Clinical-functional assessment of patients with aortic stenosis undergoing transcatheter aortic valve implantation
Avaliação clínico-funcional de pacientes com estenose aórtica submetidos ao implante transcateter de valva aórtica
Wátila Moura Sousa, Giulliano Gardenghi, Fernando Henrique Fernandes, Maurício Lopes Prudente, Jordana Campos Martins de Oliveira, Luiz Fernando Martins de Souza Filho, Ana Cristina Silva Rebelo
Abstract
Background: transcatheter aortic valve implantation (TAVI) is known to enhance valve structure and function in old adults with aortic stenosis. Aim: to evaluate the clinical and functional characteristics of 40 patients (mean age 79 ± 5 years) undergoing transfemoral TAVI during their hospital stay. Methods: this cross-sectional study. Data on mean aortic valve area, Society of Thoracic Surgeons (STS) morbidity and mortality score, echocardiographic measurements, peak cough flow (PCF), handgrip strength (HGS), 5-meter walk test (5MWT), and 6-minute walk test (6MWT) were collected at three time points: pre-TAVI, post-TAVI, and at hospital discharge. Results: results showed reductions in peripheral oxygen saturation (p = 0.004), peak aortic gradient (p = 0.001), and mean aortic gradient post-TAVI (p = 0.001), along with increased left ventricular ejection fraction (p = 0.001) and prolonged 5MWT completion time on the first postoperative day (p =0.003). Moderate negative correlations were observed between the European System for Cardiac Operative Risk Evaluation II score (EuroSCORE II) score and PCF (r = -0.329; p = 0.041), STS with PCF (r = -0.473; p = 0.002), and STS with 6MWT at discharge (r = -0.324; p = 0.044), as well as STS with HGS pre-TAVI (r = -0.363; p = 0.041). Conclusion: changes in clinical and functional variables, the increase in 5MWT time suggests a deterioration in frailty in the population. Implementing pre- and postoperative rehabilitation programs may help mitigate functional losses in this clinically vulnerable population.
Keywords
Resumo
Introdução: o implante transcateter de válvula aórtica (TAVI) é conhecido por melhorar a estrutura e função da válvula em idosos com estenose aórtica. Objetivo: avaliar as características clínicas e funcionais de 40 pacientes (idade média de 79 ± 5 anos) submetidos a TAVI transfemoral durante a internação hospitalar. Métodos: estudo observacional. Dados sobre área valvar aórtica média, escore de morbidade e mortalidade da Society of Thoracic Surgeons (STS), medidas ecocardiográficas, pico de fluxo de tosse (PFT), força de preensão manual (FPM), teste de caminhada de 5 metros (TC5M) e teste de caminhada de 6 minutos (TC6M) foram coletados em três momentos: pré-TAVI, pós-TAVI e na alta hospitalar. Resultados: os resultados mostraram reduções na saturação periférica de oxigênio (p = 0,004), pico do gradiente aórtico (p = 0,001) e gradiente aórtico médio pós-TAVI (p = 0,001), juntamente com aumento da fração de ejeção do ventrículo esquerdo (p = 0,001) e prolongamento do tempo de conclusão do TC5M no primeiro dia de pós-operatório (p =0,003). Foram observadas correlações negativas moderadas entre o escore European System for Cardiac Operative Risk Evaluation II score (EuroSCORE II) e PFT (r = -0,329; p = 0,041), STS com PFT (r = -0,473; p = 0,002) e STS com TC6 na alta hospitalar (r = -0,324; p = 0,044), bem como do STS com FPM pré-TAVI (r = -0,363; p = 0,041). Conclusão: alterações nas variáveis clínicas e funcionais, o aumento do tempo do TC5M sugere piora da fragilidade na população. A implementação de programas de reabilitação pré e pós-operatória pode ajudar a mitigar as perdas funcionais nesta população clinicamente vulnerável.
DOI da versão traduzida: https://doi.org/10.47066/2966-4837.2024.0013pt
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Referências
1. Thaden JJ, Nkomo VT, Enriquez-Sarano M. The global burden of aortic stenosis. Prog Cardiovasc Dis. 2014;56(6):565-71. http://doi.org/10.1016/j.pcad.2014.02.006. PMid:24838132.
2. Nechwatal RM, Bestehorn K, Leuschner F, Hagendorff A, Guha M, Schlitt A. Nachsorge nach kathetergestütztem perkutanen Aortenklappenersatz (TAVI). Herz. 2021;46(Suppl 1):41-7. http://doi.org/10.1007/s00059-020-04915-1. PMid:32313970.
3. Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease: developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Rev Esp Cardiol. 2022;75(6):524. http://doi.org/10.1016/j. rec.2022.05.006. PMid:35636831.
4. Di Pasquale G, Vassiliki’ Coutsoumbas G, Zagnoni S, Filippini E, Resciniti E. Aortic stenosis in the elderly can be prevented: old risk factors and a new pathological condition. Eur Heart J Suppl. 2019;21(Suppl B):B52-3. http://doi.org/10.1093/ eurheartj/suz017. PMid:30948947.
5. Siqueira ARDO, Siqueira SRDO, Mangione JA, Cristóvão SAB, Mauro MFZ, Costa FAAD. TAVI: the game changer for the future! Are we ready to implant hope into patient’s heart? Int J Cardiovasc Sci. 2015;28(5). http://doi.org/10.5935/2359- 4802.20150052.
6. Howard C, Jullian L, Joshi M, Noshirwani A, Bashir M, Harky A. TAVI and the future of aortic valve replacement. J Card Surg. 2019;34(12):1577-90. http://doi.org/10.1111/jocs.14226. PMid:31600005.
7. Cribier A, Eltchaninoff H, Bash A, Borenstein N, Tron C, Bauer F, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation. 2002;106(24):3006- 8. http://doi.org/10.1161/01.CIR.0000047200.36165.B8. PMid:12473543.
8. Abdul-Jawad Altisent O, Puri R, Regueiro A, Chamandi C, Rodriguez-Gabella T, Del Trigo M, et al. Predictors and association with clinical outcomes of the changes in exercise capacity after transcatheter aortic valve replacement. Circulation. 2017;136(7):632-43. http:// doi.org/10.1161/CIRCULATIONAHA.116.026349. PMid:28588077.
9. WHO: World Health Organization. Diet, nutrition and the prevention of chronic diseases: report of a joint WHO/ FAO expert consultation. Geneva: WHO/FAO; 2003. (WHO Technical Report Series; 916).
10. Lean MEJ, Han TS, Morrison CE. Waist circumference as a measure for indicating need for weight management. BMJ. 1995;311(6998):158-61. http://doi.org/10.1136/ bmj.311.6998.158. PMid:7613427.
11. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377-81. http://doi. org/10.1249/00005768-198205000-00012. PMid:7154893.
12. Freitas FSD, Parreira VF, Ibiapina CDC. Aplicação clínica do pico de fluxo da tosse: uma revisão de literatura. Fisioter Mov. 2010;23(3):495-502. http://doi.org/10.1590/S0103- 51502010000300016.
13. Reis MM, Arantes PMM. Medida da força de preensão manual: validade e confiabilidade do dinamômetro Saehan. Fisioter Pesqui. 2011;18(2):176-81. http://doi.org/10.1590/ S1809-29502011000200013.
14. Novaes RD, Miranda ASD, Silva JDO, Tavares BVF, Dourado VZ. Equações de referência para a predição da força de preensão manual em brasileiros de meia idade e idosos. Fisioter Pesqui. 2009;16(3):217-22. http://doi.org/10.1590/ S1809-29502009000300005.
15. ATS: American Thoracic Society. ERS: European Respiratory Society. ATS/ERS statement on respiratory muscle testing. Am J Respir Crit Care Med. 2002;166(4):518-624. http://doi. org/10.1164/rccm.166.4.518. PMid:12186831.
16. Neder JA, Andreoni S, Lerario MC, Nery LE. Reference values for lung function tests: II. Maximal respiratory pressures and voluntary ventilation. Braz J Med Biol Res. 1999;32(6):719- 27. http://doi.org/10.1590/S0100-879X1999000600007. PMid:10412550.
17. Alexander KP. Walking as a window to risk and resiliency. Circulation. 2017;136(7):644-5. http://doi.org/10.1161/ CIRCULATIONAHA.117.028889. PMid:28588078.
18. ATS: American Thoracic Society. Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166(1):111-7. http://doi. org/10.1164/ajrccm.166.1.at1102. PMid:12091180.
19. Soares MR, Pereira CADC. Teste de caminhada de seis minutos: valores de referência para adultos saudáveis no Brasil. J Bras Pneumol. 2011;37(5):576-83. http://doi. org/10.1590/S1806-37132011000500003.
20. Siqueira DA, Abizaid AAC, Ramos AA, Jeronimo AD, LeBihan D, Barreto RB, et al. Impacto da curva de aprendizado na seleção de pacientes e nos resultados clínicos do implante por cateter de prótese aórtica. Rev Bras Cardiol Invasiva. 2014;22(3):216-24. http://doi.org/10.1590/0104- 1843000000036.
21. Mäkikallio T, Jalava MP, Husso A, Virtanen M, Laakso T, Ahvenvaara T, et al. Ten-year experience with transcatheter and surgical aortic valve replacement in Finland. Ann Med. 2019;51(3-4):270-9. http://doi.org/10.1080/07853890.2019 .1614657. PMid:31112060.
22. Zhou Y, Zhang L, Hua K, Zhang J, Yang X. The benefit of fibrosa layer stripping technique during minimally invasive aortic valve replacement for calcified aortic valve stenosis: a randomized controlled trial. J Card Surg. 2021;36(2):466- 74. http://doi.org/10.1111/jocs.15215. PMid:33314388.
23. Zapolanski A, Mak AWC, Ferrari G, Johnson C, Shaw RE, Brizzio ME, et al. Impact of New York Heart Association Classification, advanced age and patient-prosthesis mismatch on outcomes in aortic valve replacement surgery. Interact Cardiovasc Thorac Surg. 2012;15(3):371-6. http://doi.org/10.1093/icvts/ivs231. PMid:22665381.
24. Afilalo J, Kim S, O’Brien S, Brennan JM, Edwards FH, Mack MJ, et al. Gait speed and operative mortality in older adults following cardiac surgery. JAMA Cardiol. 2016;1(3):314- 21. http://doi.org/10.1001/jamacardio.2016.0316. PMid:27438112.
25. Ueshima D, Nai Fovino L, Mojoli M, Napodano M, Fraccaro C, Tarantini G. The interplay between permanent pacemaker implantation and mortality in patients treated by transcatheter aortic valve implantation: a systematic review and meta-analysis. Catheter Cardiovasc Interv. 2018;92(3):E159-67. http://doi.org/10.1002/ccd.27681. PMid:30019825.
26. Bhushan S, Huang X, Li Y, He S, Mao L, Hong W, et al. Paravalvular leak after transcatheter aortic valve implantation its incidence, diagnosis, clinical implications, prevention, management, and future perspectives: a review article. Curr Probl Cardiol. 2022;47(10):100957. http://doi. org/10.1016/j.cpcardiol.2021.100957. PMid:34364915.
27. Albabtain MA, Arafat AA, Alonazi Z, Aluhaydan H, Alkharji M, Alsaleh R, et al. Risk of bleeding after transcatheter aortic valve replacement: impact of preoperative antithrombotic regimens. Rev Bras Cir Cardiovasc. 2022;37(6):836- 42. http://doi.org/10.21470/1678-9741-2020-0538. PMid:34673514.
28. Toppen W, Johansen D, Sareh S, Fernandez J, Satou N, Patel KD, et al. Improved costs and outcomes with conscious sedation vs general anesthesia in TAVR patients: time to wake up? PLoS One. 2017;12(4):e0173777. http://doi. org/10.1371/journal.pone.0173777. PMid:28379981.
29. Barbanti M, Baan J, Spence MS, Iacovelli F, Martinelli GL, Saia F, et al. Feasibility and safety of early discharge after transfemoral transcatheter aortic valve implantation – rationale and design of the FAST-TAVI registry. BMC Cardiovasc Disord. 2017;17(1):259. http://doi.org/10.1186/ s12872-017-0693-0. PMid:29017461.
30. Sampaio RO, Pires LJT, Vieira MLC, Tarasoutchi F. Severe aortic stenosis with low gradient and preserved ejection fraction. Arq Bras Cardiol. 2015;28:216-25. http://doi. org/10.5935/2318-8219.20150029.
31. Deucher Z Jr, Bastos ES, Feitosa JLDA, Giambroni R Fo, Azevedo JAP, Sá MPL, et al. Gradiente residual em operação de valva aórtica. Rev Bras Cir Cardiovasc. 2000;15(2). http:// doi.org/10.1590/S0102-76382000000200006.
32. Karaduman BD, Ayhan H, Keleş T, Bozkurt E. Impact of transcatheter aortic valve implantation in symptomatic patients with very severe aortic stenosis. Turk Kardiyol Dern Ars. 2021;49(2):97-107. http://doi.org/10.5543/ tkda.2021.72273. PMid:33709915.
33. Onohara T, Yoshikawa Y, Watanabe T, Kishimoto Y, Harada S, Horie H, et al. Cost analysis of transcatheter versus surgical aortic valve replacement in octogenarians: analysis from a Single Japanese Center. Heart Vessels. 2021;36(10):1558-65. http://doi.org/10.1007/s00380-021- 01826-x. PMid:33710376.
34. Alaparthi GK, Gatty A, Samuel SR, Amaravadi SK. Effectiveness, safety, and barriers to early mobilization in the Intensive Care Unit. Crit Care Res Pract. 2020;2020:7840743. http:// doi.org/10.1155/2020/7840743. PMid:33294221.
35. Choi J, Baek S, Kim G, Park H. Peak voluntary cough flow and oropharyngeal dysphagia as risk factors for pneumonia. Ann Rehabil Med. 2021;45(6):431-9. http://doi.org/10.5535/ arm.21068. PMid:35000368.
36. Waite I, Deshpande R, Baghai M, Massey T, Wendler O, Greenwood S. Home-based preoperative rehabilitation (Prehab) to improve physical function and reduce hospital length of stay for frail patients undergoing coronary artery bypass graft and valve surgery. J Cardiothorac Surg. 2017;12(1):91. http://doi. org/10.1186/s13019-017-0655-8. PMid:29073924.
Submetido em:
14/01/2025
Aceito em:
05/05/2025
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