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ObjectiveTranscatheter aortic valve replacement has been an alternative to invasive treatment for symptomatic severe aortic stenosis in high risk patients. The primary endpoint was 30-day and 1-year mortality from any cause. Secondary endpoints were to compare the clinical and echocardiographic variation pre-and post- transcatheter aortic valve replacement, and the occurrence of complications throughout a 4-year follow-up period.MethodsThis prospective cohort, nestled to a multicenter study (Registro Brasileiro de Implante de Bioprótese por Cateter), describes the experience of a public tertiary center in transcatheter aortic valve replacement. All patients who underwent this procedure between October 2011 and February 2016 were included.ResultsFifty-eight patients underwent transcatheter aortic valve replacement. The 30-day all-cause mortality was 5.2% (n=3) and after 1 year was 17.2% (n=10). A significant improvement in New York Heart Association functional classification was observed when comparing pre-and post- transcatheter aortic valve replacement (III or IV 84.4% versus 5.8%; P<0.001). A decline in peak was observed (P<0.001) and mean (P<0.001) systolic transaortic gradient. The results of peak and mean post-implant transaortic gradient were sustained after one year (P=0.29 and P=0.36, respectively). Left ventricular ejection fraction did not change significantly during follow-up (P=0.41). The most frequent complications were bleeding (28.9%), the need for permanent pacemaker (27.6%) and acute renal injury (20.6%).ConclusionMortality and complications in this study were consistent with worldwide experience. Transcatheter aortic valve replacement had positive clinical and hemodynamic results, when comparing pre-and post-procedure, and the hemodynamic profile of the prosthesis was sustained throughout follow-up.

A primeira definição de insuficiência cardíaca (IC) publicada em livro foi de Lewis1, em 1933, e apresentava forte correlação com estado edematoso, uma vez que a IC, na época, era o principal fator fisiopatológico contribuinte para o edema e dispnéia. Era descrita, portanto, como “condição em que o coração não consegue descarregar seu conteúdo adequadamente”. Com advento do estudo hemodinâmico invasivo, Braunwald2 em 1992 publicou uma nova definição para IC que, acrescenta e destaca, o conceito das pressões de enchimento e descreve a IC como “incapacidade do coração de bombear sangue de forma a atender às necessidades metabólicas tissulares, ou pode fazê-lo somente com elevadas pressões de enchimento”. Esse conceito, embora útil do ponto de vista fisiopatológico, não é aplicado para maioria dos pacientes com IC e está presente somente nas formas terminais da doença.

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