RESUMO
BACKGROUND: Predictors of permanent pacemaker implantation (PPMI) after self-expanding transcatheter aortic valve implant (TAVI) were described. Is unknown if PPMI predictors remain in the era of high implants using the cusp overlap (COP). METHODS: Single-center, prospective, consecutive case series of patients undergoing self-expanding TAVI with the COP approach. The status of PPMI and other clinical events were ascertained at 30 days. RESULTS: A total of 261 patients were included (84% with Evolut, n = 219). Implant depth >4 mm was infrequent (13.8%). TAVI depth (OR 1.259; p = 0.005), first or second-degree auriculo-ventricular block (OR 3.406; p = 0.033), right-bundle (OR 15.477; p < 0.0001), and incomplete left-bundle branch block (OR 7.964; p = 0.036) were found to be independent predictors of PPMI. The risk of PPMI with deep implant and no electrical disturbances was 3%, and 0% with high implant and no prior electrical disturbances. Those who received PPMI had no statistically significant increased risk of death, myocardial infarction, stroke, bleeding events, or vascular complications at 30 days, but longer hospital stay (mean difference 1.43 days more, p = 0.003). CONCLUSIONS: Implant depth and prior conduction abnormalities remain the main predictors of PPMI using self-expanding TAVI in the COP era. Patients with high implants and no prior conduction abnormalities may be candidates for early discharge after uneventful self-expanding TAVI, while the rest may need inpatient monitoring regardless of achieving a high implant. The need for PPMI was associated with longer hospital stays.
RESUMO
Introdução: As doenças valvares representam a segunda maior indicação de intervenções cirúrgicas cardíacas no Brasil e no mundo. Nesse sentido, a avaliação da qualidade de vida relacionada à saúde (QVRS) após a correção cirúrgica de valvopatias, por meio de instrumentos de medidas em saúde específicos e válidos para este público, tem se tornado emergente na prática clínica, com vistas à avaliação do referido construto. Durante a revisão de literatura, encontramos o Health-Related Quality of Life Questionnaire - HeartQoL, validado em diversos países e em distintos idiomas, todavia, o mesmo não foi adaptado para o português falado no Brasil com esta população específica. Objetivo: O objetivo do estudo foi realizar a adaptação transcultural e analisar as propriedades psicométricas do HeartQoL com indivíduos brasileiros submetidos à correção cirúrgica de valvopatias. Método: Trata-se de estudo metodológico, apreciado pelos Comitês de Ética em Pesquisa das instituições envolvidas. O processo de adaptação transcultural foi realizado conforme o referencial teórico adotado. As amostras consecutivas e não probabilísticas foram constituídas, nas três etapas, por pacientes atendidos no Ambulatório de Valvopatias do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. A coleta de dados ocorreu entre 2022 e 2023, por meio de entrevistas, com 30 pacientes, para a análise semântica do questionário, com outros 30 pacientes, para a realização do pré-teste, e com 140 pacientes, para avaliação das propriedades psicométricas. A validade de construto foi realizada por meio da correlação de Spearman entre o escore global e os domínios do HeartQoL, com os componentes físico e mental do Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). A validade estrutural, ou dimensionalidade, foi realizada pela análise fatorial confirmatória, e a avaliação da confiabilidade, por meio do coeficiente de alfa de Cronbach, para a verificação da consistência interna. Para as análises, foi adotado o nível de significância de 5%. Resultados: A versão adaptada para o português falado no Brasil apresentou-se equivalente à versão original em inglês do questionário. Apresentou evidências de validade de conteúdo a partir da avaliação do comitê de juízes e do pré-teste na amostra elegível para essa etapa. Além disso, apresentou evidências de validade de construto convergente, com correlações positivas e de forte magnitude entre o domínios físico do HeartQoL e o componente físico do SF-36, e entre o domínio emocional do HeartQoL e o componente mental do SF-36. Também apresentou evidências de validade estrutural a partir da confirmação do modelo estrutural com 14 itens e dois domínios e com índices de ajustes satisfatórios (x2 = 118,85; g.l. = 76; p = 0,0012; RMSEA = 0,0635; SRMR = 0,0440; CFI = 0,9604; TLI = 0,9526). Apresentou evidência de confiabilidade a partir do coeficiente de alfa de Cronbach, com valores satisfatórios na avaliação global (α = 0,93) e na avaliação por domínio (físico: α = 0,92; emocional: α = 0,83). Conclusão: O questionário está adaptado culturalmente para o português falado no Brasil, e possui evidências de validade e de confiabilidade comparáveis à versão original quando testadas em pacientes após a correção cirúrgica de valvopatias.
Introduction: Valve diseases represent the second major indication for cardiac surgery in Brazil and worldwide. In this regard, the assessment of health-related quality of life (HRQoL) after valve surgery repair, through specific and valid health measurement instruments for this public, has become emerging in clinical practice, with a view to assessing the said construct. During the literature review, we found the Health-Related Quality of Life Questionnaire - HeartQoL, validated in several countries and in different languages, however, it was not adapted to Brazilian Portuguese with this specific population. Objective: The study aimed to carry out the cross-cultural adaptation and analyze the psychometric properties of HeartQoL with Brazilian individuals undergoing valve surgery repair. Method: This is a methodological study, assessed by the Research Ethics Committees of the institutions involved. The cross-cultural adaptation process was carried out according to the adopted theoretical framework. Consecutive and non-probabilistic samples were constituted, in the three stages, by patients assisted at the Valvopathies Ambulatory of the Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. Data collection took place between 2022 and 2023, through interviews, with 30 patients, for the semantic analysis of the questionnaire, with another 30 patients, for the pre-test, and with 140 patients, for assessing psychometric properties. Construct validity was performed using Spearman's correlation between the global score and the HeartQoL domains, with the physical and mental components of the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). Structural validity, or dimensionality, was performed using confirmatory factor analysis, and reliability was assessed using Cronbach's alpha coefficient to verify internal consistency. For the analyses, a significance level of 5% was adopted. Results: The adapted version for Brazilian Portuguese was equivalent to the original English version of the questionnaire. It presented evidence of content validity based on assessment by committee of judges and the pre-test in the sample eligible for this stage. Moreover, it presented evidence of convergent construct validity with positive and strong correlations between the HeartQoL physical domains and the SF-36 physical component, and between the HeartQoL emotional domain and the SF-36 mental component. It also presented evidence of structural validity from the confirmation of the structural model with 14 items and two domains and with satisfactory adjustment indices (x2 = 118.85; g.l. = 76; p = 0.0012; RMSEA = 0.0635; SRMR = 0.0440; CFI = 0.9604; TLI = 0.9526). It showed evidence of reliability based on Cronbach's alpha coefficient, with satisfactory values in the global assessment (α = 0.93) and in the assessment by domain (physical: α = 0.92; emotional: α = 0.83). Conclusion: The questionnaire is culturally adapted to Brazilian Portuguese, and has evidence of validity and reliability comparable to the original version when tested in patients after valve surgery repair.
Assuntos
Humanos , Qualidade de Vida , Cirurgia Torácica , Comparação Transcultural , Estudo de Validação , Valvopatia AórticaRESUMO
Introdução: As doenças valvares representam a segunda maior indicação de intervenções cirúrgicas cardíacas no Brasil e no mundo. Nesse sentido, a avaliação da qualidade de vida relacionada à saúde (QVRS) após a correção cirúrgica de valvopatias, por meio de instrumentos de medidas em saúde específicos e válidos para este público, tem se tornado emergente na prática clínica, com vistas à avaliação do referido construto. Durante a revisão de literatura, encontramos o Health-Related Quality of Life Questionnaire - HeartQoL, validado em diversos países e em distintos idiomas, todavia, o mesmo não foi adaptado para o português falado no Brasil com esta população específica. Objetivo: O objetivo do estudo foi realizar a adaptação transcultural e analisar as propriedades psicométricas do HeartQoL com indivíduos brasileiros submetidos à correção cirúrgica de valvopatias. Método: Trata-se de estudo metodológico, apreciado pelos Comitês de Ética em Pesquisa das instituições envolvidas. O processo de adaptação transcultural foi realizado conforme o referencial teórico adotado. As amostras consecutivas e não probabilísticas foram constituídas, nas três etapas, por pacientes atendidos no Ambulatório de Valvopatias do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. A coleta de dados ocorreu entre 2022 e 2023, por meio de entrevistas, com 30 pacientes, para a análise semântica do questionário, com outros 30 pacientes, para a realização do pré-teste, e com 140 pacientes, para avaliação das propriedades psicométricas. A validade de construto foi realizada por meio da correlação de Spearman entre o escore global e os domínios do HeartQoL, com os componentes físico e mental do Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). A validade estrutural, ou dimensionalidade, foi realizada pela análise fatorial confirmatória, e a avaliação da confiabilidade, por meio do coeficiente de alfa de Cronbach, para a verificação da consistência interna. Para as análises, foi adotado o nível de significância de 5%. Resultados: A versão adaptada para o português falado no Brasil apresentou-se equivalente à versão original em inglês do questionário. Apresentou evidências de validade de conteúdo a partir da avaliação do comitê de juízes e do pré-teste na amostra elegível para essa etapa. Além disso, apresentou evidências de validade de construto convergente, com correlações positivas e de forte magnitude entre o domínios físico do HeartQoL e o componente físico do SF-36, e entre o domínio emocional do HeartQoL e o componente mental do SF-36. Também apresentou evidências de validade estrutural a partir da confirmação do modelo estrutural com 14 itens e dois domínios e com índices de ajustes satisfatórios (x2 = 118,85; g.l. = 76; p = 0,0012; RMSEA = 0,0635; SRMR = 0,0440; CFI = 0,9604; TLI = 0,9526). Apresentou evidência de confiabilidade a partir do coeficiente de alfa de Cronbach, com valores satisfatórios na avaliação global (α = 0,93) e na avaliação por domínio (físico: α = 0,92; emocional: α = 0,83). Conclusão: O questionário está adaptado culturalmente para o português falado no Brasil, e possui evidências de validade e de confiabilidade comparáveis à versão original quando testadas em pacientes após a correção cirúrgica de valvopatias.
Introduction: Valve diseases represent the second major indication for cardiac surgery in Brazil and worldwide. In this regard, the assessment of health-related quality of life (HRQoL) after valve surgery repair, through specific and valid health measurement instruments for this public, has become emerging in clinical practice, with a view to assessing the said construct. During the literature review, we found the Health-Related Quality of Life Questionnaire - HeartQoL, validated in several countries and in different languages, however, it was not adapted to Brazilian Portuguese with this specific population. Objective: The study aimed to carry out the cross-cultural adaptation and analyze the psychometric properties of HeartQoL with Brazilian individuals undergoing valve surgery repair. Method: This is a methodological study, assessed by the Research Ethics Committees of the institutions involved. The cross-cultural adaptation process was carried out according to the adopted theoretical framework. Consecutive and non-probabilistic samples were constituted, in the three stages, by patients assisted at the Valvopathies Ambulatory of the Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. Data collection took place between 2022 and 2023, through interviews, with 30 patients, for the semantic analysis of the questionnaire, with another 30 patients, for the pre-test, and with 140 patients, for assessing psychometric properties. Construct validity was performed using Spearman's correlation between the global score and the HeartQoL domains, with the physical and mental components of the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). Structural validity, or dimensionality, was performed using confirmatory factor analysis, and reliability was assessed using Cronbach's alpha coefficient to verify internal consistency. For the analyses, a significance level of 5% was adopted. Results: The adapted version for Brazilian Portuguese was equivalent to the original English version of the questionnaire. It presented evidence of content validity based on assessment by committee of judges and the pre-test in the sample eligible for this stage. Moreover, it presented evidence of convergent construct validity with positive and strong correlations between the HeartQoL physical domains and the SF-36 physical component, and between the HeartQoL emotional domain and the SF-36 mental component. It also presented evidence of structural validity from the confirmation of the structural model with 14 items and two domains and with satisfactory adjustment indices (x2 = 118.85; g.l. = 76; p = 0.0012; RMSEA = 0.0635; SRMR = 0.0440; CFI = 0.9604; TLI = 0.9526). It showed evidence of reliability based on Cronbach's alpha coefficient, with satisfactory values in the global assessment (α = 0.93) and in the assessment by domain (physical: α = 0.92; emotional: α = 0.83). Conclusion: The questionnaire is culturally adapted to Brazilian Portuguese, and has evidence of validity and reliability comparable to the original version when tested in patients after valve surgery repair.
Assuntos
Qualidade de Vida , Cirurgia Torácica , Estudo de Validação , Valvopatia AórticaRESUMO
Introdução: As doenças valvares representam a segunda maior indicação de intervenções cirúrgicas cardíacas no Brasil e no mundo. Nesse sentido, a avaliação da qualidade de vida relacionada à saúde (QVRS) após a correção cirúrgica de valvopatias, por meio de instrumentos de medidas em saúde específicos e válidos para este público, tem se tornado emergente na prática clínica, com vistas à avaliação do referido construto. Durante a revisão de literatura, encontramos o Health-Related Quality of Life Questionnaire - HeartQoL, validado em diversos países e em distintos idiomas, todavia, o mesmo não foi adaptado para o português falado no Brasil com esta população específica. Objetivo: O objetivo do estudo foi realizar a adaptação transcultural e analisar as propriedades psicométricas do HeartQoL com indivíduos brasileiros submetidos à correção cirúrgica de valvopatias. Método: Trata-se de estudo metodológico, apreciado pelos Comitês de Ética em Pesquisa das instituições envolvidas. O processo de adaptação transcultural foi realizado conforme o referencial teórico adotado. As amostras consecutivas e não probabilísticas foram constituídas, nas três etapas, por pacientes atendidos no Ambulatório de Valvopatias do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. A coleta de dados ocorreu entre 2022 e 2023, por meio de entrevistas, com 30 pacientes, para a análise semântica do questionário, com outros 30 pacientes, para a realização do pré-teste, e com 140 pacientes, para avaliação das propriedades psicométricas. A validade de construto foi realizada por meio da correlação de Spearman entre o escore global e os domínios do HeartQoL, com os componentes físico e mental do Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). A validade estrutural, ou dimensionalidade, foi realizada pela análise fatorial confirmatória, e a avaliação da confiabilidade, por meio do coeficiente de alfa de Cronbach, para a verificação da consistência interna. Para as análises, foi adotado o nível de significância de 5%. Resultados: A versão adaptada para o português falado no Brasil apresentou-se equivalente à versão original em inglês do questionário. Apresentou evidências de validade de conteúdo a partir da avaliação do comitê de juízes e do pré-teste na amostra elegível para essa etapa. Além disso, apresentou evidências de validade de construto convergente, com correlações positivas e de forte magnitude entre o domínios físico do HeartQoL e o componente físico do SF-36, e entre o domínio emocional do HeartQoL e o componente mental do SF-36. Também apresentou evidências de validade estrutural a partir da confirmação do modelo estrutural com 14 itens e dois domínios e com índices de ajustes satisfatórios (x2 = 118,85; g.l. = 76; p = 0,0012; RMSEA = 0,0635; SRMR = 0,0440; CFI = 0,9604; TLI = 0,9526). Apresentou evidência de confiabilidade a partir do coeficiente de alfa de Cronbach, com valores satisfatórios na avaliação global (α = 0,93) e na avaliação por domínio (físico: α = 0,92; emocional: α = 0,83). Conclusão: O questionário está adaptado culturalmente para o português falado no Brasil, e possui evidências de validade e de confiabilidade comparáveis à versão original quando testadas em pacientes após a correção cirúrgica de valvopatias.
Introduction: Valve diseases represent the second major indication for cardiac surgery in Brazil and worldwide. In this regard, the assessment of health-related quality of life (HRQoL) after valve surgery repair, through specific and valid health measurement instruments for this public, has become emerging in clinical practice, with a view to assessing the said construct. During the literature review, we found the Health-Related Quality of Life Questionnaire - HeartQoL, validated in several countries and in different languages, however, it was not adapted to Brazilian Portuguese with this specific population. Objective: The study aimed to carry out the cross-cultural adaptation and analyze the psychometric properties of HeartQoL with Brazilian individuals undergoing valve surgery repair. Method: This is a methodological study, assessed by the Research Ethics Committees of the institutions involved. The cross-cultural adaptation process was carried out according to the adopted theoretical framework. Consecutive and non-probabilistic samples were constituted, in the three stages, by patients assisted at the Valvopathies Ambulatory of the Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. Data collection took place between 2022 and 2023, through interviews, with 30 patients, for the semantic analysis of the questionnaire, with another 30 patients, for the pre-test, and with 140 patients, for assessing psychometric properties. Construct validity was performed using Spearman's correlation between the global score and the HeartQoL domains, with the physical and mental components of the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). Structural validity, or dimensionality, was performed using confirmatory factor analysis, and reliability was assessed using Cronbach's alpha coefficient to verify internal consistency. For the analyses, a significance level of 5% was adopted. Results: The adapted version for Brazilian Portuguese was equivalent to the original English version of the questionnaire. It presented evidence of content validity based on assessment by committee of judges and the pre-test in the sample eligible for this stage. Moreover, it presented evidence of convergent construct validity with positive and strong correlations between the HeartQoL physical domains and the SF-36 physical component, and between the HeartQoL emotional domain and the SF-36 mental component. It also presented evidence of structural validity from the confirmation of the structural model with 14 items and two domains and with satisfactory adjustment indices (x2 = 118.85; g.l. = 76; p = 0.0012; RMSEA = 0.0635; SRMR = 0.0440; CFI = 0.9604; TLI = 0.9526). It showed evidence of reliability based on Cronbach's alpha coefficient, with satisfactory values in the global assessment (α = 0.93) and in the assessment by domain (physical: α = 0.92; emotional: α = 0.83). Conclusion: The questionnaire is culturally adapted to Brazilian Portuguese, and has evidence of validity and reliability comparable to the original version when tested in patients after valve surgery repair.
Assuntos
Humanos , Qualidade de Vida , Cirurgia Torácica , Comparação Transcultural , Estudo de Validação , Valvopatia AórticaRESUMO
The aim of this work was to obtain insights of the participation of the autonomic nervous system in different stages of calcific aortic valve disease (CAVD) by heart rate variability (HRV) analysis. Studying subjects with no valve impairments and CAVD patients, we also sought to quantify the independent contribution or explanatory capacity of the aortic valve echocardiographic parameters involved in the HRV changes caused by active standing using hierarchical partitioning models to consider other variables or potential confounders. We detected smaller adjustments of the cardiac autonomic response at active standing caused specifically by the aortic valve deterioration. The highest association (i.e., the highest percentage of independent exploratory capacity) was found between the aortic valve area and the active standing changes in the short-term HRV scaling exponent α1 (4.591%). The valve's maximum pressure gradient echocardiographic parameter was present in most models assessed (in six out of eight models of HRV indices that included a valve parameter as an independent variable). Overall, our study provides insights with a wider perspective to explore and consider CAVD as a neurocardiovascular pathology. This pathology involves autonomic-driven compensatory mechanisms that seem generated by the aortic valve deterioration.
RESUMO
Resumen Objetivo: Describir las características clínicas y los resultados operatorios y a siete años del reemplazo valvular aórtico en una cohorte de pacientes mayores de 80 años. Materiales y métodos: Estudio descriptivo retrospectivo de 75 pacientes consecutivos mayores de 80 años, intervenidos de reemplazo valvular aórtico exclusivo entre 2007 y 2019 en el Hospital Guillermo Grant Benavente. Se estudian sus características demográficas, clínicas, ecocardiográficas, riesgo operatorio, cirugías, complicaciones y mortalidad operatoria y supervivencia alejada hasta el 15 de marzo 2021. Resultados: La edad media de la cohorte fue 83,05 ± 2,9 años (rango 80-95) y 43 pacientes eran mujeres (57,3%). La lesión valvular predominante fue la estenosis aórtica (89,3%). 10 pacientes tenían enfermedad coronaria asociada (13,3%) y 2 endocarditis activa. El riesgo de mortalidad operatoria calculado por EuroSCORE aditivo, logístico, II y STS score fue 7,58 ± 1,8; 9,88 ± 6,5%; 3,72 ± 3,5% y 4,27 ± 3,2%, respectivamente. Se utilizó prótesis biológica en 70 (92%) pacientes. Hubo 29 complicaciones operatorias y fallecieron 11 (14,7%) pacientes. El seguimiento promedio fue 7,1 años (rango 2-14), durante el cual fallecen 28 pacientes. La supervivencia a uno, tres y cinco años fue 82, 76, 66 y 48% respectivamente. Conclusiones: La cirugía de reemplazo valvular aórtico en octogenarios en nuestro medio es un procedimiento poco frecuente. La mortalidad observada fue mayor que la estimada por las escalas de riesgo. El reemplazo valvular quirúrgico es una alternativa de tratamiento de la enfermedad de la válvula aórtica en pacientes seleccionados. Se deben evaluar estrategias para mejorar los resultados.
Abstract Objective: To describe the clinical characteristics and operative and 7-year results of aortic valve replacement in a cohort of patients older than 80 years. Materials and methods: Retrospective descriptive study of 75 consecutive patients older than 80 years of age who underwent exclusive aortic valve replacement between 2007 and 2019 at the Guillermo Grant Benavente Hospital. Demographic, clinical, echocardiographic characteristics, operative risk, surgeries, complications and operative mortality and long-term survival until March 15, 2021 are studied. Results: The mean age of the cohort was 83.05 ± 2.9 years (range 80-95) and 43 patients were women (57.3%). The predominant valve lesion was aortic stenosis (89.3%). Ten patients had an associated coronary artery disease (13.3%) and 2 had active endocarditis. The risk of operative mortality calculated by EuroSCORE additive, logistic, II and STS score was 7.58 ± 1.8; 9.88 ± 6.5%; 3.72 ± 3.5% and 4.27 ± 3.2%, respectively. A biological prosthesis was used in 70 (92%) patients. There were 31 operative complications and 11 (14.7%) patients died. The mean follow-up was 7.1 years (range 2-14), during which 28 patients died. Survival at 1, 3, and 5 years was 82, 76, 66 and 48%, respectively. Conclusions: Aortic valve replacement surgery in octogenarians in our setting is a rare procedure. The observed mortality was higher than that estimated by the risk scales. Surgical valve replacement is an alternative treatment for aortic valve disease in selected patients. Strategies to improve results should be evaluated.
RESUMO
Percutaneous surgery is the treatment of choice of isolated aortic coarctation in adults However, when there are other heart problems related to aortic coarctation, its surgical management may vary. We report a 41-year-old male presenting with aortic coarctation associated with severe, symptomatic, bicuspid aortic valve lesions and significant left ventricular dysfunction. He underwent open heart surgery for the surgical resolution of these problems. One year after surgery the results are satisfactory with no evidence of postoperative complications and a significant improvement of patient symptoms and left ventricular function.
Assuntos
Humanos , Masculino , Adulto , Coartação Aórtica/cirurgia , Coartação Aórtica/complicações , Coartação Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Complicações Pós-Operatórias , Doença da Válvula Aórtica BicúspideRESUMO
COVID-19 pandemic generated multiple challenges for the health system. Cardiovascular disease is associated with a worse prognosis of infections. Moreover, most hospital resources and operative rooms were destined to patients with COVID-19 infection, deferring the treatment of most valvular patients requiring surgery. We report seven patients with symptomatic severe aortic stenosis who underwent transcatheter aortic valve implantation (TAVI) with conscious sedation and early discharge. No patient required intensive care unit admission or mechanical ventilation. After a 90-day follow-up, there were no complications or unplanned readmissions.
Assuntos
Humanos , Estenose da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/etiologia , Substituição da Valva Aórtica Transcateter/efeitos adversos , COVID-19 , Alta do Paciente , Fatores de Risco , Sedação Consciente/efeitos adversos , Resultado do Tratamento , PandemiasAssuntos
Estenose da Valva Aórtica , Substituição da Valva Aórtica Transcateter , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Humanos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do TratamentoRESUMO
RESUMEN Introducción: El reemplazo quirúrgico de la válvula aórtica (REEAO) en pacientes con valvulopatía aórtica grave sintomática, es el tratamiento definido como el de referencia. Sin embargo, el implante valvular aórtico transcatéter (TAVI) se posiciona actualmente como una alternativa en pacientes de diferentes riesgos según los scores internacionales. Algunas guías consideran al TAVI como el procedimiento preferible en los pacientes añosos. Objetivos: Conocer el riesgo y resultados de morbimortalidad del REEAO en pacientes adultos clasificados según la edad en mayores de 75 años, o de 75 años o menos. Material y métodos: Estudio retrospectivo sobre 228 pacientes consecutivos intervenidos mediante REEAO entre el 1 de enero de 2011 y el 31 de diciembre de 2020 por valvulopatía aórtica grave sintomática. Del total de pacientes operados, 46 (16%) eran mayores de 75 años (Grupo 1, G1) y 182 pacientes (84%) tenían 75 años o menos (Grupo 2, G2). Se excluyeron pacientes con enfermedad coronaria concomitante, endocarditis bacteriana u otras valvulopatías asociadas. Resultados: Los pacientes del G1 tenían mayor riesgo de morbimortalidad quirúrgica analizado por scores de riesgo validados: ArgenSCORE de 1,55 (RIC 0,99-3,33) vs 1,08 (RIC 0,68-2,23), p = 0,02 y STS score de 2,33 (RIC 1,57-3,23) vs. 0,94 (RIC 0,721,44), p = 0,0001, con respecto al G2; no se encontraron en cambio diferencias significativas en el EuroSCORE II : 2,37 (RIC 1,19-3,61) vs. 1,83 (RIC 1,16-3,04), p = 0,2. La mortalidad registrada global fue del 1,7% (G1: 2,1% vs. G2: 1,6% , p NS); no se observaron accidente cerebrovascular (ACV) ni infarto agudo de miocardio (IAM) perioperatorios. Conclusiones: La escasa presentación de muerte, ACV e IAM sugiere que el tratamiento seleccionado para estos pacientes fue adecuado, con excelentes resultados sin diferencias entre los dos grupos etarios.
ABSTRACT Background: Surgical aortic valve replacement (SAVR) is the reference treatment in patients with symptomatic severe aortic valve disease. However, according to international scores, transcatheter aortic valve implantation (TAVI) is currently an alternative in different risk patients, and some guidelines consider TAVI as a preferable procedure in elderly patients. Objectives: The aim of this study was to assess SAVR morbidity and mortality risk and results in adult patients, classified according to age as >75 years or ≤75 years. Methods: A retrospective study was performed on 228 consecutive patients undergoing SAVR between January 1, 2011 and December 31, 2020 for symptomatic severe aortic valve disease. Among the total number of patients operated on, 46 (16%) were >75 years (Group 1, G1) and 182 (84%) were ≤75 years (Group 2, G2). Patients with concomitant coronary heart disease, bacterial endocarditis or other associated valve diseases were excluded from the analysis. Results: Group 1 patients had greater risk of surgical morbidity and mortality analyzed by validated risk scores: ArgenSCORE 1.55 (IQR 0.99-3.33) vs 1.08 (IQR 0.68-2.23), p = 0.02 and STS score 2.33 (IQR 1.57-3.23) vs. 0.94 (IQR 0.72-1.44), p = 0.0001, with respect to G2, while no significant differences were found for EuroSCORE II: 2.37 (IQR 1.19-3.61) vs. 1.83 (IQR 1.163.04), p = 0.2. Overall mortality was 1.7% (G1: 2.1% vs. G2: 1.6%, p=NS), with no perioperative stroke or acute myocardial infarction (AMI). Conclusions: The low number of deaths, stroke and AMI observed suggests that the selected treatment for these patients was adequate, with excellent results and without significant differences between these two age groups.
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BACKGROUND: Calcific aortic valve stenosis (CAVS) is a fatal disease and there is no pharmacological treatment to prevent the progression of CAVS. This study aims to identify genes potentially implicated with CAVS in patients with congenital bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) in comparison with patients having normal valves, using a knowledge-slanted random forest (RF). RESULTS: This study implemented a knowledge-slanted random forest (RF) using information extracted from a protein-protein interactions network to rank genes in order to modify their selection probability to draw the candidate split-variables. A total of 15,191 genes were assessed in 19 valves with CAVS (BAV, n = 10; TAV, n = 9) and 8 normal valves. The performance of the model was evaluated using accuracy, sensitivity, and specificity to discriminate cases with CAVS. A comparison with conventional RF was also performed. The performance of this proposed approach reported improved accuracy in comparison with conventional RF to classify cases separately with BAV and TAV (Slanted RF: 59.3% versus 40.7%). When patients with BAV and TAV were grouped against patients with normal valves, the addition of prior biological information was not relevant with an accuracy of 92.6%. CONCLUSION: The knowledge-slanted RF approach reflected prior biological knowledge, leading to better precision in distinguishing between cases with BAV, TAV, and normal valves. The results of this study suggest that the integration of biological knowledge can be useful during difficult classification tasks.
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Aortic stenosis is a progressive heart valve disorder characterized by calcification of the leaflets. Heart rate variability (HRV) analysis has been proposed for assessing the heart response to autonomic activity, which is documented to be altered in different cardiac diseases. The objective of the study was to evaluate changes of HRV in patients with aortic stenosis by an active standing challenge. Twenty-two volunteers without alterations in the aortic valve (NAV) and twenty-five patients diagnosed with moderate and severe calcific aortic valve stenosis (AVS) participated in this cross-sectional study. Ten minute electrocardiograms were performed in a supine position and in active standing positions afterwards, to obtain temporal, spectral, and scaling HRV indices: mean value of all NN intervals (meanNN), low-frequency (LF) and high-frequency (HF) bands spectral power, and the short-term scaling indices (α1 and αsign1). The AVS group showed higher values of LF, LF/HF and αsign1 compared with the NAV group at supine position. These patients also expressed smaller changes in meanNN, LF, HF, LF/HF, α1, and αsign1 between positions. In conclusion, we confirmed from short-term recordings that patients with moderate and severe calcific AVS have a decreased cardiac parasympathetic supine response and that the dynamic of heart rate fluctuations is modified compared to NAV subjects, but we also evidenced that they manifest reduced autonomic adjustments caused by the active standing challenge.
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Background: Despite being introduced 20 years ago minimally invasive aortic valve replacement is only performed routinely in a minority of patients world-wide. Aim: To report the operative outcome of minimally invasive aortic valve replacement done through a partial upper sternotomy. Patients and Methods: Retrospective analysis of data recorded prospectively of 450 consecutive patients with a median age of 66 years (59% males) who had a minimally invasive aortic replacement. Results: 79% of patients had aortic stenosis. Cross clamp/cardiopulmonary bypass times (median) were 56 and 68 minutes respectively. Conversion to full sternotomy was required in 2.6% of patients, reoperation for bleeding in 2.9%. 1.6% suffered a stroke and 19% postoperative atrial fibrillation. 0.9% required a permanent pacemaker. Postoperative mortality was 0.9%. Median postoperative hospital stay was six days. Conclusions: Minimally invasive aortic valve replacement can be performed with satisfactory results.
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Humanos , Masculino , Feminino , Idoso , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Minimamente InvasivosRESUMO
Although aortic valve replacement remains the gold standard treatment for aortic valve diseases like stenosis (AS) or insufficiency, new surgical methods have been developed with a focus in the reconstruction of the aortic valve rather than replacing it. The Ozaki procedure involves a tailored replacement of each individual valvular leaflet with glutaraldehyde-treated autologous pericardium and aims to reproduce the normal anatomy of the aortic valve. Cases of patients with unicuspid aortic valve treated with the Ozaki procedure are uncommon in the litrature and become even more rare when it comes to concomitant diseases like AS and ascending aorta aneurysm. We present the case of a 21-year-old, fit and asymptomatic male, with unicuspid aortic valve with severe stenosis and ascending aorta dilatation, surgically treated with tricuspidization of the aortic valve with glutaraldehyde-treated autologous pericardium and replacement of the ascending aorta with a straight synthetic graft. Postoperative studies showed a fully functional, neo-tailored tricuspid aortic valve with trivial regurgitation. The patient had an uncomplicated recovery, stayed in the intensive care unit for 2 days and was discharged on the 7th postoperative day.
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Aneurisma Aórtico , Doenças das Valvas Cardíacas , Adulto , Aorta , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/cirurgia , Valva Aórtica/cirurgia , Humanos , Masculino , Adulto JovemRESUMO
We present a first case of Staphylococcus cohnii endocarditis in an 80-year-old patient with a history of valve regurgitation. Endocarditis by this organism has not been reported previously. The patient declined treatment and died a few days later. When present, S. cohnii endocarditis has a poor prognosis as a result of associated comorbidities and the infection itself.
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We present a case of a 36-year-old male patient with known arthrogryposis multiplex congenita and an associated unicuspid aortic valve. The patient later developed a significant aneurysm of the ascending aorta, however refused surgical intervention and missed follow-up appointments for 5 years. During an urgent, general practitioner-initiated transthoracic echocardiography follow-up, a chronic type A aortic dissection was diagnosed as a result of progressive aortic dilatation. Due to the stationary pressure gradients and non-progressive leaflet fibrosis, a conservative approach for to the unicuspid aortic valve was chosen, combined with replacement of the ascending aorta and partial replacement of the aortic arch.
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Dissecção Aórtica , Implante de Prótese de Valva Cardíaca , Adulto , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/cirurgia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Tratamento Conservador , Doenças das Valvas Cardíacas , Humanos , MasculinoRESUMO
Abstract We present a case of a 36-year-old male patient with known arthrogryposis multiplex congenita and an associated unicuspid aortic valve. The patient later developed a significant aneurysm of the ascending aorta, however refused surgical intervention and missed follow-up appointments for 5 years. During an urgent, general practitioner-initiated transthoracic echocardiography follow-up, a chronic type A aortic dissection was diagnosed as a result of progressive aortic dilatation. Due to the stationary pressure gradients and non-progressive leaflet fibrosis, a conservative approach for to the unicuspid aortic valve was chosen, combined with replacement of the ascending aorta and partial replacement of the aortic arch.
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Humanos , Masculino , Adulto , Implante de Prótese de Valva Cardíaca , Dissecção Aórtica/cirurgia , Dissecção Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Valva Aórtica/diagnóstico por imagem , Tratamento Conservador , Doenças das Valvas CardíacasRESUMO
OBJECTIVE: We sought to compare the new transcatheter aortic valve replacement (TAVR) device ACURATE neo (ACT) with the already established CoreValve (MCV) and SAPIEN XT (SXT) for the treatment of severe aortic stenosis (AS). BACKGROUND: Very few data on TAVR devices are available beyond MCV and SAPIEN and there is no previous study comparing ACT with MCV and SXT. METHODS: We prospectively evaluated consecutive patients who underwent transfemoral TAVR for the treatment of severe AS. Clinical outcomes were reported following Valve Academic Research Consortium 2 (VARC-2) criteria. RESULTS: A total of 162 patients (ACT n = 49, MCV n = 56, SXT n = 57), were included. MCV group had higher valve embolization/migration rates (ACT none; MCV 9%; SXT 2%; P = 0.034) causing lower device success rates (ACT 98%; MCV 86%; SXT 95%; P = 0.043). At 30 days, there was no significant difference in all-cause mortality (P = 0.22), cardiovascular mortality (P = 0.20), periprocedural myocardial infarction (P = 0.40), stroke (P = 0.64), major vascular complications (P = 0.48), life-threatening bleeding (P = 0.29), acute kidney injury stage 2/3 (P = 0.69), or VARC-2 composite early safety endpoints (P = 0.21). MCV group had higher rates of new permanent pacemaker implantation (ACT 6%; MCV 25%; SXT 11%; P = 0.013). Follow-up echocardiography showed no significant difference in aortic valve mean pressure gradient (P = 0.73) or moderate/severe aortic regurgitation (P = 0.19) between groups. CONCLUSIONS: In a "real world" registry, ACT compared favorably against the well-studied SXT and MCV devices in both safety and efficacy. MCV implantation was associated with lower device success rates and higher rates of new permanent pacemaker implantation. © 2016 Wiley Periodicals, Inc.
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Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas , Equipe de Assistência ao Paciente , Substituição da Valva Aórtica Transcateter/instrumentação , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/fisiopatologia , Brasil , Feminino , Hemodinâmica , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Desenho de Prótese , Recuperação de Função Fisiológica , Sistema de Registros , Índice de Gravidade de Doença , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do TratamentoRESUMO
OBJECTIVES: The objectives of the present study were to analyze the variation of renal function after transcatheter aortic valve replacement (TAVR) focused on acute kidney injury (AKI) and its impact on short- and mid-term mortality. BACKGROUND: Changes on renal function after TAVR and their impact on clinical outcomes are incompletely understood until now. METHODS: At two tertiary centers 221 consecutive patients were submitted to TAVR. Kidney injury was defined according to VARC-2 criteria. Patients were classified according to the presence (group 1) or absence (group 2) of AKI. Creatinine values were collected daily until seventh day after procedure, 1 month, 6 months, and then 1 year after TAVR. RESULTS: At baseline, groups were similar, except for EuroSCORE II (8.66% vs. 7.34%, P = 0.02) and glomerular filtration rate (GFR) (39.59 vs. 48.49 mL/min.1.73 m2 , P = 0.002). Overall 30 day-mortality and 1-year mortality were 6.3% and 14.0%, respectively. Both 30-day mortality (23.1% vs. 1.2%, P < 0.001) and 1-year mortality (44.2% vs. 4.7%, P < 0.001) were higher in group 1. After multivariable-adjusted models, the only independent predictor for AKI after TAVR was baseline GFR (HR: 1.37, 95% CI: 1.08-1.77, P = 0.01). The independent risk factors for 1-year mortality were AKI (HR: 15.66, 95% CI: 6.07-44.63, P < 0.001), COPD (HR: 3.14, 95% CI: 1.05-9.40, P = 0.04) and aortic regurgitation grade postprocedure ≥ 2 (P = 0.05) also after multivariate analysis. CONCLUSIONS: In this TAVR cohort, baseline GFR was the only independent predictor of AKI, which negatively impacted on 30-day and 1-year mortality. © 2016 Wiley Periodicals, Inc.
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Injúria Renal Aguda/etiologia , Estenose da Valva Aórtica/terapia , Valva Aórtica , Cateterismo Cardíaco/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Rim/fisiopatologia , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/mortalidade , Injúria Renal Aguda/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/fisiopatologia , Biomarcadores/sangue , Brasil , Cateterismo Cardíaco/instrumentação , Cateterismo Cardíaco/métodos , Distribuição de Qui-Quadrado , Creatinina/sangue , Ecocardiografia , Feminino , Taxa de Filtração Glomerular , Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Análise Multivariada , Razão de Chances , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Centros de Atenção Terciária , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: The study sought to evaluate outcomes and predictors of mortality after transcatheter aortic valve implantation (TAVI). BACKGROUND: TAVI registries can reliably address outcomes and issues that adversely affect results in real-life. METHODS: All endpoints and complications were analyzed according to Valve Academic Research Consortium-2 criteria. RESULTS: Between January 2008 and January 2013, 418 patients underwent TAVI in 18 centers and were included in the Brazilian registry. The transfemoral approach was used in 96.2% of the procedures. The CoreValve and Sapien XT prosthesis were used in 360 (86.1%) and 58 (13.9%) cases, respectively. All-cause mortality at 30 days and 1 year were 9.1 and 21.5%. Chronic obstructive pulmonary disease (COPD) (HR: 3.50), acute kidney injury (AKI) (HR: 3.07), stroke (HR: 2.71) and moderate/severe paravalvular regurgitation (PVR) (HR: 2.76) emerged as independent predictors of overall mortality. COPD (OR: 3.00), major vascular complications (OR: 7.99) and device malpositioning (OR: 6.97) were predictors of early (≤30 days) mortality, while COPD (HR: 2.68), NYHA class III/IV (HR: 3.04), stroke (HR: 4.15), AKI (HR: 2.44) and moderate/severe PVR (HR: 3.20) impacted late (>30 days) mortality. The use of transesophageal echocardiogram (TEE) to monitor the procedure was found to be a protective factor against overall (HR: 0.57) and late (HR: 0.47) mortality. CONCLUSION: This multicenter registry reflected a real-life national TAVI experience. Comorbidities, periprocedural complications and moderate/severe PVR were associated with increased mortality and the use of TEE to monitor the procedure acted as a protective factor.