Impacto clínico em curto e longo prazo da Válvula Aórtica Percutânea (VAP) em Portugal de acordo com diferentes acessos – Dados do Registo Nacional de Cardiologia de Intervenção de VAP
Autor(a) principal: | |
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Data de Publicação: | 2020 |
Outros Autores: | , , , , , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10362/147428 |
Resumo: | Introduction: The Portuguese National Registry of Transcatheter Aortic Valve Implantation records prospectively the characteristics and outcomes of transcatheter aortic valve implantation (TAVI) procedures in Portugal. Objectives: To assess the 30-day and one-year outcomes of TAVI procedures in Portugal. Methods: We compared TAVI results according to the principal access used (transfemoral (TF) vs. non-transfemoral (non-TF)). Cumulative survival curves according to access route, other procedural and clinical variables were obtained. The Valve Academic Research Consortium-2 (VARC-2) composite endpoint of early (30-days) safety was assessed. VARC-2 predictors of 30-days and 1-year all-cause mortality were identified. Results: Between January 2007 and December 2018, 2346 consecutive patients underwent TAVI (2242 native, 104 valve-in-valve; mean age 81±7 years, 53.2% female, EuroSCORE-II - EuroS-II, 4.3%). Device success was 90.1% and numerically lower for non-TF (87.0%). Thirty-day all-cause mortality was 4.8%, with the TF route rendering a lower mortality rate (4.3% vs. 10.1%, p=0.001) and higher safety endpoint (86.4% vs. 72.6%, p<0.001). The one-year all-cause mortality rate was 11.4%, and was significantly lower for TF patients (10.5% vs. 19.4%, p<0.002). After multivariate analysis, peripheral artery disease, previous percutaneous coronary intervention, left ventricular dysfunction and NYHA class III-IV were independent predictors of 30-day all-cause mortality. At one-year follow-up, NYHA class III-IV, non-TF route and occurrence of life-threatening bleeding predicted mortality. Kaplan-Meier survival analysis of the first year of follow-up shows decreased survival for patients with an EuroS-II>5% (p<0.001) and who underwent non-TF TAVI (p<0.001). Conclusion: Data from our national real-world registry showed that TAVI was safe and effective. The use of a non-transfemoral approach demonstrated safety in the short term. Long-term prognosis was, however, adversely associated with this route, with comorbidities and the baseline clinical status. |
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Impacto clínico em curto e longo prazo da Válvula Aórtica Percutânea (VAP) em Portugal de acordo com diferentes acessos – Dados do Registo Nacional de Cardiologia de Intervenção de VAPShort and long-term clinical impact of transcatheter aortic valve implantation in Portugal according to different access routesData from the Portuguese National Registry of TAVIHeart failureSevere aortic valvular diseaseTAVICardiology and Cardiovascular MedicineIntroduction: The Portuguese National Registry of Transcatheter Aortic Valve Implantation records prospectively the characteristics and outcomes of transcatheter aortic valve implantation (TAVI) procedures in Portugal. Objectives: To assess the 30-day and one-year outcomes of TAVI procedures in Portugal. Methods: We compared TAVI results according to the principal access used (transfemoral (TF) vs. non-transfemoral (non-TF)). Cumulative survival curves according to access route, other procedural and clinical variables were obtained. The Valve Academic Research Consortium-2 (VARC-2) composite endpoint of early (30-days) safety was assessed. VARC-2 predictors of 30-days and 1-year all-cause mortality were identified. Results: Between January 2007 and December 2018, 2346 consecutive patients underwent TAVI (2242 native, 104 valve-in-valve; mean age 81±7 years, 53.2% female, EuroSCORE-II - EuroS-II, 4.3%). Device success was 90.1% and numerically lower for non-TF (87.0%). Thirty-day all-cause mortality was 4.8%, with the TF route rendering a lower mortality rate (4.3% vs. 10.1%, p=0.001) and higher safety endpoint (86.4% vs. 72.6%, p<0.001). The one-year all-cause mortality rate was 11.4%, and was significantly lower for TF patients (10.5% vs. 19.4%, p<0.002). After multivariate analysis, peripheral artery disease, previous percutaneous coronary intervention, left ventricular dysfunction and NYHA class III-IV were independent predictors of 30-day all-cause mortality. At one-year follow-up, NYHA class III-IV, non-TF route and occurrence of life-threatening bleeding predicted mortality. Kaplan-Meier survival analysis of the first year of follow-up shows decreased survival for patients with an EuroS-II>5% (p<0.001) and who underwent non-TF TAVI (p<0.001). Conclusion: Data from our national real-world registry showed that TAVI was safe and effective. The use of a non-transfemoral approach demonstrated safety in the short term. Long-term prognosis was, however, adversely associated with this route, with comorbidities and the baseline clinical status.NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)RUNGuerreiro, CláudioFerreira, Pedro CarrilhoTeles, Rui CampanteBraga, PedroCanas da Silva, PedroPatrício, LinoSilva, João CarlosBaptista, Joséde Sousa Almeida, ManuelGama Ribeiro, VascoSilva, BrunoBrito, JoãoInfante Oliveira, EduardoCacela, DuarteMadeira, SérgioSilveira, João2023-01-12T22:15:45Z2020-122020-12-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article13application/pdfhttp://hdl.handle.net/10362/147428por0870-2551PURE: 27716010https://doi.org/10.1016/j.repc.2020.02.014info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2024-03-11T05:28:31Zoai:run.unl.pt:10362/147428Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T03:52:55.234681Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Impacto clínico em curto e longo prazo da Válvula Aórtica Percutânea (VAP) em Portugal de acordo com diferentes acessos – Dados do Registo Nacional de Cardiologia de Intervenção de VAP Short and long-term clinical impact of transcatheter aortic valve implantation in Portugal according to different access routesData from the Portuguese National Registry of TAVI |
title |
Impacto clínico em curto e longo prazo da Válvula Aórtica Percutânea (VAP) em Portugal de acordo com diferentes acessos – Dados do Registo Nacional de Cardiologia de Intervenção de VAP |
spellingShingle |
Impacto clínico em curto e longo prazo da Válvula Aórtica Percutânea (VAP) em Portugal de acordo com diferentes acessos – Dados do Registo Nacional de Cardiologia de Intervenção de VAP Guerreiro, Cláudio Heart failure Severe aortic valvular disease TAVI Cardiology and Cardiovascular Medicine |
title_short |
Impacto clínico em curto e longo prazo da Válvula Aórtica Percutânea (VAP) em Portugal de acordo com diferentes acessos – Dados do Registo Nacional de Cardiologia de Intervenção de VAP |
title_full |
Impacto clínico em curto e longo prazo da Válvula Aórtica Percutânea (VAP) em Portugal de acordo com diferentes acessos – Dados do Registo Nacional de Cardiologia de Intervenção de VAP |
title_fullStr |
Impacto clínico em curto e longo prazo da Válvula Aórtica Percutânea (VAP) em Portugal de acordo com diferentes acessos – Dados do Registo Nacional de Cardiologia de Intervenção de VAP |
title_full_unstemmed |
Impacto clínico em curto e longo prazo da Válvula Aórtica Percutânea (VAP) em Portugal de acordo com diferentes acessos – Dados do Registo Nacional de Cardiologia de Intervenção de VAP |
title_sort |
Impacto clínico em curto e longo prazo da Válvula Aórtica Percutânea (VAP) em Portugal de acordo com diferentes acessos – Dados do Registo Nacional de Cardiologia de Intervenção de VAP |
author |
Guerreiro, Cláudio |
author_facet |
Guerreiro, Cláudio Ferreira, Pedro Carrilho Teles, Rui Campante Braga, Pedro Canas da Silva, Pedro Patrício, Lino Silva, João Carlos Baptista, José de Sousa Almeida, Manuel Gama Ribeiro, Vasco Silva, Bruno Brito, João Infante Oliveira, Eduardo Cacela, Duarte Madeira, Sérgio Silveira, João |
author_role |
author |
author2 |
Ferreira, Pedro Carrilho Teles, Rui Campante Braga, Pedro Canas da Silva, Pedro Patrício, Lino Silva, João Carlos Baptista, José de Sousa Almeida, Manuel Gama Ribeiro, Vasco Silva, Bruno Brito, João Infante Oliveira, Eduardo Cacela, Duarte Madeira, Sérgio Silveira, João |
author2_role |
author author author author author author author author author author author author author author author |
dc.contributor.none.fl_str_mv |
NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM) RUN |
dc.contributor.author.fl_str_mv |
Guerreiro, Cláudio Ferreira, Pedro Carrilho Teles, Rui Campante Braga, Pedro Canas da Silva, Pedro Patrício, Lino Silva, João Carlos Baptista, José de Sousa Almeida, Manuel Gama Ribeiro, Vasco Silva, Bruno Brito, João Infante Oliveira, Eduardo Cacela, Duarte Madeira, Sérgio Silveira, João |
dc.subject.por.fl_str_mv |
Heart failure Severe aortic valvular disease TAVI Cardiology and Cardiovascular Medicine |
topic |
Heart failure Severe aortic valvular disease TAVI Cardiology and Cardiovascular Medicine |
description |
Introduction: The Portuguese National Registry of Transcatheter Aortic Valve Implantation records prospectively the characteristics and outcomes of transcatheter aortic valve implantation (TAVI) procedures in Portugal. Objectives: To assess the 30-day and one-year outcomes of TAVI procedures in Portugal. Methods: We compared TAVI results according to the principal access used (transfemoral (TF) vs. non-transfemoral (non-TF)). Cumulative survival curves according to access route, other procedural and clinical variables were obtained. The Valve Academic Research Consortium-2 (VARC-2) composite endpoint of early (30-days) safety was assessed. VARC-2 predictors of 30-days and 1-year all-cause mortality were identified. Results: Between January 2007 and December 2018, 2346 consecutive patients underwent TAVI (2242 native, 104 valve-in-valve; mean age 81±7 years, 53.2% female, EuroSCORE-II - EuroS-II, 4.3%). Device success was 90.1% and numerically lower for non-TF (87.0%). Thirty-day all-cause mortality was 4.8%, with the TF route rendering a lower mortality rate (4.3% vs. 10.1%, p=0.001) and higher safety endpoint (86.4% vs. 72.6%, p<0.001). The one-year all-cause mortality rate was 11.4%, and was significantly lower for TF patients (10.5% vs. 19.4%, p<0.002). After multivariate analysis, peripheral artery disease, previous percutaneous coronary intervention, left ventricular dysfunction and NYHA class III-IV were independent predictors of 30-day all-cause mortality. At one-year follow-up, NYHA class III-IV, non-TF route and occurrence of life-threatening bleeding predicted mortality. Kaplan-Meier survival analysis of the first year of follow-up shows decreased survival for patients with an EuroS-II>5% (p<0.001) and who underwent non-TF TAVI (p<0.001). Conclusion: Data from our national real-world registry showed that TAVI was safe and effective. The use of a non-transfemoral approach demonstrated safety in the short term. Long-term prognosis was, however, adversely associated with this route, with comorbidities and the baseline clinical status. |
publishDate |
2020 |
dc.date.none.fl_str_mv |
2020-12 2020-12-01T00:00:00Z 2023-01-12T22:15:45Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10362/147428 |
url |
http://hdl.handle.net/10362/147428 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.none.fl_str_mv |
0870-2551 PURE: 27716010 https://doi.org/10.1016/j.repc.2020.02.014 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
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openAccess |
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13 application/pdf |
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RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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