Implante transcateter de valva aórtica para o tratamento da estenose aórtica grave: uma revisão sistemática de estudos de avaliação econômica completa / Transcatheter aortic valve implantation for the treatment of severe aortic stenosis: a systematic review of complete economic evaluation studies

Objetivo: Comparar o implante transcateter de valva aórtica (TAVI) ao tratamento conservador em pacientes inoperáveis ou à cirurgia de troca valvar (SAVR) em pacientes com risco cirúrgico alto ou intermediário conforme a Society of Thoracic Surgeons (STS), por meio de uma revisão sistemática de avaliações econômicas completas. Avaliar a variabilidade de modelos econômicos, parâmetros, pressupostos e sua influência nos resultados finais. Métodos: Foi realizada uma busca da literatura nas bases Medline, EMBASE, Cochrane Library, Web of Science, SciELO e International HTA Base e busca manual. Foram incluídas análises econômicas completas baseadas em modelos econômicos publicadas entre 2011 e 2022, em português, inglês e espanhol. A qualidade dos estudos foi avaliada usando o instrumento QHES (Quality of Health Economic Studies). Resultados: Foram incluídos 36 estudos, majoritariamente análises de custo-utilidade (64%), da Europa (41%), utilizando dados de eficácia dos estudos PARTNER. O modelo de Markov (61%) foi predominante. O custo da prótese do TAVI foi um parâmetro de impacto na análise de sensibilidade nos três grupos. Os estudos alcançaram uma boa qualidade no instrumento QHES. Conclusão: O TAVI tendeu a ser custo-efetivo em relação aos comparadores. Os modelos não foram homogêneos nos parâmetros, horizontes temporais e taxa de desconto, podendo impactar a custo-efetividade do TAVI e dificultar a comparação dos resultados entre diferentes países e perspectivas.

ABSTRACT Objective: To compare transcatheter aortic valve implantation (TAVI) to conservative treatment in inoperable patients or to valve replacement surgery (SAVR) in patients at high or intermediate surgical risk according to the Society of Thoracic Surgeons (STS), through a systematic review of comprehensive economic evaluations. Evaluate the variability of economic models, parameters, assumptions and their influence on final results. Methods: A literature search was performed in Medline, EMBASE, Cochrane Library, Web of Science, SciELO and International HTA Base and manual search. Complete economic analyzes based on economic models published between 2011 and 2022 in Portuguese, English and Spanish were included. The quality of the studies was evaluated using the QHES (Quality of Health Economic Studies) instrument. Results: Thirty-six studies were included, mostly cost-utility analyses (64%), from Europe (41%), and using efficacy data from the PARTNER studies. The Markov model (61%) was predominant. The cost of the TAVI prosthesis was the most important parameter in the sensitivity analysis in the three groups. The studies achieved a good quality in QHES instrument. Conclusion: TAVI tended to be cost-effective relative to comparators. The models were not homogeneous in parameters, time horizons and discount rate, which may have an impact on the cost-effectiveness of TAVI, making it difficult to compare the results between different countries and perspectives.

Minimally Invasive Direct Coronary Artery Bypass and Percutaneous Coronary Intervention Followed by Transcatheter Aortic Valve Implantation: A Promising Concept in High?risk Octogenarians

Objectives: In this article, we present our initial clinical experience with staged minimally invasive direct coronary bypass (MIDCAB), percutaneous coronary intervention (PCI), and transcatheter aortic valve implantation (TAVI) in high?risk octogenarians (Hybrid). Background: The use of percutaneous techniques for managing structural heart diseases, especially in elderly high?risk patients, has revolutionized the treatment of structural heart diseases. These procedures are present predominantly being offered as isolated interventions. The feasibility, clinical benefit, and outcomes of combining these techniques with MIDCAB have not been sufficiently explored and have subsequently been underreported in the contemporary literature. Methods: Four consecutive octogenarians with severe aortic stenosis (AS) and complex coronary artery disease (CAD) that were at high risk for conventional surgery with extracorporeal circulation (ECC) were discussed in our Multidisciplinary Heart Team(MDH). Our MDH consisted of an interventional cardiologist, cardiac surgeon, and cardiac anesthesiologist. A hybrid approach with the alternative strategy comprising of MIDCAB, PCI, and TAVI in a staged fashion was agreed on. All 4 patients had both PCI/stenting and MIDCAB prior to deployment of the TAVI?prosthesis. Results: From January 2019 to December 2020, 4 consecutive patients aged between 83 and 85 (3male/1 female) years were scheduled for MIDCAB/ PCI followed by percutaneous treatment of severe symptomatic AS. Intraoperatively, one patient was converted to full sternotomy, and surgery was performed by off?pump coronary artery bypass grafting. The overall procedural success rate was 100% in all 4 patients with resolution of their initial presenting cardiopulmonary symptoms. There were no severe complications associated with all hybrid procedures. There was no 30?day mortality in all patients. All patients were discharged home with a median hospital stay ranging between 9 and 25days. All patients have since then been followed?up regularly. There was one noncardiac?related mortality at 6?months postsurgery. All other patients were well at 1?year follow?up with improved NewYork Heart Association Class II. Conclusions: In a selected group of elderly, high prohibitive risk patients with CAD and severe symptomatic AS, a staged approach with MIDCAB and PCI followed by TAVI can be safely performed with excellent outcomes. We advocate a MDH?based preliminary evaluation of this patient cohort in selecting suitable patients and appropriate timing of each stage of the hybrid procedure.

Acute Acquired Immune Thrombocytopenia After Cardiac Surgery: A Challenging Case

Thrombocytopenia is a common condition that recognizes an infinite number of possible causes, especially in specific settings like the one covered in this case report: the postoperative period of cardiac surgery. We report a case of an old male with multiple comorbidities who underwent a coronary angioplasty procedure and aortic valve replacement. He showed severe thrombocytopenia in the postoperative days. Differential diagnosis required a big effort, also for the experts in the field. Our goal was to aggressively treat the patient with prednisolone, platelets, and intravenous immunoglobulins to maximize the prognosis. Our patient developed no complications and was discharged successfully

Implications of five-year outcomes of PERIGON trial for bioprosthetic aortic valve replacement / 中国胸心血管外科临床杂志

@#For patients with aortic valve disease who require replacement of their native valve, surgical aortic valve replacement (SAVR) has been the standard of care. Due to the hemorrhage and thromboembolic risks of long-term anticoagulation therapy for mechanical prosthesis, bioprosthetic aortic valve replacement (AVR) has a trend to be used in younger patients, which raising the concern for the durability of bioprosthetic valves. The newly published 5-year outcomes of PERIGON trial, with no structural valve deterioration, again demonstrated the favorable durability of the new generation bioprosthetic valves, further providing the evidence of using bioprosthetic AVR in younger patients. At the meantime, the rapid progress of transcatheter aortic valve implantation (TAVI) has brought a new treatment option. For younger patients with low risks, choosing SAVR or TAVI becomes a critical decision. This paper reviews the outcomes of PERIGON trial and its implications to the clinical practice and research of bioprosthetic AVR.

Declaración de la Latinoamerican Association of Cardiac & Endovascular Surgery (LACES) sobre las guías de la AHA/ACC para el manejo de la enfermedad valvular 2020 / Latin American Association of Cardiac and Endovascular Surgery statement regarding the 2020 ACC/AHA guidelines for the management of valvular heart disease

Resumen Se han publicado ya las nuevas guías 2020 de recomendación clínica de la AHA/ACC para el tratamiento de pacientes con valvulopatía. Luego de un análisis profundo, con base en los más grandes estudios clínicos y en la situación en los países de Latinoamérica, la Latinoamerican Association of Cardiac & Endovascular Surgery (LACES) redactó una declaración en relación con algunas de las nuevas recomendaciones.

Abstract The new clinical guidelines of the AHA/ACC for the treatment of patients with Valvulopathy 2020 have been published. After an in-depth analysis, based on the largest clinical trials and taking into account the situation in our countries in Latin America, the Latinoamerican Association of Cardiac & Endovascular Surgery (LACES) drafting a statement on some of the new recommendations.

Cardiac Tamponade during Transcatheter Aortic Valve Implantation (TAVI)

Transcatheter aortic valve implantation (TAVI) is a new minimally invasive procedure for symptomatic patients with severe aortic stenosis and surgical high-risk. Numerous technical improvements have been developed to simplify the procedure and reduce the incidence of complications. Temporary pacing of the right ventricle remains mandatory to ensure transient hypotension and low cardiac output while performing predilation of the aortic annulus and accurately position and deploy the valve. Temporary pacing is also crucial as a backup pacing device if complete atrioventricular block develops after TAVI. Implanting a temporary pacing wire requires additional venous vascular access and a pacing lead, both of which may generate complications. Cardiac tamponade during TAVI is a rare complication. We present the case of a cardiac tamponade during TAVI probably due to right ventricular perforation associated with pacing. We report some measures to avoid such complications and improve the TAVI procedure

Clinical characteristics and mid-term follow-up of elderly patients with severe aortic stenosis not eligible for TAVI

BACKGROUND: The treatment for symptomatic severe aortic stenosis (AS) is the correction of valve stenosis by surgical valve replacement and more recently by transcatheter aortic valve implant (TAVI). However, in some high risk surgical patients, TAVI is not possible for technical or clinical reasons or due to the unavailability of the endoprosthesis. OBJECTIVE: The aim of this study was to evaluate a mid-term follow-up of symptomatic severe AS patients who are not eligible for TAVI trials, as well as to identify the clinical features of these patients. METHODS: This was an observational, retrospective study conducted with 475 symptomatic severe AS patients, evaluated by the Heart Team between 2000 and 2017. Inclusion criterias were: patients considered not to be eligible for TAVI. The Shapiro-Wilk test was applied to evaluate normality. Non-paired t and Mann-Whitney tests were applied for continuous variables, while the chi-squared and Fischer exact tests were applied for categorical variables, with a level of significance of p<0,05. RESULTS: The heart team evaluated 475 patients: 25 (5.26%) died before any intervention could be proposed; 326 (68.3%) were submitted to TAVI, so the study population consisted of 124 patients not eligible for TAVI. Of these, 31 (25%) underwent surgery and 93 (75%) remained in clinical treatment. In a mean 56 months- follow-up the mortality in clinical group was 46.2%. In the surgical group the mortality was 23.9% (in-hospital 12.9% and late mortality 11% in a mean 47.4 months follow-up). The patients that died presented a significantly lower left ventricle ejection fraction (LVEF), a smaller valve area, and a larger end-systolic diameter of the LV. CONCLUSION: The mortality of the clinical group's patients was significantly higher than the surgical mortality (46.2% vs. 12.9%; p=0.021). The patients of the clinical group were older, weighed less, and had a higher incidence of renal failure and a higher STS score.

Lo mejor del Congreso 2020 de la Sociedad Europea de Cardiología: la experiencia digital / The best of the 2020 European Society of Cardiology Congress: the digital experience / O melhor do Congresso da Sociedade Europeia de Cardiologia 2020: a experiência digital

Resumen: La necesidad de distanciamiento social impuesta por la actual pandemia por coronavirus obligó a las diferentes sociedades científicas a realizar sus actividades en formato completamente virtual. La Sociedad Europea de Cardiología no ha sido la excepción. Desde el 29 de agosto al 1 de septiembre de 2020 se celebró este evento sin precedentes que, además de contar con 125.000 profesionales de 213 países, permitió el acceso gratuito a todos los cibernautas. De esta manera, la actualidad en cardiología pudo llegar a todos los rincones del mundo, pese a las circunstancias tan complejas. Como ya es tradición de la revista, realizamos un resumen de los principales ensayos presentados durante el congreso: - Early Rhythm-Control Therapy in Patients with Atrial Fibrillation (EAST-AFNET 4) - Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure (The EMPEROR-Reduced Trial Investigators) - Efficacy and Safety of Mavacamten in Adults with Symptomatic Obstructive Hypertrophic Cardiomyopathy (EXPLORER-HCM) - Angiotensin Receptor Neprilysin Inhibition Compared with Individualized Medical Therapy for Comorbidities in Patients with Heart Failure and Preserved Ejection Fraction (The PARALLAX Trial) - A Study to Evaluate the Effect of Dapagliflozin on Renal Outcomes and Cardiovascular Mortality in Patients with Chronic Kidney Disease (DAPA-CKD) - Aspirin with or without Clopidogrel after Transcatheter Aortic-Valve Implantation (POPULAR TAVI (Cohort A)) - Colchicine in Patients with Chronic Coronary Disease (The LoDoCo2 Trial Investigators) - Pharmacological Blood Pressure-Lowering for Primary and Secondary Prevention of Cardiovascular Disease Across Different Levels of Blood Pressure (BPLTTC) - Continuing versus suspending angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: Impact on adverse outcomes in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (The BRACE CORONA Trial) - Randomized Trial of Transfusion Strategies in Patients with Myocardial Infarction and Anemia (REALITY Trial)

Summary The need for social distancing imposed by the current coronavirus pandemic, forced the different scientific societies to carry out their activities in a completely virtual format. And the European Society of Cardiology has not been the exception. From August 29 to September 1 of 2020, this unprecedented event was held which, in addition to having 125,000 health professionals from 213 countries, allowed free access to all netizens. In this way, current affairs in cardiology could reach all corners of the world, despite such complex circumstances. As is the tradition of the magazine, we present a summary of the main essays presented during the congress: - Early Rhythm-Control Therapy in Patients with Atrial Fibrillation (EAST-AFNET 4) - Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure (The EMPEROR-Reduced Trial Investigators) - Efficacy and Safety of Mavacamten in Adults with Symptomatic Obstructive Hypertrophic Cardiomyopathy (EXPLORER-HCM) - Angiotensin Receptor Neprilysin Inhibition Compared with Individualized Medical Therapy for Comorbidities in Patients with Heart Failure and Preserved Ejection Fraction (The PARALLAX Trial) - A Study to Evaluate the Effect of Dapagliflozin on Renal Outcomes and Cardiovascular Mortality in Patients with Chronic Kidney Disease (DAPA-CKD) - Aspirin with or without Clopidogrel after Transcatheter Aortic-Valve Implantation (POPULAR TAVI (Cohort A)) - Colchicine in Patients with Chronic Coronary Disease (The LoDoCo2 Trial Investigators) - Pharmacological Blood Pressure-Lowering for Primary and Secondary Prevention of Cardiovascular Disease Across Different Levels of Blood Pressure (BPLTTC) - Continuing versus suspending angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: Impact on adverse outcomes in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (The BRACE CORONA Trial) - Randomized Trial of Transfusion Strategies in Patients with Myocardial Infarction and Anemia (REALITY Trial)

Resumo A necessidade de distanciamento social imposto pela atual pandemia do coronavírus, obrigou as diferentes sociedades científicas a desenvolverem suas atividades de forma totalmente virtual. E a Sociedade Europeia de Cardiologia não foi exceção. De 29 de agosto a 1º de setembro 2020, foi realizado esse evento inédito que, além de contar com 125.000 profissionais de saúde de 213 países, possibilitou o acesso gratuito a todos os internautas. Dessa forma, a atualidade da cardiologia pode atingir todos os cantos do mundo, apesar de circunstâncias tão complexas. Como é tradição da revista, apresentamos um resumo dos principais ensaios apresentados durante o congresso: - Early Rhythm-Control Therapy in Patients with Atrial Fibrillation (EAST-AFNET 4) - Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure (The EMPEROR-Reduced Trial Investigators) - Efficacy and Safety of Mavacamten in Adults with Symptomatic Obstructive Hypertrophic Cardiomyopathy (EXPLORER-HCM) - Angiotensin Receptor Neprilysin Inhibition Compared with Individualized Medical Therapy for Comorbidities in Patients with Heart Failure and Preserved Ejection Fraction (The PARALLAX Trial) - A Study to Evaluate the Effect of Dapagliflozin on Renal Outcomes and Cardiovascular Mortality in Patients with Chronic Kidney Disease (DAPA-CKD) - Aspirin with or without Clopidogrel after Transcatheter Aortic-Valve Implantation (POPULAR TAVI (Cohort A)) - Colchicine in Patients with Chronic Coronary Disease (The LoDoCo2 Trial Investigators) - Pharmacological Blood Pressure-Lowering for Primary and Secondary Prevention of Cardiovascular Disease Across Different Levels of Blood Pressure (BPLTTC) - Continuing versus suspending angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: Impact on adverse outcomes in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (The BRACE CORONA Trial) - Randomized Trial of Transfusion Strategies in Patients with Myocardial Infarction and Anemia (REALITY Trial)

Reemplazo valvular aórtico por cateterismo. Estado actual / Aortic valvular replacement by catheterism. Current state

Resumen La estenosis aórtica grave es una enfermedad común cuya prevalencia crece con el envejecimiento de la población. El reemplazo valvular aórtico quirúrgico (SAVR) ha sido la única alternativa efectiva hasta la aparición del reemplazo valvular aórtico por cateterismo (TAVR o TAVI). Este procedimiento se usó inicialmente para pacientes inoperables en quienes dos ensayos clínicos aleatorios y varios registros mostraron su superioridad sobre el tratamiento médico conservador. Dos ensayos clínicos adicionales en pacientes que, a pesar de ser considerados operables, tenían alto riesgo quirúrgico, demostraron la no inferioridad de TAVR versus reemplazo quirúrgico. Investigaciones posteriores probaron también su efectividad en pacientes de riesgo intermedio y bajo. Algunas complicaciones, como las relacionadas al acceso vascular, el accidente cerebro vascular, la necesidad de marcapasos definitivo y la regurgitación periprotésica, han ido disminuyendo con la mejoría de la tecnología, la curva de aprendizaje y la estrategia mínimamente invasiva actual. Queda pendiente determinar la durabilidad para establecer cuál será el papel de TAVR en la práctica clínica.

Abstract Severe aortic stenosis is a common disease whose prevalence is steadily growing with population ageing. Surgical aortic valve replacement (SAVR) has been the only effective alternative until the introduction of transcatheter aortic valve replacement (TAVR or TAVI). This procedure was initially used for non-surgical candidate patients where two randomized clinical trials and several registries showed superiority over conservative medical treatment. Furthermore, two additional clinical trials including high surgical risk patients proved the non-inferiority of TAVR versus surgical replacement. Similar findings regarding effectiveness were observed in other clinical trials including intermediate and low risk patients. Technical and procedural improvements, including learning curve and the current minimally invasive strategy have decreased periprocedural and mid-term complications such as those related with vascular access, stroke, the need for permanent pacemaker implantation and paravalvular leak. All things considered, durability is a pending question to establish which would be the role of TAVR in current and future practice.

Reestructuración del abordaje de la patología estructural cardiaca en tiempos de pandemia por COVID-19 / Restructuring of the approach to structural pathology Cardiac in times of pandemic by COVID-19

Resumen La red sanitaria en el entorno de la pandemia por COVID-19 ha sufrido un gran impacto. La reorganización de la misma ha sido fundamental para poder atender la emergencia sanitaria, y en algunos países, ha sido incluso de forma abrupta. La atención oportuna de las enfermedades cardiovasculares continúa siendo una prioridad por la elevada mortalidad que ella implica especialmente en estadios muy avanzados de la enfermedad, y la modificación en la atención médica en el contexto actual no puede afectar la asistencia de patologías cardíacas. Los programas de cardiología estructural y cirugía cardíaca en nuestro país se han consolidado y crecido en los últimos años, ofreciendo múltiples procedimientos percutáneos o mínimamente invasivos para cardiopatías de alta morbimortalidad. La continuación de los mismos, a pesar de las dificultades por la pandemia, es necesaria en ciertos casos. Este documento reúne las principales recomendaciones basados en textos internacionales al respecto, para mantener el cuidado cardiovascular en Costa Rica pese al COVID-19 en el ámbito de la cardiopatía estructural.

Abstract The health system in the context of the COVID-19 pandemic has suffered a great impact. Thus, organization has been essential in maintaining the ability to respond to the health emergency, and in some countries, it has even been abrupt. The treatment of cardiovascular diseases continues to be a priority, and the modification of medical care in the current context cannot affect the timely procedures of cardiac pathologies. The structural cardiology and cardiac surgery programs in our country have been consolidated and grown in recent years, offering multiple percutaneous or minimally invasive procedures for heart disease with high morbidity and mortality. Their continuation, despite the difficulties caused by the outbreak, is necessary in certain cases. This document brings together the main recommendations based on international guidelines and experts opinions in this regard, to maintain cardiovascular care in Costa Rica despite COVID-19.

Successful Surgical Aortic Valve Replacement for Prosthetic Valve Endocarditis 10 Months after Transcatheter Aortic Valve Implantation / 日本心臓血管外科学会雑誌

An 87-year-old man underwent a transcatheter aortic valve implantation (TAVI) for severe aortic stenosis. Approximately 8 months later, he was readmitted to our institution because of a cerebral infarction. Viridans Streptococcus was identified from the blood culture, and transesophageal echocardiography revealed a mobile mass on the leaflet. Prosthetic valve endocarditis (PVE) was diagnosed and we initially administered intravenous antibiotic therapy for 4 weeks, after which the patient underwent surgical aortic valve replacement. Herein, we report on the surgical AVR in the patient using a pericardial valve after successful removal of the infected prosthetic valve, and discuss some issues related to this rare complication after TAVI.

Lo mejor del Congreso Uruguayo de Cardiología 2019 / The best of the 2019 Uruguayan Congress of Cardiology / O melhor do Congresso Uruguaio de Cardiologia 2019

Resumen: El 35° Congreso Uruguayo de Cardiología tuvo lugar en Punta del Este, del 7 al 9 de noviembre. Como cada año, constituyó una oportunidad de actualización en diferentes áreas de la cardiología, contando con la participación de invitados nacionales e internacionales. Asimismo, se dio a conocer la actividad científica desarrollada por diferentes autores mediante la exposición de temas libres. A continuación, comentamos los siete artículos premiados por el Comité Científico. - Prevención de muerte súbita (PREMUDE) en jugadores de fútbol: 10 años de valoración precompetitiva. - Perfil clínico de la fibrilación auricular en el posoperatorio de cirugía cardíaca. - Protocolo de cardio-oncología para el seguimiento de pacientes con riesgo de disfunción ventricular por quimioterapia. - Implicancia del uso del score de calcio coronario en la re-estratificación del riesgo cardiovascular en prevención primaria. - Análisis de la morbimortalidad asociada a implante percutáneo de válvula aórtica: valor de variables clínicas y scores de riesgo a mediano plazo. - Anticoagulación en bioprótesis valvular aórtica. Ensayo clínico randomizado multicéntrico. - Strain global longitudinal del ventrículo izquierdo permite predecir mejoría funcional y sobrevida en pacientes con insuficiencia mitral severa asintomática y función normal. Metaanálisis.

Summary: The 35th Uruguayan Congress of Cardiology was held in Punta del Este in November 7th to 9th. As every year, it was an opportunity to update in different cardiovascular areas with participation of national and international guests. Scientific activity of different authors was also announced, through exposition of several articles. We will comment the seven awarded abstracts. - Sudden death prevention (PREMUDE) in soccer players: 10 years of pre-competitive assessment. - Clinical profile of atrial fibrillation in the postoperative period of cardiac surgery. - Cardio-oncology protocol for the follow-up of patients at risk of ventricular dysfunction due to chemotherapy. - Implication of the use of coronary calcium score in the re-stratification of cardiovascular risk in primary prevention. - Analysis of morbidity and mortality associated with percutaneous aortic valve implantation: value of clinical variables and medium-term risk scores. - Anticoagulation in aortic valve bioprosthesis. Multicenter randomized clinical trial. - Longitudinal global left ventricular strain allows prediction of functional improvement and survival in patients with severe asymptomatic mitral regurgitation and normal function. Meta-analysis.

Resumo: O 35º Congresso Uruguaio de Cardiologia, aconteceu em Punta del Este, de 7 a 9 de novembro. Como todos os anos, foi uma oportunidade de atualização em diferentes áreas cardiológicas, graças à experiência de convidados nacionais e internacionais. Também foi anunciada a atividade científica de diferentes serviços, através da exposição de vários artigos. Propomos comentar os sete artigos premiados. - Prevenção de morte súbita (PREMUDE) em jogadores de futebol: 10 anos de avaliação pré-competitiva. - Perfil clínico da fibrilação atrial no pós-operatório de cirurgia cardíaca. - Protocolo cardio-oncológico para acompanhamento de pacientes com risco de disfunção ventricular devido à quimioterapia. - Implicação do uso do escore de cálcio coronariano na ré estratificação do risco cardiovascular na prevenção primária. - Análise da morbimortalidade associada ao implante valvar aórtico percutâneo: valor de variáveis clínicas e escores de risco a médio prazo. - Anticoagulação na bioprótese valvar aórtica. Ensaio clínico randomizado multicêntrico. - O strain global longitudinal do ventrículo esquerdo permite predizer melhora funcional e sobrevida em pacientes com insuficiência mitral assintomática grave e função normal. Meta-análise.

Lo mejor del Congreso Virtual ACC/WCC 2020 / The best of the 2020 ACC/WCC Virtual Congress / O melhor do Congresso Virtual ACC/WCC 2020

Resumen: La pandemia generada por el SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus) ha constituido un desafío mundial. En momentos de dificultad como los que se han presentado recientemente, es aún más necesaria la investigación para avanzar en el diagnóstico y tratamiento de las diferentes patologías. Utilizando el amplio desarrollo de los medios de comunicación, este año el Congreso del Colegio Americano de Cardiología (ACC por su sigla en inglés) se celebró del 28 al 30 de marzo en un formato virtual, permitiendo a profesionales de todo el mundo acceder a múltiples actividades científicas con el mismo nivel de excelencia que en las sesiones presenciales. Realizaremos un breve resumen de alguno de los principales trabajos científicos presentados: - Tailored Antiplatelet Initiation to Lessen Outcomes Due to Decreased Clopidogrel Response after Percutaneous Coronary Intervention: TAILOR-PCI. - Rivaroxaban in Peripheral Artery Disease after Revascularization: VOYAGER PAD trial. - Vericiguat in Patients with Heart Failure and Reduced Ejection Fraction: VICTORIA Study Group. - The Evolut Low Risk Bicuspid Study. - PARTNER 3. Two-year clinical and echocardiographic outcomes. - Ticagrelor with and without Aspirin in Acute Coronary Syndrome After PCI: the TICO Trial - Apixaban for the Treatment of Venous Thromboembolism Associated with Cancer: Caravaggio trial. - Ten-year Outcomes After Drug-eluting Stents Versus Coronary Artery Bypass Grafting for Left Main Coronary Disease: Extended Follow Up of the PRECOMBAT Trial. - Anticoagulation with or without Clopidogrel after Transcatheter Aortic-Valve Implantation: POPular TAVI.

Summary The SARS-CoV-2 pandemic has been a global challenge. In times of difficulty such as those that have recently arisen, research is even more necessary to advance in the diagnosis and treatment of different pathologies. Using the extensive development of the media, this year the American Congress of Cardiology was held from March 28 to 30 in a virtual format, allowing professionals from around the world to access multiple scientific activities with the same level of excellence as in face-to-face sessions. We will make a brief summary of some of the main scientific papers presented: - Tailored Antiplatelet Initiation to Lessen Outcomes Due to Decreased Clopidogrel Response after Percutaneous Coronary Intervention: TAILOR-PCI. - Rivaroxaban in Peripheral Artery Disease after Revascularization: VOYAGER PAD trial:. - Vericiguat in Patients with Heart Failure and Reduced Ejection Fraction: VICTORIA Study Group. - The Evolut Low Risk Bicuspid Study. - PARTNER 3. Two-year clinical and echocardiographic outcomes. - Ticagrelor with and without Aspirin in Acute Coronary Syndrome After PCI: the TICO Trial. - Apixaban for the Treatment of Venous Thromboembolism Associated with Cancer: Caravaggio trial. - Ten-year Outcomes After Drug-eluting Stents Versus Coronary Artery Bypass Grafting for Left Main Coronary Disease: Extended Follow Up of the PRECOMBAT Trial. - Anticoagulation with or without Clopidogrel after Transcatheter Aortic-Valve Implantation: POPular TAVI.

Resumo: A pandemia de SARS-CoV-2 tem sido um desafio global. Em tempos de dificuldade como os que surgiram recentemente, a pesquisa é ainda mais necessária para avançar no diagnóstico e tratamento de diferentes patologias. Utilizando o amplo desenvolvimento da mídia, este ano o Congresso Americano de Cardiologia foi realizado de 28 ao 30 de março em um formato virtual, permitindo que profissionais de todo o mundo acessassem diversas atividades científicas com o mesmo nível de excelência que nas sessões presenciais. Faremos um breve resumo de alguns dos principais trabalhos científicos apresentados: - Tailored Antiplatelet Initiation to Lessen Outcomes Due to Decreased Clopidogrel Response after Percutaneous Coronary Intervention: TAILOR - PCI. - Rivaroxaban in Peripheral Artery Disease after Revascularization: VOYAGER PAD trial. - Vericiguat in Patients with Heart Failure and Reduced Ejection Fraction: VICTORIA Study Group. - The Evolut Low Risk Bicuspid Study. - PARTNER 3. Two-year clinical and echocardiographic outcomes. - Ticagrelor with and without Aspirin in Acute Coronary Syndrome After PCI: the TICO Trial. - Apixaban for the Treatment of Venous Thromboembolism Associated with Cancer: Caravaggio trial. - Ten-year Outcomes After Drug-eluting Stents Versus Coronary Artery Bypass Grafting for Left Main Coronary Disease: Extended Follow Up of the PRECOMBAT Trial. - Anticoagulation with or without Clopidogrel after Transcatheter Aortic-Valve Implantation: POPular TAVI.

Research progress of antithrombotic therapy after transcatheter aortic valve implantation / 中国胸心血管外科临床杂志

@#Traditional surgical aortic valve replacement is associated with a high risk of serious complications, especially in elderly patients with other preoperative diseases and unable to undergo thoracotomy. Therefore, transcatheter aortic valve implantation (TAVI) is now the accepted standard treatment for patients with symptomatic severe aortic stenosis at elevated risk for conventional surgical valve replacement. Currently, guidelines propose the use of dual antiplatelet therapy for the prevention of thromboembolic events after TAVI in the patients without an indication for oral anticoagulation. While, this strategy is empiric and largely based on expert consensus extrapolated from the arena of percutaneous coronary intervention. Antithrombotic therapy is associated with a significant occurrence of both thrombotic and bleeding complications, thus, the balance between thrombotic and bleeding risk is critical. This review summarizes current guidelines and the evidence underpinning them and explores the rational for using antiplatelet and/or anticoagulant strategies after TAVI.

Enfoque minimalista en el implante de válvula aórtica percutánea / A minimalist approach for transcatheter aortic valve replacement

RESUMEN INTRODUCCIÓN: En pacientes con estenosis Aórtica (EA) severa sintomática, el implante de válvula aórtica percutánea transcatéter (TAVI) por vía transfemoral constituye el estándar de tratamiento en aquellos de riesgo quirúrgico intermedio o alto. El uso de un abordaje minimalista ha demostrado ser seguro y efectivo, si bien no existen reportes sobre la realidad nacional Métodos: Estudio descriptivo sobre la experiencia con pacientes sometidos al implante de TAVI bajo un protocolo minimalista en Unidad de Cardiología Intervencional y Hemodinamia del Hospital Sótero del Río desde Enero de 2018. Se analizaron las variables clínicas de los pacientes y del procedimiento así como desenlaces clínicos intrahospitalarios y seguimiento alejado. Resultados: Entre Enero 2018 hasta Abril 2019, un total de 10 pacientes fueron sometidos al implante de TAVI por vía transfemoral. El score STS-PROM promedio fue de 7,1. Se logró un implante exitoso en el 100% de los casos con un gradiente medio residual de 8 mmHg y sin leak moderado a severo en ningún paciente. No hubo eventos cerebrovasculares isquémicos perioperatorios ni muerte en este grupo. Se requirió implante de marcapasos definitivo en 3 pacientes y un paciente presentó hematoma femoral perioperatorio que requirió transfusión de glóbulos rojos. La mediana de la estadía hospitalaria fue de 2 días. Conclusiones: El uso de una estrategia minimalista para el implante de TAVI en nuestra realidad nacional es seguro y aplicable. Los resultados perioperatorios y a 30 días fueron comparables a los descritos en experiencias internacionales.

ABSTRACT BACKGROUND: In patients with symptomatic severe aortic stenosis, transcatheter percutaneous aortic valve implant (TAVI) is the standard treatment in those with intermediate or high surgical risk. The use of a minimalist approach has proven to be safe and effective, although there are no reports on the national reality Methods: Descriptive study on the experience with patients undergoing TAVI implantation under a minimalist protocol at the Interventional Cardiology and Hemodynamics Unit of the Hospital Sótero del Río since January 2018. Clinical characteristics of the patients and the procedure were analyzed as well as intrahospital outcomes and at 30-days follow up. Results: Between January 2018 and April 2019, a total of 10 patients underwent TAVI implantation by transfemoral approach in our institution. The average STS-PROM score was 7.1. A successful implant was achieved in 100% of cases with an average residual gradient of 8 mmHg and no moderate to severe leak in any patient. There were no perioperative ischemic cerebrovascular events nor death in this group. A definitive pacemaker implant was required in 3 patients and one patient developed femoral hematoma that required red blood cell transfusion. The median hospital stay was 2 days. Conclusions: The use of a minimalist strategy for TAVI implantation in our national reality is safe and applicable. Immediate results and at 30-days follow up were comparable to those described in international experiences.

Implante percutáneo de válvula aórtica transcatéter por vía femoral en paciente joven con obesidad extrema / Trans femoral TAVI in extremely obese patient with severe aortic stenosis

RESUMEN:TAVI transfemoral en una paciente con obesidad extrema y estenosis aórtica severa. Una mujer extremadamente obesa (IMC 62.5 Kg/M2) con estenosis aórtica severa fue descartada para cirugía bariátrica y reemplazo valvular aórtico. Se efectuó una TAVI por vía transfemoral, sin anestesia general. Se describen cuidadosas técnicas para efectuar la punción femoral y su sellado posterior. La paciente se recuperó sin incidentes, la gradiente transvalvular aórtica se redujo significativamente y hubo mínima insuficiencia valvular.

ABSTRACT: An extremely obese woman (BMI 62.5 Kg/M2) with severe symptomatic aortic stenosis was discarded for bariatric surgery or aortic valve replacement. A transfemoral TAVI was performed, without general anesthesia. Careful techniques to perform and seal the transfemoral puncture are described. The patient recovered uneventfully with a significant decrease in aortic valve gradient and minimal aortic insufficiency.

TAVI in Intermediate-risk patients: a review in purpose of a case / TAVI en pacientes de riesgo intermedio: una revisión a propósito de un caso

Abstract: Background: Aortic stenosis is the most common valvular heart disease worldwide. The prognosis is adverse without a valve replacement. Transcatheter aortic valve implantation (TAVI) has proven to be an effective treatment in high-surgical risk patients. Recent trials have highlighted the non-inferiority of TAVI compared with open surgery in patients with intermediate surgical risk. Case report: A 76-year-old man with severe aortic stenosis and intermediate surgical risk (STS-PROM 4.8%) who underwent TAVI with no complications. Results: Hospital discharge was decided five days after the procedure and continued outpatient follow-up. After two years remains in NYHA functional class I with a normofunctional percutaneous prosthesis. Conclusion: As this clinical case shows, TAVI has proven to be an effective treatment in patients with aortic stenosis and intermediate surgical risk. This is the first experience in this type of patients reported in our country.(AU)

Resumen: Antecedentes: La estenosis aórtica es la valvulopatía más común en todo el mundo. El pronóstico es sombrío sin reemplazo valvular. La implantación valvular aórtica transcatéter (TAVI) ha demostrado ser un tratamiento eficaz en pacientes de alto riesgo quirúrgico. Ensayos muy recientes destacaron la no-inferioridad de TAVI en comparación con la cirugía abierta en pacientes con riesgo quirúrgico intermedio. Caso clínico: Se presenta un hombre de 76 años de edad con estenosis aórtica severa y riesgo quirúrgico intermedio (STS-PROM 4.8%), al que se realiza TAVI sin complicaciones. Resultados: El alta hospitalaria se decide cinco días después del procedimiento para continuar el seguimiento ambulatorio. Después de dos años, el seguimiento permanece en la clase funcional I de la NYHA con una prótesis percutánea normofuncional. Conclusión: Como muestra este caso clínico, TAVI ha demostrado ser un tratamiento eficaz en pacientes de riesgo quirúrgico intermedio. Ésta es la primera experiencia en el uso de esta tecnología en este tipo de pacientes reportada en nuestro país.(AU)