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Early Outcomes After Aortic Valve Replacement, in 906 Patients, Older Than 70 Years Of Age - The Brazilian Aortic Valve Replacement Study (BRAVARS)
Rui M.S. Almeida1, Joo Carlos Leal2, Fernando Moraes3, Eduardo K. Saadi4, Renato A. Kalil5, Orlando Petrucci6, Gustaco C. Ribeiro7, Ricardo Sgarbieri8, Leonardo A. Mulinari9, Fernando Pivatto, Jr.5, Diogo Feraz3, Cledicyon E. Costa7, Pedro P. Oliveira6, Kelter J. Sgobi8, Christian Hahn9.
1Unioeste, Cascavel, Brazil, 2FAMERP, Sao Jose do Rio Preto, Brazil, 3UFPE, Recife, Brazil, 4UFRGS, Porto Alegre, Brazil, 5Instituto de Cardiologia, Porto Alegre, Brazil, 6Unicamp, Campinas, Brazil, 7PUC-Campinas, Campinas, Brazil, 8UFTM, Uberaba, Brazil, 9UFPr, Curitiba, Brazil.

OBJECTIVE - Transcatheter aortic valve implantation (TAVI) become an established intervention, for management of high-risk patients with aortic stenosis. Despite the fact that the Heart Team is mandatory to decide which type of treatment should be performed in a certain patient, a comparison of results, between techniques, should be done. To stratify patients' morbidity and mortality, patients, older than 70 years, who underwent isolated aortic valve replacement (AVR), by conventional bypass technique, were evaluated. METHODS - A retrospective cohort study, between Jan/2001 and Dec/2011, in patients who underwent AVR from nine Brazilian centers, enrolling a total of 906 patients. All the data was collected in one center was stored in one center (RMSA) and analyzed in another (JCL), being this analysis blind. RESULTS - The mean age was 75.93±4.60 years, being 53.86% men. The estimated mortality ranged from 5.87 to 40.57% calculated with EuroScore II (ES) index. The surgery was elective in 96.48% and biological prostheses were used in 894 patients, due to age and patients' choice. The valve diameter most frequently implanted was that of number 23 mm in 42.39% of the group. The mean cross clamp and bypass time were, respectively 57.60±19.16 and 72.59±22.85 minutes. The length of stay at ICU was 4.38±6.27 days and the length of stay in the hospital was 11.02±11.66 days. The hospital mortality, considering 30 days, was 4.63%, being sepsis and cardiogenic shock the most frequently causes of death. A sub analyses on patients older than 80 years (n=206) with a mean age of 82.66±2.55 years was performed, with no statistical difference from the all group. The OR for variables age, sex, bypass time and ES were calculated. Risk factor for death, by logistic regression were ES, above 10% (p<0,01) and by-pass time (p=0,02). CONCLUSIONS - Conventional AVR, in patients above 70 years of age, is safe with an acceptable risk for the overall group, and the depending variables found were ES and bypass time. These data should be the golden standard for any type of procedure, such as TAVI, and should be taken into account when discussing between Heart Team.

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