Carla Agatiello

Avaliação do stent coronário eluidor de everolimus XIENCE TM V na cpopulação feminina latino-americana do estudo de braço único SPIRIT Women: acompanhamento clínico de um ano

BACKGROUND: Drug-eluting stent trials have predominantly examined male populations of European descent. SPIRIT Women single-arm study evaluates the XIENCETM V everolimus-eluting stent in complex de novo lesions in a real world female population, including Latin American patients. This analysis provides an insight into how this population responds to stenting when compared to non-Latin American patients. METHODS: Of the 1,572 patients enrolled from 73 non-US sites, 138 (9%) were recruited from Argentina, Brazil and Venezuela. RESULTS: Target lesions had reference vessel diameter ranging between 2.25 mm and 4 mm and lesion length ≤ 28 mm. Baseline characteristics were similar between the groups, with exception to a higher prevalence of hypertension, anterior myocardial infarction (MI) and family history of coronary artery disease in the Latin American cohort. Lesions tended to be more complex in Latin American women with a smaller reference vessel diameter, longer lesion length, increased eccentricity and angulation, and more type B2/C lesions. Events were adjudicated according to the guidelines of the Academic Research Consortium. At 1 year, the composite endpoint of death, MI and target vessel revascularization (TVR) was 12.1% in the non-Latin American population and 10.1% in the Latin American population (P = 0.58). CONCLUSIONS: At 1 year, the low rates of adverse cardiac events, including stent thrombosis, target lesion failure, cardiac death, MI and TVR in Latin American women were comparable to those of the non-Latin American women, despite the higher complexity of lesions. These results demonstrate the safety and efficacy of the XIENCETM V stent in this small cohort of Latin American patients, in line with what is observed in larger and more varied populations.

A repetição da valvuloplastia aórtica por balão é uma boa estratégia para alívio dos sintomas e seleção de pacientes para substituição percutânea da valva aórtica

INTRODUCAO: A valvuloplastia aortica por balao voltou a ganhar interesse desde o inicio da era da substituicao percutânea da valva aortica, por ser um procedimento que pode ser repetido como ponte e tambem por ser boa estrategia para a selecao de pacientes para o novo procedimento. METODO: De janeiro de 2001 a janeiro de 2009, 174 pacientes consecutivos com estenose aortica sintomatica grave e alto risco cirurgico calculado pelo EuroSCORE/ STS foram submetidos a valvuloplastia aortica por balao na Franca e na Argentina, utilizando-se a mesma tecnica. Desse total, 21 (12,1%) precisaram repetir a valvuloplastia aortica por balao em decorrencia de reestenose e os resultados foram comparados aos dos 153 pacientes que realizaram somente o primeiro procedimento. A tecnica mais utilizada foi o acesso retrogrado com abordagem femoral utilizando introdutores de 10 F, 12 F ou 14 F, com tamanhos de balao variando de 20 mm a 23 mm. RESULTADOS: A media de idade foi de 80,4 ± 9,7 anos e o EuroSCORE foi de 21 ± 2%. Abordagem femoral retrograda foi utilizada em 95% dos casos. Os resultados do procedimento primario foram os seguintes: a area valvar aortica aumentou de 0,9 ± 19 cm2 para 1,02 ± 0,20 cm2 e o gradiente medio caiu de 50 ± 21 mmHg para 22 ± 11 mmHg. Os resultados foram semelhantes apos a repeticao da valvuloplastia aortica por balao em termos da area valvar aortica, com melhora de 0,60 ± 0,1 cm2 para 1,01 ± 0,25 cm2 em um periodo de 13 ± 9 meses entre os dois procedimentos. As taxas de complicacoes hospitalares foram: morte, 3,3% vs. 9,5% (P = 0,20); acidente vascular cerebral embolico, 1,3% vs. 0 (P = 0,20); regurgitacao aortica macica, 3,3% vs. 9,5% (P = 0,20); ruptura do balao, 1,3% vs. 0 (P = 0,20); tamponamento pericardico, 0 vs. 5% (P = 0,12); e complicacoes vasculares, 3,9% vs. 9,5% (P = 0,25). No total, 48 pacientes (27,5%) foram selecionados como bons candidatos para substituicao percutânea da valva aortica durante o periodo de acompanhamento nos dois paises, dos quais 36 realizaram o procedimento na Franca e 4, na Argentina. CONCLUSOES: A repeticao da valvuloplastia aortica por balao e uma estrategia util em pacientes idosos naocirurgicos com estenose aortica sintomatica grave para aliviar os sintomas apos reestenose e como ponte para a substituicao percutânea da valva aortica. Essa tecnica pode ser repetida com baixa taxa de complicacoes.

Clinical outcome in nonagenarians undergoing transcatheter valve replacement

Background Nonagenarians are mostly denied from different therapeutic strategies due to high preoperative risk. We present the results of nonagenarians with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Methods Our retrospective analysis include baseline and procedural data along with clinical outcome. Clinical follow-up was performed in all patients after TAVR. Results Out of 689 patients, 33 nonagenarians with a mean age of 90.9 ± 1.4 years suffering from severe AS and elevated comorbidity index (logistic EuroSCORE of 16.3 ± 9.6%, STS score 11.1 ± 9.9%) underwent TAVR between September 2009 and July 2016 using self-expanding prosthesis. Baseline transthoracic echocardiography reported a mean aortic valve area (AVA) of 0.64 ± 0.12 cm2 with a mean pressure gradient of 56.1 ± 16.1 mmHg. Five (16.2%) patients had postprocedural moderate/severe aortic regurgitation. One patient died intraoperally due to ventricular perforation during predilatation, while two patients died within the first 30 days, one due to cardiogenic shock and the other due to pneumonia. No patient experienced a myocardial infarction or a stroke, while ten (30.3%) required permanent pacemaker placement. At follow-up (mean 20.3 months, range 1–78 months), all cause and cardiovascular mortality was 24.2% and 15.1%, respectively. Two patients presented heart failure and 12 (40%) had exertional dyspnea. By echo, mean valve area was 1.72 ± 0.12 cm2 and mean gradient 11.2 ± 1.4 mmHg. Two patients (16.7%) presented moderate aortic regurgitation. Conclusion Our case series demonstrate that even with elevated comorbidity index, clinical endpoints and valve-associated results are relatively favorable in nonagenarians treated with TAVR.

Consenso del implante valvular aórtico percutáneo del Colegio Argentino de Cardioangiólogos Intervencionistas 2016

1 Coordinadora: Dra. Carla Agatiello. Comité de Redacción: Dra. Alfonsina Candiello, Dr. Matías Sztejfman, Dr. Carlos Fava, Dr. Diego Grinfeld, Dr. Ignacio Seropian, Dr. Antonio Scuteri, Dr. Aníbal Damonte, Dr. Juan Mieres. Comité de Revisión: Dr. Hugo Londero, Dr. Oscar Mendiz, Dr. Fernando Cura, Dr. Daniel Berrocal, Dr. Miguel Payaslian, Dr. Alfredo Rodríguez, Dr. José Álvarez, Dr. Claudio Cigalini, Dr. Ernesto Torresani, Dr. Arturo Fernández Murga, Dr. José Gómez Moreno, Dr. Marcelo Menéndez, Dr. Alejandro Cherro, Dr. Jorge Baccaro, Dr. Alejandro Álvarez