Mid- to long-term clinical and echocardiographic outcomes after transcatheter aortic valve replacement with a new-generation, self-expandable system.

OBJECTIVES: The aim of the study was to evaluate mid- to late clinical and echocardiographic outcomes after transcatheter aortic valve replacement (TAVR) with Acurate neo™ (Boston Scientific, Boston, MA). BACKGROUND: TAVR is an established treatment for aortic stenosis (AS). Few data exist on mid- to long-term outcomes and durability after new-generation valves. METHODS: All consecutive patients (n = 104) who underwent Acurate neo™ implantation from 2012 to 2018 were included. Follow-up was systematically performed at 1, 6, 12, and 24 months and yearly thereafter. Outcomes were reported according to VARC-2, and structural valve deterioration (SVD) or bioprosthetic valve failure defined accordingly to new definitions. RESULTS: Mean age was 82 ± 5.4 years, 56.7% were female and the Society of Thoracic Surgeons score for mortality was 5.9 ± 4%. Patients were followed for a median of 3 years (1,092 days; IQR 1.5-4 years), and the maximum follow-up was 7 years. All-cause mortality values at 1 and 5 years were 8.5% and 40.5%, respectively. No relevant changes in mean gradient and orifice area occurred (7.9 ± 3.8 mmHg and 1.9 ± 0.3 cm2 at 1 year; 6.6 ± 2.1 mmHg and 1.8 ± 0.3 cm2 at 5 years), and there was a significant rate of paravalvular leaks resolution at 1, 2, and 3 years (p = .004; p < .001; p < .001, respectively). None of the patients had leaflet thrombosis or endocarditis. One patient developed SVD at 84 months. CONCLUSIONS: Acurate neo™ was associated with sustained echocardiographic results. Reassuring mid- to long-term outcomes was observed in this cohort of elderly patients with severe AS.

Mid- to long-term clinical and echocardiographic outcomes after transcatheter aortic valve replacement with a newgeneration, self-expandable system / Desfechos clínicos e ecocardiográficos de médio a longo prazo após a substituição da válvula aórtica transcateter com uma nova geração, sistema auto-expansível

Abstract Objectives: The aim of the study was to evaluate mid- to late clinical and echocardiographic outcomes after transcatheter aortic valve replacement (TAVR) with A curate neo™ (Boston Scientific, Boston, MA). Background: TAVR is an established treatment for aortic stenosis (AS). Few data exist on mid- to long-term outcomes and durability after new-generation valves. Methods: All consecutive patients (n = 104) who underwent A curate neo™ implantation from 2012 to 2018 were included. Follow-up was systematically performed at 1, 6, 12, and 24 months and yearly thereafter. Outcomes were reported according to VARC-2, and structural valve deterioration (SVD) or bioprosthetic valve failure defined accordingly to new definitions. Results: Mean age was 82 ± 5.4 years, 56.7% were female and the Society of Thoracic Surgeons score for mortality was 5.9 ± 4%. Patients were followed for a median of 3 years (1,092 days; IQR 1.5­4 years), and the maximum follow-up was 7 years. All-cause mortality values at 1 and 5 years were 8.5% and 40.5%, respectively. No relevant changes in mean gradient and orifice area occurred (7.9 ± 3.8 mmHg and 1.9 ± 0.3 cm2 at 1 year; 6.6 ± 2.1 mmHg and 1.8 ± 0.3 cm2 at 5 years), and there was a significant rate of paravalvular leaks resolution at 1, 2, and 3 years (p = .004; p < .001; p < .001, respectively). None of the patients had leaflet thrombosis or endocarditis. One patient developed SVD at 84 months. Conclusions: A curate neo™ was associated with sustained echocardiographic results. Reassuring mid- to long-term outcomes was observed in this cohort of elderly patients with severe AS.

Dopperecocardiografia na avaliação de pacientes com angina estável / Doppler-echocardiography in the evaluation of patients with stable angina

A dopperecocardiografia é uma das modalidades diagnósticas utilizadas com maior freqüência nas investigações de cardiopatias e que tem experimentado utilidade crescente na avaliação de pacientes com suspeita clínica de insuficiência coronária. As modernas técnicas de análise de movimentação segmentar em repouso e sob estresse, associadas às modalidades de documentação da perfusão miocárdica, têm feito com que a aceitação dessa forma de investigação seja cada vez mais ampla, assim como sua contribuição clínica.

Fluoroscopia perioperatória em revascularização de membros inferiores / Perioperative fluoroscopy in lowter lim revascularization

No período de feveretro/1997 a março/2001 a fluoroscopia perioperatoria foi utiliZada em 88 cirurgías de revascularização de membros inferiores. O método foi aplicado no pré-operatório em 14,7 por cento , em 27,2 por cento no intra-operatório e em 97,7 por cento no pós-operatório. Ela determinou alteração de conduta em 25 por cento destas cirurgias.Auxiliou na escolha do leito vascular revascularizado em 6,8 por cento dos casos. No intra-operatório, fatores de risco para a oclusão do enxerto foram identificados e corrigidos em 5,7 por cento. Ao término da círurgia a fluoroscopia determínou reoperação em 12,5 por cento dos casos.A perviedade do enxerto foi de 91,4 por cento e de 89,7 por cento no primeiro e terceiro mês de acompanhamento.A fluoroscopia mostra-se importante método auxiliar à cirurgia de revascularização de membros inferiores. Neste trabalho, sugere sensibilidade superior à arteriografiaconvencional na escolha do leito arterial e na identificação e correção de falhas técnicas que possam comprometer a perviedade do enxerto...