiro; Adelaide V. Dias; Alberto Rodrigues; Pedro Braga
Abstract
<p>Aortic balloon valvuloplasty (ABV), introduced in 1986, quickly loss its wide adoption due to the high incidence of re-estenosis after the procedure and also due to improved skills in transcatheter aortic valve implantation (TAVI). It has seen a reemergence in the last few years has a bailout therapy in critical care patients presenting with cardiogenic shock (CS) and severe aortic stenosis (AS), who are temporarily unable to tolerate such a procedure as TAVI or surgery for valve replacement.</p> <p>We did a retrospective analysis of every ABV performed between 1/01/2008 and 30/11/2018 in our hospital and identified those admitted to the Cardiac Intensive Care Unit due to cardiogenic shock with severe aortic stenosis. Procedures were categorized as emergent (within 24h after decision to intervene) and urgent (24h after the decision was made but before discharge).</p> <p>During this period, of 98 ABV performed, 14 were made in patients with CS with severe AS, 9 of them being emergent.</p> <p>The average age of patients was 76.2±7.2 years, 6 of them female. Mean peak trans-aortic gradients before ABV was 73.13±31.27mmHg in emergent cases and 43±14.78mmHg in urgent cases.</p> <p>On the day of ABV, mean Euroscore II and Sequential Organ Failure (SOFA) were, respectively, 19±7% and 9.9±3.4 in emergent cases and 11±5% and 4.8±4.2 in urgent cases. In patients deemed emergent, there was a tendency for a decrease in SOFA in the days following the procedure, although not statistically significant (p>0,05).</p> <p>Noteworthy aortic regurgitation did not occur in any patient, neither there were any major post-procedure complications.</p> <p>30-day mortality was 33% in emergent cases and 0% in urgent cases.</p> <p>In emergent cases, 4 were later submitted to TAVI and 1 had surgery for aortic valve replacement surgery. Only 1 patient in the urgent group was regarded as a candidate for TAVI.</p> <p>Emergent cases presented with higher scores of severity and procedure risk, having also greater mortality. However, this group had the most individuals later deemed fit for procedures, hence presenting status of patients does not influence their condition once the acute event has been treated.</p> <p>ABV as bailout treatment may be safe in patients presenting with CS and severe AS, allowing patient survival for elective definitive treatment.</p>
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