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1.
Medicine (Baltimore) ; 98(45): e17915, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702671

RESUMO

Trans-catheter aortic valve replacement (TAVR) has become an alternative to surgical aortic valve replacement (SAVR) in high and intermediate risk patients with aortic stenosis. TAVR programs are spreading from large referral centers and being established in community based institutions. The purpose of this study was to compare the outcomes of TAVR to those of SAVR in a community hospital.A historical cohort study of patients with aortic stenosis and pre-post procedure echocardiography data who underwent SAVR or TAVR in Cape Cod Hospital between January 2014 and December 2016. Patient characteristics and procedure outcomes were compared between the two procedures.The study included 230 patients, of them 111 underwent SAVR and 119 underwent TAVR. None of the patients died during the 30 days after the procedure. TAVR patients had higher rates of postoperative mild+ aortic regurgitation (AR) (29.4% vs 12.6%, P = .002), postoperative atrial ventricular blocks (11.8% vs 0.9%, P = .001), and more often need an implantation of pacemaker (16.8% vs 0.9%, P < .001). Postoperative mean gradient of SAVR patients was higher (median 14 vs 11 mm Hg, P = .001) and atrial fibrillation postoperatively was more frequent (18.9% vs 2.5%, P < .001). Length of stay after procedure was shorter in TAVR patients (median 2 vs 4 days, P < .001).After controlling for confounders, the use of TAVR was associated with an increased risk for postoperative pacemaker implantation (OR = 16.3, 95%CI 1.91-138.7, P = .011), lower mean gradient (-4.327, 95%CI -7.68 to -0.98, P = .011), and lower risk for atrial fibrillation (OR = 0.11, 95%CI 0.03-0.38, P = .001), but not with postoperative AR (OR = 0.84, 95%CI 0.22-3.13, P = .789).In conclusion, short-term mortality was not reported in SAVR or TAVR patients. However, TAVR was associated with an increased risk for postoperative pacemaker implantation but with a lower risk for atrial fibrillation. Aortic valves implanted through a trans-catheter approach are also associated with a better hemodynamic performance.


Assuntos
Estenose da Valva Aórtica/cirurgia , Complicações Pós-Operatórias/epidemiologia , Substituição da Valva Aórtica Transcateter/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Ecocardiografia , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/classificação , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
2.
Arch Cardiovasc Dis ; 112(8-9): 512-522, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31474571

RESUMO

BACKGROUND: Despite the worldwide development of transcatheter aortic valve implantation (TAVI) over the last decade, strategies that take patient characteristics into account to guide the choice of transcatheter heart valve have not been evaluated. AIM: To evaluate the immediate results of TAVI using a tailored choice of balloon-expandable or self-expanding transcatheter heart valve, according to each patient's clinical and anatomical characteristics. METHODS: This single-centre observational study included all patients treated with TAVI from 2012 to 2017. The 30-day results were reported according to Valve Academic Research Consortium-2 criteria. A total of 502 patients were included (mean age, 81±9 years; 52% men; mean EuroSCORE II, 7.0±6.5%). Three main variables guided the choice of transcatheter heart valve: the anatomy of the iliofemoral arteries and of the aortic root, and the general condition of the patient. RESULTS: A SAPIEN™ balloon-expandable transcatheter heart valve was used in 275 patients (55%) and a CoreValve™ self-expanding transcatheter heart valve in 227 patients (45%). The approach was transfemoral in 427 patients (85%), and only 29 patients (6%) required transthoracic access. At 30-day follow-up, the rates of adverse events were as follows: mortality, 3.2%; stroke, 3.0%; major bleeding, 5.9%; and major vascular complications, 6.0%. Rates of complications at 30 days were similar in the SAPIEN™ and CoreValve™ groups, except for a higher rate of pacemaker implantation in the latter group (29.5% vs. 14.5%; P<0.001). CONCLUSION: The choice of balloon-expandable or self-expanding transcatheter heart valve tailored to the patient's clinical and anatomical characteristics allows for maximal use of the transfemoral approach, and is associated with low 30-day rates of major complications and mortality.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Valvuloplastia com Balão , Próteses Valvulares Cardíacas , Desenho de Prótese , Substituição da Valva Aórtica Transcateter/instrumentação , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/fisiopatologia , Tomada de Decisão Clínica , Feminino , Humanos , Masculino , Seleção de Pacientes , Complicações Pós-Operatórias/etiologia , Recuperação de Função Fisiológica , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do Tratamento
3.
Int Heart J ; 60(5): 1091-1097, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484865

RESUMO

Low-voltage computed tomographic angiography (CTA) is a highly effective technique to reduce contrast media volume. We sought to examine the suitability of low tube voltage CTA with a reduced contrast media volume protocol using third-generation 192-slice dual-source CT in patients undergoing transcatheter aortic valve implantation (TAVI). CTA was performed to aid TAVI planning for 40 consecutive patients with severe aortic stenosis. For the first 10 patients (120/100 kV group), we used a conventional tube voltage combined CTA protocol (an ECG-gated helical scan; 120 kV, non-gated helical scan; 100 kV). For the subsequent 30 patients (70-kV group), we adopted a low tube voltage CTA protocol. We evaluated vascular attenuation, image noise, contrast-to-noise ratio (CNR), and renal function. The mean contrast media (CM) volume was 77.7 ± 17.7 mL in the 120/100-kV group and 30.9 ± 6.3 mL in the 70-kV group (P < 0.001). In the images of the aortic valve complex, the mean attenuation was not significant difference for both groups. In the images of the aorto-femoral arteries, mean attenuation was > 250 Hounsfield Units and CNR was > 10 in all vascular segments for both groups. There was no significant difference in the change of renal function in the 70-kV group, but renal function in the 120/100-kV group decreased within 1-3 months after CTA. Low tube voltage CTA using third-generation dual-source CT is suitable to assess procedural planning for TAVI. This approach maintains image quality and reduces the required CM volume.


Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Angiografia por Tomografia Computadorizada/métodos , Doses de Radiação , Exposição à Radiação/prevenção & controle , Substituição da Valva Aórtica Transcateter/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Estudos de Coortes , Meios de Contraste , Feminino , Seguimentos , Hospitais Universitários , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
5.
Braz J Cardiovasc Surg ; 34(3): 318-326, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31310471

RESUMO

OBJECTIVES: This study sought to evaluate the impact of prosthesis-patient mismatch (PPM) on the risk of early-term mortality after transcatheter aortic valve implantation (TAVI). METHODS: Databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica dataBASE [EMBASE], Cochrane Controlled Trials Register [CENTRAL/CCTR], ClinicalTrials.gov, Scientific Electronic Library Online [SciELO], Latin American and Caribbean Literature on Health Sciences [LILACS], and Google Scholar) were searched for studies published until February 2019. PPM after TAVI was defined as moderate if the indexed effective orifice area (iEOA) was between 0.85 cm2/m2 and 0.65 cm2/m2 and as severe if iEOA ≤ 0.65 cm2/m2. RESULTS: The search yielded 1,092 studies for inclusion. Of these, 18 articles were analyzed, and their data extracted. The total number of patients included who underwent TAVI was 71,106. The incidence of PPM after TAVI was 36.3% (25,846 with PPM and 45,260 without PPM). One-year mortality was not increased in patients with any PPM (odds ratio [OR] 1.021, 95% confidence interval [CI] 0.979-1.065, P=0.338) neither in those with moderate PPM (OR 0.980, 95% CI 0.933-1.029, P=0.423). Severe PPM was separately associated with high risk (OR 1.109, 95% CI 1.041-1.181, P=0.001). CONCLUSION: The presence of severe PPM after TAVI increased early-term mortality. Although moderate PPM seemed harmless, the findings of this study cannot not rule out the possibility of it being detrimental, since there are other registries that did not address this issue yet.


Assuntos
Próteses Valvulares Cardíacas/efeitos adversos , Falha de Prótese/efeitos adversos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/mortalidade , Humanos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Falha de Tratamento
6.
Braz J Cardiovasc Surg ; 34(3): 361-365, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31310476

RESUMO

Prosthesis-patient mismatch (PPM) after surgical aortic valve replacement (SAVR) is an issue that has been overlooked (not to say neglected). Cardiac surgeons must bear in mind that this is a real problem that we must tackle. The purpose of this paper is to be a wake-up call to the surgical community by giving a brief overview of what PPM is, its incidence and impact on the outcomes. We also discuss the increasing role played by imaging for predicting and assessing PPM after SAVR (with which surgeons must become more acquainted) and, finally, we present some options to avoid PPM after the surgical procedure.


Assuntos
Próteses Valvulares Cardíacas/efeitos adversos , Falha de Prótese/efeitos adversos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Humanos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/mortalidade , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Substituição da Valva Aórtica Transcateter/mortalidade , Falha de Tratamento
7.
EuroIntervention ; 15(9): e749-e756, 2019 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-31334701

RESUMO

AIMS: The aim of this study was to evaluate the impact of a horizontal aorta (HA) on device success and short-term clinical outcomes of transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS: We retrospectively assessed 547 consecutive patients treated with transfemoral second-generation non-balloon-expandable (NBE) (n=447) and balloon-expandable (BE) (n=100) TAVI for symptomatic severe aortic stenosis. Aortic angulation (AA) was evaluated with preprocedural computed tomography. Patients were dichotomised according to a previously established AA cut-point: HA group (AA ≥48°, n=230) and normal aorta (NA) group (AA <48°, n=317). Endpoints were considered according to the Valve Academic Research Consortium-2 definitions. Fluoroscopy time (32.8±16.4 vs 30.3±13.9 minutes, p=0.060) and radiation dose (kerma area product 120.8±99.7 vs 103.7±81.1 Gy·cm2, p=0.033) were higher in the HA group as compared to the NA group. No difference in device success was observed between patients with and without an HA (88.3% vs 88.0%, p=0.929). No differences in device success and 30-day outcomes were observed when comparing HA and NA patients, according to BE and NBE prostheses. CONCLUSIONS: The presence of an HA has no impact on device success and short-term clinical outcomes of TAVI with either second-generation NBE or BE devices.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter/instrumentação , Aorta/diagnóstico por imagem , Valvuloplastia com Balão/efeitos adversos , Cateterismo Periférico/efeitos adversos , Fluoroscopia , Humanos , Desenho de Prótese , Estudos Retrospectivos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
8.
Expert Rev Cardiovasc Ther ; 17(7): 479-496, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31198065

RESUMO

Introduction: Transcatheter aortic valve implantation (TAVI) is the treatment of choice for a large proportion of patients with severe aortic stenosis. Despite numerous technological and clinical advances, TAVI remains associated with thrombotic complications requiring antithrombotic pharmacotherapy, which exposes to the risk of bleeding, especially in elderly individuals. The optimal antithrombotic regimen following TAVI is uncertain and several investigations are ongoing. Areas covered: Clinical guidelines are mostly driven by observational trials and experts' opinions, thus resulting into low-grade level of evidence. The aim of the current review is to critically explore the epidemiology, pathophysiology and prognostic value of thrombotic and bleeding events after TAVI, and to review the current literature on antithrombotic strategies following the procedure. Expert opinion: Thrombotic and bleeding events remain major complications occurring in the frail population that is currently offered TAVI. Waiting for upcoming evidence from ongoing randomized clinical trials, tailoring antithrombotic therapies based on patients' characteristics, values and circumstances is a preferable approach.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Fibrinolíticos/uso terapêutico , Trombose/tratamento farmacológico , Substituição da Valva Aórtica Transcateter/efeitos adversos , Feminino , Humanos , Masculino , Trombose/etiologia , Resultado do Tratamento
9.
Expert Rev Med Devices ; 16(7): 589-602, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31172837

RESUMO

INTRODUCTION: Transcatheter aortic replacement (TAVR) has revolutionized the treatment of aortic stenosis during the last years. Despite improvements in transcatheter heart valve systems, the rate of conduction disturbances after TAVR, particularly new-onset left bundle branch block (new-onset LBBB), has not decreased over time. AREAS COVERED: Overview of the current data regarding new-onset LBBB post-TAVR focusing on clinical outcomes. EXPERT OPINION: New-onset LBBB remains the most common complication after TAVR, occurring in 6-77% of cases with the use of newer generation transcatheter valve systems. The most consistent factor determining new-onset LBBB post-TAVR has been prosthesis implantation depth. The potential evolution to high degree atrioventricular block (HAVB) and the chronic effect on left ventricular ejection fraction (LVEF) may impact the clinical outcomes in this subset of patients. New-onset LBBB has been associated with an increased risk of PPM after TAVR. Conversely, inconsistent results have been reported regarding the impact of LBBB on hospitalization for heart failure and mortality. Current data do not support an indication for 'prophylactic' PPM in all new-onset LBBB patients. However, a specific subset of patients (those with either a very long PR or wide QRS) may benefit from a PPM to prevent HAVB or sudden death.


Assuntos
Bloqueio de Ramo/complicações , Substituição da Valva Aórtica Transcateter , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/cirurgia , Sistema de Condução Cardíaco/patologia , Insuficiência Cardíaca/complicações , Humanos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
11.
JAMA ; 321(22): 2193-2202, 2019 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-31184741

RESUMO

Importance: Transcatheter aortic valve replacement (TAVR) indications are expanding, leading to an increasing number of patients with bicuspid aortic stenosis undergoing TAVR. Pivotal randomized trials conducted to obtain US Food and Drug Administration approval excluded bicuspid anatomy. Objective: To compare the outcomes of TAVR with a balloon-expandable valve for bicuspid vs tricuspid aortic stenosis. Design, Setting, and Participants: Registry-based prospective cohort study of patients undergoing TAVR at 552 US centers. Participants were enrolled in the Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) Transcatheter Valve Therapies Registry from June 2015 to November 2018. Exposures: TAVR for bicuspid vs tricuspid aortic stenosis. Main Outcomes and Measures: Primary outcomes were 30-day and 1-year mortality and stroke. Secondary outcomes included procedural complications, valve hemodynamics, and quality of life assessment. Results: Of 81 822 consecutive patients with aortic stenosis (2726 bicuspid; 79 096 tricuspid), 2691 propensity-score matched pairs of bicuspid and tricuspid aortic stenosis were analyzed (median age, 74 years [interquartile range {IQR}, 66-81 years]; 39.1%, women; mean [SD] STS-predicted risk of mortality, 4.9% [4.0%] and 5.1% [4.2%], respectively). All-cause mortality was not significantly different between patients with bicuspid and tricuspid aortic stenosis at 30 days (2.6% vs 2.5%; hazard ratio [HR], 1.04, [95% CI, 0.74-1.47]) and 1 year (10.5% vs 12.0%; HR, 0.90 [95% CI, 0.73-1.10]). The 30-day stroke rate was significantly higher for bicuspid vs tricuspid aortic stenosis (2.5% vs 1.6%; HR, 1.57 [95% CI, 1.06-2.33]). The risk of procedural complications requiring open heart surgery was significantly higher in the bicuspid vs tricuspid cohort (0.9% vs 0.4%, respectively; absolute risk difference [RD], 0.5% [95% CI, 0%-0.9%]). There were no significant differences in valve hemodynamics. There were no significant differences in moderate or severe paravalvular leak at 30 days (2.0% vs 2.4%; absolute RD, 0.3% [95% CI, -1.3% to 0.7%]) and 1 year (3.2% vs 2.5%; absolute RD, 0.7% [95% CI, -1.3% to 2.7%]). At 1 year there was no significant difference in improvement in quality of life between the groups (difference in improvement in the Kansas City Cardiomyopathy Questionnaire overall summary score, -2.4 [95% CI, -5.1 to 0.3]; P = .08). Conclusions and Relevance: In this preliminary, registry-based study of propensity-matched patients who had undergone transcatheter aortic valve replacement for aortic stenosis, patients with bicuspid vs tricuspid aortic stenosis had no significant difference in 30-day or 1-year mortality but had increased 30-day risk for stroke. Because of the potential for selection bias and the absence of a control group treated surgically for bicuspid stenosis, randomized trials are needed to adequately assess the efficacy and safety of transcatheter aortic valve replacement for bicuspid aortic stenosis.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/anormalidades , Acidente Vascular Cerebral/etiologia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/mortalidade , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/cirurgia , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Pontuação de Propensão , Estudos Prospectivos , Sistema de Registros , Risco
12.
JAMA ; 321(23): 2306-2315, 2019 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-31211345

RESUMO

Importance: Reducing postprocedural stroke is important to improve the safety of transcatheter aortic valve replacement (TAVR). Objective: This study evaluated the trends of stroke occurring within 30 days after the procedure during the first 5 years TAVR was used in the United States, the association of stroke with 30-day mortality, and the association of medical therapy with 30-day stroke risk. Design, Setting, and Participants: Retrospective cohort study including 101 430 patients who were treated with femoral and nonfemoral TAVR at 521 US hospitals in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies Registry from November 9, 2011, through May 31, 2017. Thirty-day follow-up ended June 30, 2017. Exposures: TAVR. Main Outcomes and Measures: The rates of 30-day transient ischemic attack and stroke were assessed. Association of stroke with 30-day mortality and association of antithrombotic medical therapies with postdischarge 30-day stroke were assessed with a Cox proportional hazards model and propensity-score matching, respectively. Results: Among 101 430 patients included in the study (median age, 83 years [interquartile range {IQR}, 76-87 years]; 47 797 women [47.1%]; and 85 147 patients [83.9%] treated via femoral access), 30-day postprocedure follow-up data was assessed in all patients. At day 30, there were 2290 patients (2.3%) with a stroke of any kind (95% CI, 2.2%-2.4%), and 373 patients (0.4%) with transient ischemic attacks (95% CI, 0.3%-0.4%) . During the study period, 30-day stroke rates were stable without an increasing or decreasing trend in all patients (P for trend = .22) and in the large femoral access subgroup (P trend = .47). Among cases of stroke within 30 days, 1119 strokes (48.9%) occurred within the first day and 1567 (68.4%) within 3 days following TAVR. The occurrence of stroke was associated with a significant increase in 30-day mortality: 383 patients (16.7%) of 2290 who had a stroke vs 3662 patients (3.7%) of 99 140 who did not have a stroke died (P < .001; risk-adjusted hazard ratio [HR], 6.1 [95% CI, 5.4-6.8]; P < .001). After propensity-score matching, 30-day stroke risk was not associated with whether patients in the femoral cohort were (0.55%) or were not (0.52%) treated with dual antiplatelet therapy at hospital discharge (HR, 1.04; 95% CI, 0.74-1.46) nor was it associated with whether patients in the nonfemoral cohort were (0.71%) or were not (0.69%) treated with dual antiplatelet therapy (HR, 1.02; 95% CI, 0.54-1.95). Similarly, 30-day stroke risk was not associated with whether patients in the femoral cohort were (0.57%) or were not (0.55) treated with oral anticoagulant therapy at hospital discharge (HR, 1.03; 95% CI, 0.73-1.46) nor was it associated with whether patients in the nonfemoral cohort were (0.75%) or were not (0.82%) treated with an oral anticoagulant (HR, 0.93; 95% CI, 0.47-1.83). Conclusions and Relevance: Between 2011 and 2017, the rate of 30-day stroke following transcatheter aortic valve replacement in a US registry population remained stable.


Assuntos
Estenose da Valva Aórtica/cirurgia , Acidente Vascular Cerebral/etiologia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/cirurgia , Feminino , Próteses Valvulares Cardíacas , Humanos , Masculino , Prognóstico , Pontuação de Propensão , Modelos de Riscos Proporcionais , Sistema de Registros , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia , Estados Unidos/epidemiologia
14.
EuroIntervention ; 15(8): 671-677, 2019 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-31062696

RESUMO

AIMS: Sarcopaenia is a prevalent disease of ageing, associated with adverse clinical outcomes. We aimed to compare in-hospital adverse outcomes and overall mortality in sarcopaenic and non-sarcopaenic patients undergoing transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS: This was a retrospective cohort study including 602 patients who underwent TAVR. Sarcopaenia was defined as skeletal muscle mass index <55.4 cm2/m2 in males and <38.9 cm2/m2 in females obtained through pre-TAVR CT scan. Mortality, length of hospital stay, ICU admission, and Valve Academic Research Consortium (VARC)-2-defined post-TAVR complications were defined as outcomes. Study participants (mean age 80.9±8.9 years and 56.8% male) were followed for a median of 1.5 years. Two thirds of the TAVR population was sarcopaenic. In-hospital outcomes were similar in both groups; however, overall survival was worse in sarcopaenic patients (HR for mortality=1.46 [1.06-2.14], p=0.02). In a multivariable model, sarcopaenia, porcelain aorta, pre-TAVR atrial fibrillation/flutter, severe chronic kidney disease, chronic pulmonary disease, VARC-2 bleeding, acute renal failure following TAVR, and post-TAVR cardiac arrest were predictors of mortality. CONCLUSIONS: Sarcopaenic patients had similar in-hospital clinical outcomes to non-sarcopaenic patients following TAVR which reveals TAVR safety in sarcopaenic patients. However, sarcopaenia was an independent risk factor for midterm mortality indicating its potential value in systematic evaluation of this highly comorbid population in order to decide the best treatment approaches.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/diagnóstico por imagem , Sarcopenia/complicações , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Sarcopenia/mortalidade , Sarcopenia/fisiopatologia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do Tratamento
15.
Khirurgiia (Mosk) ; (4): 66-71, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31120450

RESUMO

Transcatheter aortic valve implantation (TAVI) has become the standard treatment for advanced age and high risk patients with severe aortic stenosis. The incidence of life-threatening complications during TAVI has significantly decreased over the last decade due to advanced current surgical experience. However, there is a risk of perioperative life-threatening complications which can require emergency hemodynamic support. Veno-arterial extracorporeal membrane oxygenation (ECMO) may represent an effective strategy for immediate hemodynamic stabilization until further treatment of the underlying complication. It is presented case report of TAVI under ECMO performed at the Kemerovo Research Institute for Complex Issues of Cardiovascular Diseases. Emergency ECMO represents a feasible strategy for stabilization until further treatment of life-threatening complications during TAVI.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Oxigenação por Membrana Extracorpórea , Substituição da Valva Aórtica Transcateter/métodos , Estudos de Viabilidade , Próteses Valvulares Cardíacas , Humanos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
16.
Isr Med Assoc J ; 5(21): 322-325, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31140223

RESUMO

BACKGROUND: Access-site bleeding is a common complication of transfemoral transcatheter aortic valve implantation (TAVI). Percutaneous stent-graft implantation within the femoral artery may achieve hemostasis and avert the need for more invasive surgical vascular repair; however, failure to advance a guidewire antegradely via the injured vessel may preclude stent delivery. While retrograde stent-graft delivery from the distal vasculature may potentially enable percutaneous control of bleeding, this approach has not been reported. OBJECTIVES: To assess the feasibility of a retrograde approach for stent-graft implantation in the treatment of access-site bleeding following transfemoral TAVI. METHODS: A prospective TAVI registry was analyzed. Of 349 patients who underwent TAVI, transfemoral access was used in 332 (95%). Access-site injury requiring stent-graft implantation occurred in 56 (17%). In four patients (7%), antegrade wiring across the site of vascular injury was not possible and a retrograde approach for stent delivery was used. RESULTS: Distal vascular access was achieved via the superficial femoral or profunda artery. Retrograde advancement of a polymer-coated 0.035" wire to the abdominal aorta, followed by stent-graft delivery to the common femoral artery, achieved hemostasis in all cases. During a median (interquartile range) follow-up period of 198 (618) days (range 46-2455) there were no deaths and no patient required additional vascular interventions. CONCLUSIONS: A retrograde approach for stent-graft delivery is feasible and allows percutaneous treatment of a common femoral artery injury following TAVI in patients who are not suitable for the conventional antegrade approach.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Cateterismo Periférico , Artéria Femoral/cirurgia , Complicações Intraoperatórias , Hemorragia Pós-Operatória , Substituição da Valva Aórtica Transcateter , Lesões do Sistema Vascular , Idoso , Idoso de 80 Anos ou mais , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/métodos , Estudos de Viabilidade , Feminino , Próteses Valvulares Cardíacas , Hemostasia Cirúrgica/métodos , Humanos , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/terapia , Masculino , Avaliação de Processos e Resultados (Cuidados de Saúde) , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/terapia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/instrumentação , Substituição da Valva Aórtica Transcateter/métodos , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/terapia
17.
Nursing ; 49(6): 24-31, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31124850

RESUMO

Transcatheter aortic valve replacement (TAVR) is indicated in some patients with severe aortic stenosis for whom surgical intervention is not deemed appropriate. This article explores when TAVR may be the preferred treatment option over surgical aortic valve replacement and discusses various prosthetic valve devices. The TAVR procedure, diagnostic screenings, complications, postoperative management, and nursing considerations are also outlined.


Assuntos
Estenose da Valva Aórtica/enfermagem , Substituição da Valva Aórtica Transcateter/enfermagem , Valva Aórtica , Próteses Valvulares Cardíacas , Humanos , Programas de Rastreamento/enfermagem , Diagnóstico de Enfermagem , Cuidados Pós-Operatórios/enfermagem , Índice de Gravidade de Doença , Substituição da Valva Aórtica Transcateter/efeitos adversos
18.
Rev Port Cir Cardiotorac Vasc ; 26(1): 51-53, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31104377

RESUMO

INTRODUCTION: Transcatheter aortic valve implantation has emerged as an effective alternative to the traditional method of surgical aortic valve replacement in high risk or inoperable patients. Infective endocarditis after transcatheter aortic valve implantation is a post-operative complication with a high rate of mortality, and thus far, very few cases of successful surgery have been reported. CASE PRESENTATION: The authors report the case of a patient that underwent transcatheter aortic valve implantation and developed an infective endocarditis following the procedure. Corrective surgery for transcatheter aortic valve's removal and aortic valve replacement was successfully performed. CONCLUSIONS: Given the increasing use of transcatheter aortic valve implantation, endocarditis will become increasingly relevant in the near future. As in conventional aortic prosthesis, for some cases, medical therapy alone is not enough. Under optimal conditions, surgery is a safe option and should be considered and discussed in a Heart Team, patient by patient.


Assuntos
Endocardite/cirurgia , Infecções Relacionadas à Prótese/cirurgia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Valva Aórtica/cirurgia , Endocardite/etiologia , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Infecções Relacionadas à Prótese/etiologia
19.
Thorac Cardiovasc Surg ; 67(4): 251-256, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30947355

RESUMO

OBJECTIVE: The purpose of this study was to evaluate the impact of chronic obstructive pulmonary disease (COPD) on clinical outcomes in patients referred for transfemoral (TF) as well as transapical (TA) aortic valve implantation and furthermore to delineate possible advantages of the TF access. METHODS: One thousand eight hundred forty-two patients undergoing transcatheter aortic valve implantation (TAVI) at two study centers were included in the present analysis. The outcome was measured and classified according to Valve Academic Research Consortium-II criteria. Kaplan-Meier estimate was used to assess long-term survival. RESULTS: The present analysis suggests that COPD has limited influence on post-procedural outcome after TAVI. Comparing the TF to TA approach, no significant difference on the impact of COPD on clinical outcomes has been found, except for longer post-procedural ventilation times in COPD patients treated via TA access (p < 0.001). CONCLUSIONS: COPD in patients referred for TAVI procedure was associated with poorer overall long-term survival, thus characterizing a high-risk population for futile treatment; however, the selection of access did not result in a significant difference in most Valve Academic Research Consortium-II-defined clinical outcomes in COPD patients.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Cateterismo Periférico/métodos , Artéria Femoral , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Substituição da Valva Aórtica Transcateter/métodos , Idoso , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/fisiopatologia , Áustria , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/mortalidade , Feminino , Alemanha , Humanos , Masculino , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/mortalidade , Sistema de Registros , Respiração Artificial , Fatores de Risco , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do Tratamento
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