Transcatheter aortic valve replacement: the experience of one brazilian health care center

Abstract Objective: Transcatheter 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. Methods: This 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. Results: Fifty-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%). Conclusion: Mortality 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.

Surgical treatment of atrial fibrillation in patients with rheumatic valve disease

Abstract Objective: To assess heart rhythm and predictive factors associated with sinus rhythm after one year in patients with rheumatic valve disease undergoing concomitant surgical treatment of atrial fibrillation. Operative mortality, survival and occurrence of stroke after one year were also evaluated. Methods: Retrospective longitudinal observational study of 103 patients undergoing rheumatic mitral valve surgery and ablation of atrial fibrillation using uni- or bipolar radiofrequency between January 2013 and December 2014. Age, gender, functional class (NYHA), type of atrial fibrillation, EuroSCORE, duration of atrial fibrillation, stroke, left atrial size, left ventricular ejection fraction, cardiopulmonary bypass time, myocardial ischemia time and type of radiofrequency were investigated. Results: After one year, 66.3% of patients were in sinus rhythm. Sinus rhythm at hospital discharge, lower left atrial size in the preoperative period and bipolar radiofrequency were associated with a greater chance of sinus rhythm after one year. Operative mortality was 7.7%. Survival rate after one year was 92.3% and occurrence of stroke was 1%. Conclusion: Atrial fibrillation ablation surgery with surgical approach of rheumatic mitral valve resulted in 63.1% patients in sinus rhythm after one year. Discharge from hospital in sinus rhythm was a predictor of maintenance of this rhythm. Increased left atrium and use of unipolar radiofrequency were associated with lower chance of sinus rhythm. Operative mortality rate of 7.7% and survival and stroke-free survival contribute to excellent care results for this approach.

Cirurgia vídeo-assistida para a ablação da fibrilação atrial isolada por radiofrequência bipolar / Videothoracoscopy for isolated atrial fibrillation ablation through bipolar radiofrequency

FUNDAMENTO: A prevalência da fibrilação atrial, os gastos com o sistema de saúde e a elevada morbidade e mortalidade associadas a ela, têm justificado a procura por novas abordagens terapêuticas. OBJETIVO: Avaliar a reprodutibilidade da técnica cirúrgica, a segurança e os resultados inicias da cirurgia vídeo-assistida para a ablação da fibrilação atrial isolada com radiofrequência bipolar. MÉTODOS: Dez pacientes (90 por cento homens) com fibrilação atrial (50 por cento paroxística) sintomática e refratária à terapia medicamentosa, sem doença cardíaca que requeresse cirurgia concomitante, foram submetidos à ablação da arritmia guiada por toracoscopia, no período de maio de 2007 a maio de 2008. Variáveis clínicas, laboratoriais e de imagem foram prospectivamente coletadas antes, durante e no seguimento pós-operatório. RESULTADOS: A cirurgia foi realizada conforme o planejado em todos os pacientes. Não houve lesão iatrogênica de estruturas intratorácicas ou óbitos. No seguimento médio de seis meses, 80 por cento dos pacientes estão livres de fibrilação atrial. Houve melhora significativa dos sintomas de insuficiência cardíaca classe funcional New York Heart Association (2,4 ± 0,5 para 1,6 ± 0,7; p = 0,011). Não houve evidência de estenose de veias pulmonares à angiotomografia, nesta série. CONCLUSÃO: A cirurgia vídeo-assistida para o tratamento da fibrilação atrial é reprodutível e segura. Há melhora evolutiva dos sintomas de insuficiência cardíaca após a cirurgia.

BACKGROUND: The prevalence of atrial fibrillation, expenses with the healthcare system and the associated high morbidity and mortality have justified the search for new therapeutic approaches. OBJECTIVE: To evaluate the reproducibility of the surgical technique, its safety and the initial outcome of the video-assisted surgery for the isolated atrial fibrillation ablation with bipolar radiofrequency. METHODS: Ten patients (90 percent men) with symptomatic atrial fibrillation (50 percent paroxystic type) that was refractory to drug therapy, with no heart disease that required concomitant surgical treatment, were submitted to arrhythmia ablation guided by thoracoscopy from May 2007 to May 2008. Clinical, laboratory and image variables were prospectively collected before, during surgery and at the postoperative follow-up. RESULTS: The surgery was carried out as planned in all patients. There was no intra-thoracic structure iatrogenic lesion or deaths. At the mean 6-month follow-up, 80 percent of the patients were free of atrial fibrillation. There was a significant improvement in the symptoms of New York Heart Association Functional Class heart failure (2.4 ± 0.5 to 1.6 ± 0.7; p=0.011). There was no evidence of pulmonary vein stenosis at the angiotomography in this series. CONCLUSION: The video-assisted surgery for the treatment of atrial fibrillation is reproducible and safe. There is a heart failure symptom evolution improvement after the surgery.