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
A significant prosthetic paravalvular leak is an uncommon and severe postsurgical complication correlated to the occurrence of congestive heart failure and hemolytic anemia. Percutaneous treatment has become an attractive and effective proposal to relieve symptoms and reduce complications in patients whose high rate of morbidity/mortality precludes a new surgery. This is the case of an 81-year-old patient with a history of biological aortic valve replacement seeking medical help due to heart failure and hemolytic anemia, with a prosthetic paravalvular regurgitation jet and high surgical mortality according to EuroSCORE II.
Assuntos
Bioprótese/efeitos adversos , Embolização Terapêutica/instrumentação , Insuficiência Cardíaca/terapia , Próteses Valvulares Cardíacas/efeitos adversos , Dispositivo para Oclusão Septal , Idoso de 80 Anos ou mais , Ecocardiografia Transesofagiana , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Humanos , MasculinoRESUMO
Abstract A significant prosthetic paravalvular leak is an uncommon and severe postsurgical complication correlated to the occurrence of congestive heart failure and hemolytic anemia. Percutaneous treatment has become an attractive and effective proposal to relieve symptoms and reduce complications in patients whose high rate of morbidity/mortality precludes a new surgery. This is the case of an 81-year-old patient with a history of biological aortic valve replacement seeking medical help due to heart failure and hemolytic anemia, with a prosthetic paravalvular regurgitation jet and high surgical mortality according to EuroSCORE II.