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Short and long-term clinical impact of transcatheter aortic valve implantation in Portugal according to different access routes: Data from the Portuguese National Registry of TAVI

2020-12Journal article Open access
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dc.contributor.authorGuerreiro, C
dc.contributor.authorFerreira, PC
dc.contributor.authorTeles, RC
dc.contributor.authorBraga, P
dc.contributor.authorCanas da Silva, P
dc.contributor.authorPatrício, L
dc.contributor.authorSilva, JC
dc.contributor.authorBaptista, J
dc.contributor.authorde Sousa Almeida, M
dc.contributor.authorGama Ribeiro, V
dc.contributor.authorSilva, B
dc.contributor.authorBrito, J
dc.contributor.authorInfante Oliveira, E
dc.contributor.authorCacela, D
dc.contributor.authorMadeira, S
dc.contributor.authorSilveira, J
dc.date.accessioned2021-01-02T00:28:04Z
dc.date.available2021-01-02T00:28:04Z
dc.date.issued2020-12
dc.description.abstractIntroduction: 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.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationRev Port Cardiol . 2020 Dec;39(12):705-717.pt_PT
dc.identifier.doi10.1016/j.repc.2020.02.014pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.26/34505
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.subjectInsuficiência Cardíacapt_PT
dc.subjectSubstituição da Valva Aórtica Transcateterpt_PT
dc.subjectTranscatheter Aortic Valve Replacementpt_PT
dc.subjectHeart failurept_PT
dc.titleShort and long-term clinical impact of transcatheter aortic valve implantation in Portugal according to different access routes: Data from the Portuguese National Registry of TAVIpt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage717pt_PT
oaire.citation.issue12pt_PT
oaire.citation.startPage705-717pt_PT
oaire.citation.titleRevista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiologypt_PT
oaire.citation.volume39pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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