Transcatheter Aortic Valve Implantation and Morbidity and Mortality-Related Factors: a 5-Year Experience in Brazil

Abstract

BackgroundTranscatheter aortic valve implantation has become an option for high-surgical-risk patients with aortic valve disease.ObjectiveTo evaluate the in-hospital and one-year follow-up outcomes of transcatheter aortic valve implantation.MethodsProspective cohort study of transcatheter aortic valve implantation cases from July 2009 to February 2015. Analysis of clinical and procedural variables, correlating them with in-hospital and one-year mortality.ResultsA total of 136 patients with a mean age of 83 years (80-87) underwent heart valve implantation; of these, 49% were women, 131 (96.3%) had aortic stenosis, one (0.7%) had aortic regurgitation and four (2.9%) had prosthetic valve dysfunction. NYHA functional class was III or IV in 129 cases (94.8%). The baseline orifice area was 0.67 ± 0.17 cm2 and the mean left ventricular-aortic pressure gradient was 47.3±18.2 mmHg, with an STS score of 9.3% (4.8%-22.3%). The prostheses implanted were self-expanding in 97% of cases. Perioperative mortality was 1.5%; 30-day mortality, 5.9%; in-hospital mortality, 8.1%; and one-year mortality, 15.5%. Blood transfusion (relative risk of 54; p = 0.0003) and pulmonary arterial hypertension (relative risk of 5.3; p = 0.036) were predictive of in-hospital mortality. Peak C-reactive protein (relative risk of 1.8; p = 0.013) and blood transfusion (relative risk of 8.3; p = 0.0009) were predictive of 1-year mortality. At 30 days, 97% of patients were in NYHA functional class I/II; at one year, this figure reached 96%.ConclusionTranscatheter aortic valve implantation was performed with a high success rate and low mortality. Blood transfusion was associated with higher in-hospital and one-year mortality. Peak C-reactive protein was associated with one-year mortality.

Estatística Cardiovascular – Brasil 2021

“…222,223 • Em outra avaliação realizada na cidade do Rio de Janeiro com 136 pacientes submetidos a TAVI [mediana de idade, 83 (80)(81)(82)(83)(84)(85)(86)(87) anos; 51% homens], a mortalidade peroperatória foi 1,5%, a mortalidade de 30 dias, 5,9%, a mortalidade hospitalar, 8,1% e a mortalidade de 1 ano, 15,5%. 224 • De 819 valvas aórticas implantadas por via percutânea até 2017, 135 pacientes (20,1%) precisaram de marca-passo permanente. Esses pacientes eram mais velhos (82,5 vs. 81,1 anos; p=0,047), predominantemente homens (59,3% vs 45%; p=0,003) e tinham bloqueio de ramo direito prévio (OR=6,19; IC 95%, 3,56 -10,75, p≤0,001).…”

Prognostic impact of baseline C‐reactive protein levels on mortality after transcatheter aortic valve implantation

“…Our search identified 14 eligible studies [13][14][15][16][17][18][19][20][21][22][23][24][25][26] including a total of 3449 patients undergoing TAVI (Table 1) and reporting early (in-hospital, 15 30-day, 17,19,23 and 3-month 20 ) and midterm (1-year, [14][15][16][17]22,25,26 600day, 13 2-year, 18,20 and 3-year 21,24 ) all-cause mortality after TAVI (Table 2). Hioki et al 20 reported data on both CRP and high-sensitive CRP (hs-CRP) form the Optimized Transcatheter Valvular Intervention (OCEAN)-TAVI registry, and we extracted the former.…”

“…18,[20][21][22]26 We converted ORs/HRs of mortality per SD (or unit) increase in CRP levels to those for high vs low CRP levels in six studies, [21][22][23][24][25][26] and vice versa in three studies. 17,19,20 In three studies, [13][14][15] SMDs in CRP levels between nonsurvivors and survivors were converted to ORs of mortality for high vs low CRP levels, from which ORs of mortality per SD increase in CRP levels were further calculated.…”

“…A number of sensitivity analyses for midterm mortality were performed. Excluding HRs for hs-CRP 21,25 (Figure S1), combining ORs/HRs of 1-year mortality [14][15][16][17]22,25,26 (Figure S2), pooling HRs of ≥2-year mortality 18,20,21,24 (Figure S3), and combining adjusted HRs 18,[20][21][22]26 (Figure S4) did not alter the primary results.…”

Atualização das Diretrizes Brasileiras de Valvopatias – 2020

“…Todas as diretrizes atuais são categóricas na indicação preferencial da TAVI em detrimento da cirurgia para pacientes inoperáveis, frágeis e/ou de alto risco cirúrgico (avaliados pelos escores STS e EuroSCORE II). [99][100][101][102][103][104][105][106][107][108][109][110][111][112][113] Entretanto, após a publicação de tais diretrizes, 4 trabalhos comparando a TAVI com a cirurgia em pacientes de baixo risco cirúrgico foram publicados. A metanálise de tais estudos demonstrou redução de mortalidade em 1 ano a favor da TAVI transfemoral.…”