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Sociedade Brasileira de Cirurgia Cardiovascular
2022
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| Acceso en línea: | https://www.redalyc.org/articulo.oa?id=398973275014 https://www.redalyc.org/journal/3989/398973275014/ https://www.redalyc.org/journal/3989/398973275014/html/ https://www.redalyc.org/journal/3989/398973275014/398973275014.epub https://www.redalyc.org/journal/3989/398973275014/movil |
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- High Residual Gradient Following a Self-Expandable Transcatheter Aortic Valve-in-Valve Implantation — Risk Factor Analysis, Outcomes, and Survival Tomasz Stankowski Sleiman Sebastian Aboul-Hassan Piotr Stepinski Tomasz Gasior Mohammed Salem Temirlan Erkenov Volker Herwig Axel Harnath Anja Muehle Michel Pompeu B O Sá Dirk Fritzsche Bartlomiej Perek Medicina Survivors Risk Factors Bioprosthesis Survival Rate Hear Valve Prosthesis Introduction: Transcatheter aortic valve-in-valve implantation (TAVI-ViV) can be associated with unfavorable hemodynamic outcomes. This study aimed to estimate the prevalence, identify the risk factors, and evaluate the outcomes and survival of patients with high residual gradients after TAVI-ViV.Methods: A total of 85 patients were included in the study. The cohort was divided into group A, with postprocedural mean pressure gradient (PG) ≥ 20 mmHg, and group B, with mean PG < 20 mmHg.Results: Postprocedural PG ≥ 20 mmHg was observed in 24.7% of the patients. In a univariate analysis, preoperative gradient, pre-existing patient-prosthesis mismatch (PPM), deep valve implantation, small degenerated valves, and an older generation of transcatheter aortic valves were found to be risk factors for high residual gradient. Multivariate analysis showed that preexisting maxPG > 60 mmHg, implantation level of 4 mm below neo-annulus, and degenerated valve size ≤ 23 mm were independent predictors of high residual gradient. There were no differences in early morbidity (myocardial infarction, pacemaker implantation, stroke, acute renal insufficiency) between groups. Kaplan-Meier estimated that the survival rate was comparable at one and five years regardless of postoperative gradient. Survivors with high residual mean gradient were significantly affected by a high New York Heart Association (NYHA) class.Conclusion: High residual transvalvular gradient after TAVI-ViV is not rare, but it does not significantly affect mortality. High residual mean gradient has a negative impact on NYHA functional class improvement after the procedure. High preoperative gradient, implantation level, and small failed bioprosthesis may predispose to increased residual gradient. 2022 artículo científico 0102-7638 https://www.redalyc.org/articulo.oa?id=398973275014 https://www.redalyc.org/journal/3989/398973275014/ https://www.redalyc.org/journal/3989/398973275014/html/ https://www.redalyc.org/journal/3989/398973275014/398973275014.epub https://www.redalyc.org/journal/3989/398973275014/movil 10.21470/1678-9741-2020-0424 en http://www.redalyc.org/revista.oa?id=3989 Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery application/pdf Sociedade Brasileira de Cirurgia Cardiovascular Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery (Brasil) Num.5 Vol.37