Implante de prótese valvar aórtica transcateter: análise da experiência do Instituto Nacional de Cardiologia
Implante de prótese valvar aórtica transcateter: análise da experiência do Instituto Nacional de Cardiologia
Data
2015
Autores
Azevedo, Fabiula Schwartz de
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
Introdução: Nos últimos anos, o implante de bioprótese aórtica transcateter (transcatheter aortic valve replacement (TAVR) ou transcatheter aortic valve implantation (TAVI)) tem sido alternativa de tratamento invasivo aos pacientes portadores de estenose aórtica (EAo) grave, sintomáticos e com alto risco operatório. A experiência do Instituto Nacional de Cardiologia (INC) (Rio de Janeiro, Brasil) em TAVI foi descrita nesta coorte prospectiva. Objetivos: O desfecho primário foi conhecer a mortalidade por qualquer causa em até dois anos de seguimento. Os desfechos secundários foram comparar a variação clínica e ecocardiográfica pré e pós TAVI, segundo a classe funcional (CF) por New York Heart Association (NYHA) e gradiente médio e máximo transaórtico; comparar o gradiente médio transaórtico pós-implante e a fração de ejeção do ventrículo esquerdo (FEVE) ao longo do período de seguimento; e a ocorrência de complicações em até 2 anos. Metodologia: Foram incluídos no estudo todos os pacientes indicados e submetidos a TAVI no INC entre outubro de 2011 e novembro de 2014. Foi realizada avaliação clínica, laboratorial, eletrocardiográfica e ecocardiográfica dos pacientes pré e pós-implante, em até 2 anos. Resultados: 45 pacientes foram submetidos a TAVI entre outubro de 2011 e novembro de 2014 e a mediana do tempo de seguimento foi de 4,4 [1,4–18,2] meses. A mediana da idade foi de 79,4 [74,3–83,2] anos, 62,2% dos pacientes eram do sexo feminino e o EuroSCORE logístico foi 13,4 [8,4–20,3]%. A mortalidade por qualquer causa foi 17,8% [IC 95%: 8% - 32,1%]. Houve melhora significativa da classe funcional comparativamente pré e pós-TAVI (CF III ou IV 84,4% versus 13,1%, p < 0,001), no último seguimento. Houve queda do gradiente sistólico máximo (80 [67-95] versus 22 [17,2–29,5] mmHg; p < 0,001) e médio (49 [40–60,7] versus 12 [9,5–15,2] mmHg; p < 0,001), comparativamente pré e pós-implante, até a alta hospitalar. Os resultados de gradiente médio transaórtico pós-implante foram sustentados durante o tempo de seguimento (p = 0,142) e a FEVE não apresentou variação significativa nos momentos de avaliação do seguimento (p = 0,392). As complicações mais frequentes foram as hemorrágicas (28,9%), a necessidade de marca-passo definitivo (20%) e a lesão renal aguda (22%). Conclusões: A mortalidade e as complicações apresentadas nesse estudo foram aceitáveis para esse grupo de pacientes. Observou-se ganho funcional e melhora dos gradientes médio e máximo transaórticos nessa população comparativamente pré e pós-procedimento. O gradiente médio transaórtico atingido sustentado durante todo o período de seguimento e não houve variação significativa da fração de ejeção comparativamente pré-TAVI e após, durante todo o seguimento
Introduction: In recent years, transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI) has been an alternative to invasive treatment for symptomatic patients, with severe aortic stenosis and high surgical risk. Methodology: The experience of National Institute of Cardiology (Rio de Janeiro, Brazil) in TAVI was described in this prospective cohort. Objectives: The primary endpoint was to know the mortality, from any cause, within two years of follow up. Secondary endpoints were to compare the clinical and echocardiographic variation pre and post-TAVI, according to functional class (FC) by New York Heart Association and peak and mean transaortic gradient; to compare the mean transaortic gradient post-implant and left ventricular ejection fraction during the follow-up period; and the occurrence of complications within 2 years. Methodology: all patients referred and underwent TAVI the INC between October 2011 and November 2014 were included. Clinical, laboratory, electrocardiographic and echocardiographic evaluation of patients was performed before and after implantation, within 2 years. Results: 45 patients underwent TAVI between October 2011 and November 2014 and the median follow up time was 4.4 [1.4 to 18.2] months. The median age was 79.4 [74.3- 83.2] years, 62.2% of patients were female and the logistic EuroSCORE was 13.4 [8.4-20.3]%. The all-cause mortality was 17.8% [95% CI: 8%-32.1%], within 2 years of follow up. A significant improvement in functional class (NYHA) was observed when comparing pre and post-TAVI (FC III or IV 84.4% versus 13.1%, p < 0.001) in the last follow-up. There was a decline in peak (80 [7-95] versus 22 [17.2- 29.5]mmHg; p < 0.001) and mean (49 [40-60.7] versus 12 [9.5-15.2]mmHg; p < 0.001) systolic gradient. The results of average post-implant transaortic gradient were sustained (p = 0.142) and left ventricular ejection fraction did not change significantly during follow-up period (p = 0,392). The most frequent complications were bleeding (28.9%), the need for permanent pacemaker (20%) and acute renal injury (22%). Conclusions: Mortality and complications in this study were acceptable for the group of patients. TAVI had positive clinical and hemodynamic results for this population compared pre and post-procedure and the hemodynamic profile of the prosthesis was sustained throughout the study period.
Introduction: In recent years, transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI) has been an alternative to invasive treatment for symptomatic patients, with severe aortic stenosis and high surgical risk. Methodology: The experience of National Institute of Cardiology (Rio de Janeiro, Brazil) in TAVI was described in this prospective cohort. Objectives: The primary endpoint was to know the mortality, from any cause, within two years of follow up. Secondary endpoints were to compare the clinical and echocardiographic variation pre and post-TAVI, according to functional class (FC) by New York Heart Association and peak and mean transaortic gradient; to compare the mean transaortic gradient post-implant and left ventricular ejection fraction during the follow-up period; and the occurrence of complications within 2 years. Methodology: all patients referred and underwent TAVI the INC between October 2011 and November 2014 were included. Clinical, laboratory, electrocardiographic and echocardiographic evaluation of patients was performed before and after implantation, within 2 years. Results: 45 patients underwent TAVI between October 2011 and November 2014 and the median follow up time was 4.4 [1.4 to 18.2] months. The median age was 79.4 [74.3- 83.2] years, 62.2% of patients were female and the logistic EuroSCORE was 13.4 [8.4-20.3]%. The all-cause mortality was 17.8% [95% CI: 8%-32.1%], within 2 years of follow up. A significant improvement in functional class (NYHA) was observed when comparing pre and post-TAVI (FC III or IV 84.4% versus 13.1%, p < 0.001) in the last follow-up. There was a decline in peak (80 [7-95] versus 22 [17.2- 29.5]mmHg; p < 0.001) and mean (49 [40-60.7] versus 12 [9.5-15.2]mmHg; p < 0.001) systolic gradient. The results of average post-implant transaortic gradient were sustained (p = 0.142) and left ventricular ejection fraction did not change significantly during follow-up period (p = 0,392). The most frequent complications were bleeding (28.9%), the need for permanent pacemaker (20%) and acute renal injury (22%). Conclusions: Mortality and complications in this study were acceptable for the group of patients. TAVI had positive clinical and hemodynamic results for this population compared pre and post-procedure and the hemodynamic profile of the prosthesis was sustained throughout the study period.
Description
Palavras-chave
Estenose aórtica, Implante de prótese valvar aórtica transcateter, Implante de prótese de válvula cardíaca, Idoso, Idoso fragilizado, Aortic valve stenosis, Transcatheter aortic valve replacement, TAVR, TAVI, Hearth valve prosthesis implantation, Aged, Frail elderly
Citação
Azevedo FS. Implante de prótese valvar aórtica transcateter: análise da experiência do Instituto Nacional de Cardiologia. Rio de Janeiro. Dissertação [Mestrado Profissional em Ciências Cardiovasculares] - Instituto Nacional de Cardiologia; 2015.