Objectives: The aim of the study was to evaluate mid-to late clinical and echocardiographic outcomes after transcatheter aortic valve replacement (TAVR) with Acurate neo™ (Boston Scientific, Boston, MA). Background: TAVR is an established treatment for aortic stenosis (AS). Few data exist on mid-to long-term outcomes and durability after new-generation valves. Methods: All consecutive patients (n = 104) who underwent Acurate neo™ implantation from 2012 to 2018 were included. Follow-up was systematically performed at 1, 6, 12, and 24 months and yearly thereafter. Outcomes were reported according to VARC-2, and structural valve deterioration (SVD) or bioprosthetic valve failure defined accordingly to new definitions. Results: Mean age was 82 ± 5.4 years, 56.7% were female and the Society of Thoracic Surgeons score for mortality was 5.9 ± 4%. Patients were followed for a median of 3 years (1,092 days; IQR 1.5-4 years), and the maximum follow-up was 7 years. All-cause mortality values at 1 and 5 years were 8.5% and 40.5%, respectively. No relevant changes in mean gradient and orifice area occurred (7.9 ± 3.8 mmHg and 1.9 ± 0.3 cm 2 at 1 year; 6.6 ± 2.1 mmHg and 1.8 ± 0.3 cm 2 at 5 years), and there was a significant rate of paravalvular leaks resolution at 1, 2, and 3 years (p = .004; p < .001; p < .001, respectively). None of the patients had leaflet thrombosis or endocarditis. One patient developed SVD at 84 months. Conclusions: Acurate neo™ was associated with sustained echocardiographic results. Reassuring mid-to long-term outcomes was observed in this cohort of elderly patients with severe AS.
Background: Thrombus formation in the left atrial appendage (LAA) is the main cause of thromboembolic events in patients with non-valvular atrial fibrillation (AF). Oral anticoagulants are considered first-line therapy for stroke prevention in AF patients. Despite its proven efficacy, long-term oral anticoagulation is associated to innumerous limitations. Percutaneous LAA closure has emerged as a new strategy for stroke prevention in high risk AF patients who are not candidates for long term oral anticoagulation therapy. Methods: We report the initial experience with percutaneous occlusion of the LAA using the new Amplatzer TM Cardiac Plug (ACP -AGA Medical Corp., Golden Valley, USA) in patients with AF and CHADS2 score > 2 who were not eligible for anticoagulation therapy. Procedures were carried out under general anesthesia and 3D transesophageal echocardiography monitoring in real time. Results: Three male patients, mean age of 79 years and CHADS2 2, 3 and 5 scores had the device successfully implanted using a transeptal approach with no complications, resulting in immediate LAA occlusion and hospital discharge two days later. At the 50-day followup, all patients were clinically well with complete LAA occlusion and no complications at transthoracic echocardiography. Conclusions: Percutaneous LAA occlusion with the new ACP seems to be an attractive alternative to prevent thromboembolic events in patients with AF and contraindications or limitations for anticoagulation therapy.
Análise da Incidência e Preditores Clínicos e Ecocardiográficos do Refluxo Paraprotético Aórtico após o Implante de Prótese Aórtica Transcateter Introdução: A incidência de refluxo paraprotético (RPP) parece maior entre os pacientes submetidos a implante de prótese aórtica transcateter e sua potencial associação com aumento da mortalidade tardia tem suscitado preocupação na comunidade científica. Nosso objetivo foi avaliar a incidência e o impacto clínico e estabelecer preditores do RPP em nossa casuística. Métodos: Entre julho de 2009 e fevereiro de 2013, 112 pacientes foram submetidos a implante de prótese aórtica transcateter. O grau do RPP pós-procedimento foi avaliado segundo os critérios do VARC 2. Dividiu-se a população em grupo RPP ausente/RPP discreto e grupo RPP moderado/RPP grave.
0,99), infarto agudo do miocárdio (0,7% vs. 1,1%; P = 0,16) e cirurgia de revascularização miocárdica de emergência (0,1% vs. 0; P = 0,62). Diabetes, coronariopatia multiarterial, lesões tipo B2/C e oclusões totais foram as variáveis que melhor explicaram a ocorrência de eventos hospitalares. CONCLUSÕES: As mulheres, que representam um terço dos pacientes submetidos a ICP em nosso serviço, têm perfil clínico mais grave, mas menor complexidade anatômica que os homens. Neste estudo, o sexo feminino não foi preditor de eventos clínicos adversos hospitalares.]]>
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