Implante transcateter da válvula aórtica em pacientes nonagenários: evolução intra-hospitalar e sobrevida no primeiro ano
Implante transcateter da válvula aórtica em pacientes nonagenários: evolução intra-hospitalar e sobrevida no primeiro ano
Data
2025
Autores
Mattos, Nelson Durval Ferreira Gomes de
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
Introdução: A Estenose Aórtica (EA) é uma doença cardiovascular que ocorre em
até 5% dos idosos (>75 anos),caracterizada pelo estreitamento da válvula aórtica e
comprometimento do fluxo sanguíneo sistêmico. Nos últimos anos, o tratamento
dessa doença evoluiu significativamente com a introdução da Implantação
Transcatéter de Válvula Aórtica (ITVA), uma alternativa minimamente invasiva à
cirurgia convencional de troca de válvula aórtica. Entretanto, a aplicação da ITVA em
pacientes nonagenários, com 89 anos ou mais, continua sendo controversa na
cardiologia devido aos desafios clínicos, éticos e econômicos e a baixa produção
científica sobre o assunto no Brasil. Objetivo: analisar os resultados da aplicação do
ITVA em pacientes nonagenários em um hospital quaternário privado do Rio de
Janeiro. Os objetivos específicos incluem analisar a mortalidade e complicações
intra-hospitalares, além da mortalidade aos 30 dias, seis meses e um ano após o
procedimento. Método: No período de dezembro de 2009 a maio de 2023, foi
realizado um estudo de coorte retrospectivo com seguimento prospectivo, baseado
na análise de um banco de dados da experiência unicêntrica em um hospital
quaternário privado no Rio de Janeiro. Quanto à análise dos dados, as variáveis
categóricas foram reportadas por meio das frequências absolutas (n) e relativas (%),
enquanto o uso da média e desvio padrão foi realizado para as variáveis contínuas
(quantitativas) por atenderem aos pressupostos de normalidade (Teste Shapiro-Wilk). A comparação entre os grupos de não-nonagenários e nonagenários foi efetuada pelos testes t independente e Qui-quadrado (χ2) para variáveis
contínuas e categóricas, respectivamente. O p-valor menor que 0,05 foi considerado
estatisticamente significante. Os dados foram analisados no GraphPad Prism 8
(GraphPad Software, San Diego, USA). Resultado: A amostra foi composta por 265
pacientes, sendo destes, 40 (15%) nonagenários (com 89 anos ou mais). Neste
grupo, a maioria era formada por mulheres (55%), hipertensos (72,5%) e com
doença renal crônica (95%). Observou-se que 12,5% tinham história prévia de
infarto do miocárdio, além dos indivíduos com revascularização coronária prévia
(17,5%). Nas características cardiológicas, a maioria estava em ritmo sinusal
(67,5%), com angina (22,5%). Em termos de procedimentos, 85% dos nonagenários
receberam anestesia geral e 100% tiveram acesso cirúrgico. A prótese mais utilizada
foi a Corevalve (67,5%), e o sucesso do ITVA, conforme critérios VARC-3, foi
alcançado em 90% dos casos. Quanto às complicações, observou-se em 42,5% e a
necessidade de marcapasso definitivo em 35% dos pacientes enquanto a
mortalidade intra-hospitalar foi de 7,5%, sendo semelhante nas avaliações de 30
dias (p= 0,42), 6 meses (p= 0,30) e um ano (p = 0,06). Conclusão: Ao analisar os
dados obtidos no estudo, pode-se sugerir que o tratamento da estenose aórtica
grave através do implante percutâneo da válvula aórtica nos pacientes nonagenários
tem um resultado imediato e a curto prazo, semelhante aos não nonagenários.
Introduction: Aortic Stenosis (AS) is a cardiovascular disease that affects up to 5% of elderly individuals over 75 years old. It is characterized by the narrowing of the aortic valve and impaired systemic blood flow. In recent years, treatment of this condition has evolved significantly with the introduction of Transcatheter Aortic Valve Implantation (TAVI), a minimally invasive alternative to conventional surgical aortic valve replacement. However, the use of TAVI in nonagenarian patients (aged 89 or older) remains controversial in cardiology due to clinical, ethical, and economic challenges, as well as the limited scientific literature on this topic in Brazil. Objective: To analyze the outcomes of TAVI in nonagenarian patients at a private quaternary hospital in Rio de Janeiro. The specific objectives include evaluating in-hospital mortality and complications, as well as mortality at 30 days, six months, and one year post-procedure. Method: From December 2009 to May 2023, a retrospective cohort study with prospective follow-up was conducted, based on the analysis of a single-center database from a private quaternary hospital in Rio de Janeiro. Categorical variables were reported using absolute (n) and relative (%) frequencies, while means and standard deviations were used for continuous variables, which met normality assumptions (Shapiro-Wilk test). Comparisons between non-nonagenarians and nonagenarians were made using independent t-tests for continuous variables and Chi-square (χ²) tests for categorical variables. A p-value of less than 0.05 was considered statistically significant. Data were analyzed using GraphPad Prism 8 (GraphPad Software, San Diego, USA). Results: The sample consisted of 265 patients, of whom 40 (15%) were nonagenarians (aged 89 or older). In this group, most were women (55%), hypertensive (72.5%), and had chronic kidney disease (95%). Additionally, 12.5% had a history of myocardial infarction, and 17.5% had previously undergone coronary revascularization. Regarding cardiac characteristics, most were in sinus rhythm (67.5%) and had angina (22.5%). In terms of procedures, 85% of nonagenarians received general anesthesia, and 100% underwent surgical access. The most commonly used prosthesis was the CoreValve (67.5%), and TAVI success, according to VARC-3 criteria, was achieved in 90% of cases. Complications were observed in 42.5% of patients, with 35% requiring a permanent pacemaker. In-hospital mortality was 7.5%, with similar rates at 30 days (p = 0.42), six months (p = 0.35), and one year (p = 0.06). Conclusion: Based on the data obtained in this study, it can be suggested that the treatment of severe aortic stenosis through transcatheter aortic valve implantation in nonagenarian patients yields immediate and short-term outcomes comparable to those in younger patients.
Introduction: Aortic Stenosis (AS) is a cardiovascular disease that affects up to 5% of elderly individuals over 75 years old. It is characterized by the narrowing of the aortic valve and impaired systemic blood flow. In recent years, treatment of this condition has evolved significantly with the introduction of Transcatheter Aortic Valve Implantation (TAVI), a minimally invasive alternative to conventional surgical aortic valve replacement. However, the use of TAVI in nonagenarian patients (aged 89 or older) remains controversial in cardiology due to clinical, ethical, and economic challenges, as well as the limited scientific literature on this topic in Brazil. Objective: To analyze the outcomes of TAVI in nonagenarian patients at a private quaternary hospital in Rio de Janeiro. The specific objectives include evaluating in-hospital mortality and complications, as well as mortality at 30 days, six months, and one year post-procedure. Method: From December 2009 to May 2023, a retrospective cohort study with prospective follow-up was conducted, based on the analysis of a single-center database from a private quaternary hospital in Rio de Janeiro. Categorical variables were reported using absolute (n) and relative (%) frequencies, while means and standard deviations were used for continuous variables, which met normality assumptions (Shapiro-Wilk test). Comparisons between non-nonagenarians and nonagenarians were made using independent t-tests for continuous variables and Chi-square (χ²) tests for categorical variables. A p-value of less than 0.05 was considered statistically significant. Data were analyzed using GraphPad Prism 8 (GraphPad Software, San Diego, USA). Results: The sample consisted of 265 patients, of whom 40 (15%) were nonagenarians (aged 89 or older). In this group, most were women (55%), hypertensive (72.5%), and had chronic kidney disease (95%). Additionally, 12.5% had a history of myocardial infarction, and 17.5% had previously undergone coronary revascularization. Regarding cardiac characteristics, most were in sinus rhythm (67.5%) and had angina (22.5%). In terms of procedures, 85% of nonagenarians received general anesthesia, and 100% underwent surgical access. The most commonly used prosthesis was the CoreValve (67.5%), and TAVI success, according to VARC-3 criteria, was achieved in 90% of cases. Complications were observed in 42.5% of patients, with 35% requiring a permanent pacemaker. In-hospital mortality was 7.5%, with similar rates at 30 days (p = 0.42), six months (p = 0.35), and one year (p = 0.06). Conclusion: Based on the data obtained in this study, it can be suggested that the treatment of severe aortic stenosis through transcatheter aortic valve implantation in nonagenarian patients yields immediate and short-term outcomes comparable to those in younger patients.
Description
Palavras-chave
Estenose aórtica, Implante transcateter de válvula aórtica, ITVA nonagenários, Não-nonagenários, Aortic stenosis, Transcatheter aortic valve replacement, TAVI nonagenarians, Non-nonagenarians.
Citação
Mattos NDFG. Implante transcateter da válvula aórtica em pacientes nonagenários: evolução intra-hospitalar e sobrevida no primeiro ano. Rio de Janeiro. Dissertação [Mestrado Profissional em Ciências Cardiovasculares] - Instituto Nacional de Cardiologia - INC; 2025