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ObjectiveTranscatheter aortic valve replacement has been an alternative to invasive treatment for symptomatic severe aortic stenosis in high risk patients. The primary endpoint was 30-day and 1-year mortality from any cause. Secondary endpoints were to compare the clinical and echocardiographic variation pre-and post- transcatheter aortic valve replacement, and the occurrence of complications throughout a 4-year follow-up period.MethodsThis prospective cohort, nestled to a multicenter study (Registro Brasileiro de Implante de Bioprótese por Cateter), describes the experience of a public tertiary center in transcatheter aortic valve replacement. All patients who underwent this procedure between October 2011 and February 2016 were included.ResultsFifty-eight patients underwent transcatheter aortic valve replacement. The 30-day all-cause mortality was 5.2% (n=3) and after 1 year was 17.2% (n=10). A significant improvement in New York Heart Association functional classification was observed when comparing pre-and post- transcatheter aortic valve replacement (III or IV 84.4% versus 5.8%; P<0.001). A decline in peak was observed (P<0.001) and mean (P<0.001) systolic transaortic gradient. The results of peak and mean post-implant transaortic gradient were sustained after one year (P=0.29 and P=0.36, respectively). Left ventricular ejection fraction did not change significantly during follow-up (P=0.41). The most frequent complications were bleeding (28.9%), the need for permanent pacemaker (27.6%) and acute renal injury (20.6%).ConclusionMortality and complications in this study were consistent with worldwide experience. Transcatheter aortic valve replacement had positive clinical and hemodynamic results, when comparing pre-and post-procedure, and the hemodynamic profile of the prosthesis was sustained throughout follow-up.

A primeira definição de insuficiência cardíaca (IC) publicada em livro foi de Lewis1, em 1933, e apresentava forte correlação com estado edematoso, uma vez que a IC, na época, era o principal fator fisiopatológico contribuinte para o edema e dispnéia. Era descrita, portanto, como “condição em que o coração não consegue descarregar seu conteúdo adequadamente”. Com advento do estudo hemodinâmico invasivo, Braunwald2 em 1992 publicou uma nova definição para IC que, acrescenta e destaca, o conceito das pressões de enchimento e descreve a IC como “incapacidade do coração de bombear sangue de forma a atender às necessidades metabólicas tissulares, ou pode fazê-lo somente com elevadas pressões de enchimento”. Esse conceito, embora útil do ponto de vista fisiopatológico, não é aplicado para maioria dos pacientes com IC e está presente somente nas formas terminais da doença.

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Indications of cardiac resynchronization therapy (CRT) do not include exercise‐induced left bundle branch block, but functional impairment could be improved with CRT in such cases. A 57‐year‐old woman with idiopathic dilated cardiomyopathy (ejection fraction 23%) presented with New York Heart Association Class IV and recurrent hospitalizations. During heart transplant evaluation, a new onset of intermittent left bundle branch block was observed on the cardiopulmonary exercise test. CRT was implanted, and 97% resynchronization rate was achieved. In 12 month follow‐up, both clinical and prognostic exercise parameters improved. In patients with heart failure with reduced ejection fraction and no left bundle branch block at rest, exercise test can uncover electromechanical dyssynchrony that may benefit from CRT.