Assuntos
Estenose da Valva Aórtica , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Humanos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do TratamentoRESUMO
BACKGROUND: Transfemoral access is the preferred approach for transcatheter aortic valve implantation (TAVI), as it is characterized by the lowest complication rate. In the majority of patients ineligible for transfemoral access, the transcarotid approach can be used. AIMS: This study aimed to compare shortterm outcomes in 2 groups of patients treated with transcarotid or transfemoral TAVI. METHODS: A retrospective comparison included 265 patients in whom the TAVI procedure was performed between 2017 and 2019 (transcarotid TAVI, n = 33; transfemoral TAVI, n = 232). Preoperative characteristics, procedural and postprocedural outcomes, as well as 30day mortality were assessed. RESULTS: Compared with the transfemoral TAVI group,patients undergoing transcarotid TAVI presented with a higher New York Heart Association (NYHA) functional class (median [interquartile range (IQR)], 3 [3-3] vs 2 [2-3]; P <0.001), a higher surgical risk (median [IQR] EuroSCORE II, 6 [4.8-10.7] vs 4.8 [2.8-7.9]; P = 0.003), and a higher incidence of peripheral artery disease (36.4% vs 18.1%; P = 0.035). The median (IQR) procedure duration in the transcarotid TAVI group was shorter than in patients undergoing transfemoral TAVI (65 [60-80] min vs 90 [80-110] min; P <0.001, respectively). In both study groups, we noted a high percentage of procedural success (transcarotid vs transfemoral TAVI, 96.9% vs 97.2%; P = 0.66). We found no significant differences between transcarotid TAVI and transfemoral TAVI in terms of periprocedural and 30day mortality as well as the number of strokes. Regardless of the access route chosen, echocardiographic parameters and the NYHA class similarly improved compared with preprocedural data. CONCLUSIONS: Despite posing a higher baseline risk and presenting a greater anatomic complexity, transcarotid access is safe and associated with 30day outcomes similar to those observed for transfemoral access. Importantly, procedural time was short and no periprocedural strokes or vascular complications were reported.
Assuntos
Estenose da Valva Aórtica , Substituição da Valva Aórtica Transcateter , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Fluoroscopia , Humanos , Estudos Retrospectivos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do TratamentoAssuntos
Estenose da Valva Aórtica , Endocardite , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Endocardite/diagnóstico por imagem , Endocardite/tratamento farmacológico , Endocardite/etiologia , Próteses Valvulares Cardíacas/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Reoperação , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do TratamentoAssuntos
Aneurisma Aórtico/cirurgia , Valva Aórtica/anormalidades , Implante de Prótese Vascular , Procedimentos Cirúrgicos Cardíacos , Doenças das Valvas Cardíacas/cirurgia , Adulto , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/etiologia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Doença da Válvula Aórtica Bicúspide , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/diagnóstico por imagem , Humanos , Desenho de Prótese , Resultado do TratamentoAssuntos
Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Anuloplastia da Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Idoso , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/fisiopatologia , Anuloplastia da Valva Cardíaca/efeitos adversos , Anuloplastia da Valva Cardíaca/normas , Feminino , Próteses Valvulares Cardíacas/normas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/normas , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Recuperação de Função Fisiológica , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
BACKGROUND: Restrictive mitral annuloplasty is the preferred method of treating secondary mitral regurgitation. The use of small annuloplasty rings to reduce the high recurrence rates may result in mitral stenosis. METHODS: Thirty-six patients who underwent restrictive mitral annuloplasty with Carpentier-Edwards classic 26 size ring underwent exercise echocardiography and ergospirometry. Resting catecholamines and N-terminal pro brain natriuretic peptide (NT-proBNP) levels were measured. RESULTS: At the time of study, the median time from operation was 16.6 months (interquartile range, 8.5 to 43.3 months). Left ventricular end-systolic volume index (LVESVI) was 67 mL/m(2) (interquartile range, 25 to 92 mL/m(2)), and ejection fraction (EF) was 38.8% (interquartile range, 28.3% to 59.0%). Mitral gradients were higher at the leaflet tips than at the annular level. Continuous wave (CW) Doppler gradients at rest were 3.4 mmHg (interquartile range, 2.4 to 4.9 mmHg) mean and 9.5 mmHg (interquartile range, 7.0 to 14.7 mmHg) maximal. On exertion, they increased to 6.8 mmHg (interquartile range, 5.4 to 8.8 mmHg) (p = 0.001) and 19.7 mmHg (interquartile range, 12.8 to 23.3 mmHg) (p = 0.001), respectively. Maximal VO2 was 18.2 mL/kg/min (interquartile range, 16.3 to 21.5 mL/kg/min), VE/VCO2 slope was 31.1 (interquartile range, 26 to 34). Epinephrine level was 0.024 ng/mL (interquartile range, 0.0098 to 0.043 ng/mL), norepinephrine was 0.61 ng/mL (interquartile range, 0.41 to 0.95 ng/mL), and NT-proBNP was 303 pg/mL (interquartile range, 155 to 553 pg/mL). Maximal VO2 negatively correlated with resting norepinephrine level (r = -0.50, p = 0.003). VE/VCO2 slope positively correlated with NT-proBNP (r = 0.36, p = 0.004) and epinephrine (r = 0.36, p = 0.04) levels and with LV volumes (r = 0.51, p = 0.006) and was negatively correlated with LVEF (r = -0.52, p = 0.004). Neither maximal VO2 nor VE/VCO2 slope correlated with the highest mean (r = 0.24, p = 0.2, and r = -0.20, p = 0.3, respectively) and maximal (r = 0.13, p = 0.5, r = -0.20, p = 0.3, respectively) mitral gradients on exertion. CONCLUSIONS: Restrictive mitral annuloplasty for secondary mitral regurgitation does result in a degree of mitral stenosis; however, primary heart disease seems more important for patient's exercise performance than the mitral stenosis resulting from using an undersized ring.