Two decades of transcatheter aortic valve implantation (TAVI) changed the history of contemporary medicine and became a reference model in cardiovascular disease. Percutaneous structural heart ...disease (SHD) therapies emerged to treat the entire heart valve and vessel spectrum, as well as congenital or acquired wall and muscular defects. (R)evolution happened back in 2002 with Alain Cribier's human aortic valve disease percutaneous milestone treatment.1 A progressive and impressive range of therapeutic alternatives for patients grew parallel to the population's longevity given the most prevalent etiology of aortic stenosis is degenerative. In fact, cardiovascular diseases remain the leading causes of death and hospitalization and represent an enormous clinical and public health burden, which disproportionately affects older adults. The World Health Organization expects octogenarians to quadruple up to 396 million by 2050. Although rheumatic heart disease has become rare in industrialized countries, its overall burden is still significant. It comes as no surprise that complex patients who can benefit from combined valvular procedures are increasingly common. The TAVI impact on cardiology and cardiac surgery surpassed the clinical field and imposed a restructure as the path taken in aortic valve disease is transposed, progressively, to other structural clinical areas, namely mitral, tricuspid, and acute stroke prevention. WHAT'S...
Dos décadas realizando implantes percutáneos de válvula aórtica (TAVI) han trasformado la historia médica contemporánea convirtiéndolo en un modelo de referencia en el tratamiento de la enfermedad ...cardiovascular. El intervencionismo transcatéter en cardiopatía estructural (CE) nació para tratar toda la válvula cardiaca y todo tipo de vasos, los defectos musculares y los defectos congénitos o adquiridos de la pared vascular. La (r)evolución sucedió en 2002 con el hito que supuso el tratamiento transcatéter de la valvulopatía aórtica humana ideado por el Dr. Alain Cribier1. El impresionante y creciente abanico de alternativas terapéuticas que tenemos hoy en día para el abordaje de los pacientes ha aumentado parejo a la longevidad de la población teniendo en cuenta que la etiología más prevalente de la estenosis aórtica es degenerativa. De hecho, las enfermedades cardiovasculares siguen siendo la principal causa de mortalidad y hospitalización y suponen una carga enorme tanto a nivel clínico como de salud pública afectando, de forma desigual, a adultos de edad avanzada. La Organización Mundial de la Salud estima que el número de octogenarios se cuadruplicará en 2050 (396 millones). Aunque la enfermedad cardiovascular reumática es una patología rara en países industrializados su carga a nivel global sigue siendo significativa. No...
Objectives
Aim of this study is to evaluate safety, feasibility, and mid‐term outcome of transcatheter aortic valve implantation (TAVI) in cardiogenic shock (CS).
Background
Balloon aortic ...valvuloplasty in patients with severe aortic valve stenosis (SAS) complicated by CS is indicated but associated with a grim prognosis. TAVI might be a more reasonable treatment option in this setting but data are scant.
Methods
From March 2008 to February 2019, 51 patients with severe aortic valvulopathy (native SAS or degenerated aortic bioprosthesis) and CS treated by TAVI in 11 European centers were included in this multicenter registry. Demographic, clinical, and procedural data were collected, as well as clinical and echocardiographic follow‐up.
Results
The mean age of our study population was 75.8 ± 13, 49% were women, and mean Society of Thoracic Surgeons (STS) score was 19 ± 15%. Device success was achieved in 94.1%, with a 5% incidence of moderate/severe paravalvular leak. The 30‐day events were mortality 11.8%, stroke 2.0%, vascular complications 5.9%, and acute kidney injury 34%. Valve Academic Research Consortium‐2 early safety endpoint was reached in 35.3% of cases. At 1‐year of follow‐up, the mortality rate was 25.7% and the readmission for congestive heart failure was 8.6%.
Conclusions
TAVI seems to be a therapeutic option for patients with CS and SAS or degenerated aortic bioprosthesis in terms of both safety and efficacy at early and long‐term follow‐up.
Significant coronary artery disease (CAD) is a frequent finding in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI), and the management of these two ...conditions becomes of particular importance with the extension of the procedure to younger and lower-risk patients. Yet, the preprocedural diagnostic evaluation and the indications for treatment of significant CAD in TAVI candidates remain a matter of debate. In this clinical consensus statement, a group of experts from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) in collaboration with the European Society of Cardiology (ESC) Working Group on Cardiovascular Surgery aims to review the available evidence on the topic and proposes a rationale for the diagnostic evaluation and indications for percutaneous revascularisation of CAD in patients with severe aortic stenosis undergoing transcatheter treatment. Moreover, it also focuses on commissural alignment of transcatheter heart valves and coronary re-access after TAVI and redo-TAVI.
Objectives
We aimed to describe hemodynamic performance and clinical outcomes at 30‐day follow‐up of the balloon‐expandable (BE) Myval transcatheter heart valve (THV) in low‐risk patients.
Background
...The results of the next‐generation BE Myval THV in low‐risk aortic stenosis (AS) patients are still unknown.
Methods
Retrospective registry performed in nine European centers including patients with low predicted operative mortality risk according to Society of thoracic surgeons (STS) and European system for cardiac operative risk evaluation (EuroSCORE‐II) scores.
Results
Between September 2019 and February 2021, a total of 100 patients (51% males, mean age 80 ± 6.5 years) were included. Mean STS score and EuroSCORE‐II were 2.4 ± 0.8% and 2.2 ± 0.7%, respectively. Intermediate sizes were used in 39% (21.5 mm: 8%, 24.5 mm: 15%, 27.5 mm: 15%). There were no cases of valve embolization, coronary artery occlusion, annulus rupture, or procedural death. A definitive pacemaker implantation was needed in eight patients (8%). At 30‐day follow‐up aortic valve area (0.7 ± 0.2 vs. 2.1 ± 0.6 cm2) and mean aortic valve gradient (43.4 ± 11.1 vs. 9.0 ± 3.7 mmHg) improved significantly (p < 0.001). Moderate aortic regurgitation occurred in 4%. Endpoints of early safety and clinical efficacy were 3 and 1%, respectively.
Conclusions
Hemodynamic performance and 30‐day clinical outcomes of the BE Myval THV in low‐risk AS patients were favorable. Longer‐term follow‐up is warranted.
During the Covid-19 pandemic there has been a general belief that hospital admissions for non-infectious causes, especially cardiovascular diseases, have fallen.
To assess the impact of the pandemic ...on admissions for ST-elevation myocardial infarction (STEMI) during the first pandemic wave.
We performed a multicenter retrospective analysis of consecutive patients presenting with STEMI in two Portuguese hospital centers in two sequential periods – P1 (March 1 to April 30) and P2 (May 1 to June 30). Patient's clinical data and hospital outcomes were compared between the years 2017 to 2019 and 2020 for both periods.
During P1 in 2020, a reduction in the number of STEMI patients was observed in comparison with previous years (26.0±4.2 vs. 16.5±4.9 cases per month; p=0.033), as well as an increase in the number of mechanical complications (0.0% vs. 3.0%; p=0.029). Percutaneous coronary interventions in the setting of failed thrombolysis were more frequent (1.9% vs. 9.1%; p=0.033). An overall trend for longer delays in key timings of STEMI care bundles was noted. Mortality was higher during P1 compared to previous years (1.9% vs. 12.1%; p=0.005).
During the first Covid-19 wave fewer patients presented with STEMI at the catheterization laboratory for percutaneous coronary intervention. These patients presented more mechanical complications and higher mortality.
Recentemente durante a pandemia por Covid-19 houve uma perceção global de uma diminuição de admissões hospitalares por causas não infeciosas, em particular por doenças cardiovasculares.
Avaliar o impacto da pandemia nas admissões por enfarte agudo do miocárdio com supradesnivelamento de ST (STEMI), na primeira onda da pandemia.
Análise multicêntrica e retrospetiva de doentes consecutivos admitidos em dois hospitais portugueses por STEMI em dois períodos sequenciais - P1 (1 de março a 30 de abril) e P2 (1 de maio a 30 de junho). Foi realizada uma comparação dos dados clínicos e de evolução hospitalar entre 2017 a 2019 e 2020 para os dois períodos.
No P1 de 2020 observou-se, relativamente a anos prévios, uma redução do número de doentes com STEMI (26,0±4,2 versus 16,5±4,9 casos por mês; p=0,033) e um aumento do número de complicações mecânicas (0,0% versus 3,0%; p=0,029). Os casos de angioplastia após trombólise falhada foram mais frequentes (1,9% versus 9,1%; p=0,033). Observou-se uma tendência global para um maior atraso nos tempos-chave de abordagem de doentes com STEMI. A taxa de mortalidade destes doentes no P1 foi superior comparativamente a anos prévios (1,9% versus 12,1%; p=0,005).
Durante a primeira onda da pandemia Covid-19 houve uma redução do número de doentes submetidos a angioplastia coronária por STEMI. Esses apresentaram mais complicações mecânicas e uma maior mortalidade.
The COVID-19 pandemic has imposed an unprecedented burden on healthcare systems worldwide, changing the profile of interventional cardiology activity.
To quantify and compare the number of ...percutaneous coronary interventions (PCIs) performed for acute and chronic coronary syndromes during the first COVID-19 outbreak with the corresponding period in previous years.
Data on PCI from the prospective multicenter Portuguese Registry on Interventional Cardiology (RNCI) were used to analyze changes in PCI for ST-elevation myocardial infarction (STEMI), non-ST-elevation acute coronary syndromes (NSTE-ACS) and chronic coronary syndromes (CCS). The number of PCIs performed during the initial period of the COVID-19 outbreak in Portugal, from March 1 to May 2, 2020, was compared with the mean frequency of PCIs performed during the corresponding period in the previous three years (2017–2019).
The total number of PCIs procedures was significantly decreased during the initial COVID-19 outbreak in Portugal (−36%, p<0.001). The reduction in PCI procedures for STEMI, NSTE-ACS and CCS was, respectively, −25% (p<0.019), −20% (p<0.068) and −59% (p<0.001).
Compared with the corresponding period in the previous three years, the number of PCI procedures performed for STEMI and CCS decreased markedly during the first wave of the COVID-19 pandemic in Portugal.
A pandemia por Covid-19 causou uma sobrecarga sem precedentes sobre os sistemas de saúde a nível mundial, alterando o perfil de atividade da cardiologia de intervenção.
Quantificar e comparar o número de intervenções coronárias percutâneas (ICP) realizadas no contexto de síndromes coronárias agudas e crónicas durante a primeira vaga de Covid-19, com o período homólogo dos anos anteriores.
Utilizou-se um registo prospetivo multicêntrico nacional, o Registo Nacional de Cardiologia de Intervenção de Intervenção Coronária Percutânea (RNCI ICP), para analisar a evolução do número de ICP realizadas por enfarte agudo do miocárdio com elevação do segmento ST (EAMcEST), síndromes coronárias agudas sem elevação do segmento ST (SCA sem elevação de ST) e síndromes coronárias crónicas (SCC). Comparou-se o número de ICP efetuadas em Portugal durante a primeira vaga de Covid-19, desde o dia 1 de março até ao dia 2 de maio, com a frequência média de ICP realizadas durante o período homólogo dos três anos anteriores (2017-2019).
O número total de ICP diminuiu significativamente durante a primeira vaga de Covid-19 em Portugal (36%, p<0,001). A redução no número de ICP no contexto de EAMcEST, SCA sem elevação do segmento ST e SCC foi, respetivamente, de −25% (p=0,019), −20% (p=0,068) e −59% (p<0,001).
Comparando com o período homólogo dos três anos anteriores, o número de ICP realizadas no contexto de EAMcEST e SCC foi significativamente reduzido durante a primeira vaga da pandemia por Covid-19 em Portugal.
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