Artigos de revistas sobre o tema "Centro Hospitalar de Vila Nova de Gaia/Espinho"
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Pires, Ilda, Madalena Cabral, Helena Figueiredo, Marta Osório, Sueli Pinelo, Helena Serra, António Barbosa, Luis Ferraz e Eduarda Felgueira. "Preservação da fertilidade masculina no Centro Hospitalar de Vila Nova de Gaia/Espinho EPE – 17 anos de experiência". Revista Internacional de Andrología 14, n.º 3 (julho de 2016): 73–79. http://dx.doi.org/10.1016/j.androl.2015.10.001.
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Presa, Ana, Cátia Santa, Joana Gomes, Joana Lopes, Linda Cruz, Maria Sousa e Inês Lopes. "Caracterização dos doentes asmáticos internados no Centro Hospitalar Vila Nova de Gaia/Espinho com infeção por SARS-CoV-2". Revista Portuguesa de Imunoalergologia 30, n.º 2 (22 de junho de 2022): 111–20. http://dx.doi.org/10.32932/rpia.2022.06.082.
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Introdução: A doença respiratória crónica, onde se inclui a asma, tem sido apontada como potencial fator de risco para doença COVID-19 de maior gravidade. Contudo, estudos recentes têm reportado taxas variáveis de prevalência de asma. Objetivos: Caracterizar os doentes asmáticos internados com infeção por SARS-CoV-2. Métodos: Análise retrospetiva observacional dos doentes internados com COVID-19 no Centro Hospitalar Vila Nova de Gaia/Espinho de 1 de março a 30 de junho. Resultados: Foram incluídos 237 doentes, dos quais 16 (6,8%) reportaram diagnóstico de asma. Comparativamente aos doentes não-asmáticos, os doentes com asma eram tendencialmente mais novos (70 anos vs 80 anos, p=0,027) tendo também menos comorbilidades (1 vs 2 p=0,014). Relativamente à abordagem terapêutica, os asmáticos tiveram maiores taxas de utilização de corticoterapia inalada, hidroxicloroquina e menor estabelecimento de teto terapêutico (respetivamente 50% vs 21,7%, p=0,027; 75% vs 48,9%, p=0,044; 6,3% vs 38%, p=0,011). A taxa de mortalidade foi inferior (12,5% vs 37,1%, p=0,047), comparativamente aos doentes não asmáticos. A gravidade da asma não influenciou nenhum dos outcomes analisados. Conclusão: Neste estudo, a asma não pareceu contribuir para doença COVID-19 de maior gravidade.
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Lima, José, Cláudia Rocha, Luísa Rocha e Paulo Costa. "Data Matrix Based Low Cost Autonomous Detection of Medicine Packages". Applied Sciences 12, n.º 19 (30 de setembro de 2022): 9866. http://dx.doi.org/10.3390/app12199866.
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Counterfeit medicine is still a crucial problem for healthcare systems, having a huge impact in worldwide health and economy. Medicine packages can be traced from the moment of their production until they are delivered to the costumers through the use of Data Matrix codes, unique identifiers that can validate their authenticity. Currently, many practitioners at hospital pharmacies have to manually scan such codes one by one, a very repetitive and burdensome task. In this paper, a system which can simultaneously scan multiple Data Matrix codes and autonomously introduce them into an authentication database is proposed for the Hospital Pharmacy of the Centro Hospitalar de Vila Nova de Gaia/Espinho, E.P.E. Relevant features are its low cost and its seamless integration in their infrastructure. The results of the experiments were encouraging, and with upgrades such as real-time feedback of the code’s validation and increased robustness of the hardware system, it is expected that the system can be used as a real support to the pharmacists.
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Pereira, Ana Teresa, Diana Malheiro Mota, Ana Samico, Pedro Horta, Tânia Rodrigues, Bárbara Moura e Lúcia Ribeiro. "Linha de apoio direto ao doente psiquiátrico de um centro hospitalar de Portugal durante a pandemia COVID-19". Revista de Medicina 100, n.º 3 (2 de agosto de 2021): 197–203. http://dx.doi.org/10.11606/issn.1679-9836.v100i3p197-203.
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Introdução. O impacto da pandemia de COVID-19 na Saúde Mental tem vindo a ser reconhecido e destacado. Para ultrapassar as dificuldades no acesso aos cuidados da saúde durante este período têm surgido algumas estratégias, tais como a criação de Linhas de Apoio Psicológico e esta abordagem foi, assim, adotada pelo Serviço de Psiquiatria e Saúde Mental do Centro Hospitalar Vila Nova de Gaia/Espinho. O objetivo deste estudo é a caracterização sociodemográfica dos pacientes que acederam à Linha, a análise das patologias mais prevalentes e a reflexão sobre a importância da sua utilização em pacientes já acompanhados previamente por Psiquiatria. Material e Métodos. Foram registrados dados relativos a variáveis sociodemográficas e clínicas dos pacientes que recorreram à Linha e realizada uma análise estatística quantitativa e descritiva. Resultados. Dentre os 100 contatos realizados, 29% foram relativos ao agravamento de sintomatologia ansiosa e depressiva e 18% a alterações comportamentais decorrentes de exacerbação de sintomas psicóticos, havendo registos também de dúvidas relacionadas à prescrição e gestão de psicofármacos. A maioria das situações foram geridas telefonicamente com medidas psicoeducativas, 39% com recurso a ajustes terapêuticos minor e uma reduzida percentagem foi orientada para avaliação presencial. Conclusão. Os dados obtidos encontram-se de acordo com o reportado na literatura que demonstra que a sintomatologia ansiosa e depressiva são as mais prevalentes no contexto desta pandemia. É essencial que sejam dinamizadas mais estratégias por profissionais de saúde com experiência clínica e em articulação com os cuidados de saúde nos períodos de crise e que sejam realizados mais estudos para compreender de que forma este auxílio pode ser otimizado.
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Martins, Susana, e Milena Carvalho. "atuação do profissional da informação em ambiente hospitalar: exemplo". Revista Fontes Documentais 7, n.º 1 (20 de maio de 2024): e71243. http://dx.doi.org/10.9771/rfd.v7i0.60872.
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A área da informação é transversal a todas as organizações. A atual formação do profissional da informação, em particular dos diplomados da licenciatura em Ciências e Tecnologias da Documentação e Informação do ISCAP- P. Porto (Portugal), permite que, em parceria com colaboradores de outros departamentos, esses profissionais promovam a automatização de procedimentos infodocumentais que se encaram como essenciais para a eficiência e eficácia das organizações. O projeto que se apresenta foi desenvolvido no Centro Hospitalar de Vila Nova de Gaia/Espinho (Portugal) e contempla duas vertentes/objetivos principais. Os objetivos deste projeto englobam a análise e pesquisa de estruturas normativas utilizadas nacional e internacionalmente conduzindo à estruturação da informação dos documentos analisados e o desenvolvimento de uma proposta de protótipo de software capaz de identificar e extrair texto de documentos em formato pdf, de forma a prestar auxílio às tarefas de descrição dos mesmos, promovendo a automatização desta tarefa. O projeto baseia-se na revisão de literatura que sustentou todo o enquadramento teórico e o trabalho prático. A estrutura de dados foi desenvolvida através da aplicação Microsoft Visual Studio com o formato XML. Procedeu-se igualmente à escolha da linguagem de programação a usar (Python) e ao desenvolvimento do protótipo. O projeto apresentou como resultados a estrutura de dados para três tipos de documentos (Relatórios; Exemplo de Audiometrias; Consentimento Informado Esclarecido e Livre) e, a criação de um protótipo capaz de, de forma automatizada, preencher metadados, agilizando assim procedimentos internos. Conclui-se que este tipo de intervenção, por parte do atual profissional da informação, é possível com o apoio do departamento de informática/tecnologias das organizações, e que, sendo possível de implementar, terá um impacto positivo no que concerne à agilização de tarefas, promovendo um mais rápido acesso à informação.
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Lima, Jose, Luísa Rocha, Cláudia Rocha e Paulo Costa. "Low-cost SARS-CoV-2 vaccine homogenization system for Pfizer-BioNTech covid-19 vials". IAES International Journal of Robotics and Automation (IJRA) 10, n.º 4 (1 de dezembro de 2021): 340. http://dx.doi.org/10.11591/ijra.v10i4.pp340-352.
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<p>The current SARS-CoV-2 pandemic has been affecting all sectors worldwide, and efforts have been targeting the enhancement of people’s health and labour conditions of collaborators belonging to healthcare institutions. The recent vaccines emerging against covid-19 are seen as a solution to address the problem that has already killed up to two million people. The preparation of the Pfizer-BioNTech covid-19 vaccine requires a specific manipulation before its administration. A correct homogenization with saline solution is needed and, therefore, a manual process with a predefined protocol should be accomplished. This action can endanger the operators’ ergonomics due to the repetitive movement of the process. This paper proposes a low-cost prototype incorporating an arduino based embedded system actuating a servomotor to perform an autonomous vials’ homogenization allowing to redirect these healthcare workers to other tasks. Moreover, a contactless start order process was implemented to avoid contact with the operator and, consequently, the contamination. The prototype was successfully tested and recognised, and is being applied during the preparation of the covid-19 vaccines at the hospital pharmacy of <em>Centro Hospitalar de Vila Nova de Gaia/Espinho</em>, <em>E.P.E.</em>, Portugal. It can be easily replicated since the source files to assemble it are provided by the authors.</p>
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Seabra, Mariana, Paula Vaz, Francisco Valente, Ana Braga e António Felino. "Two-Dimensional Identification of Fetal Tooth Germs". Cleft Palate-Craniofacial Journal 54, n.º 2 (março de 2017): 166–69. http://dx.doi.org/10.1597/14-128.
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Objective To demonstrate the efficiency and applicability of two-dimensional ultrasonography in the identification of tooth germs and in the assessment of potential pathology. Design Observational, descriptive, cross-sectional study. Setting Prenatal Diagnosis Unit of Centro Hospitalar de Vila Nova de Gaia / Espinho–Empresa Pública in Portugal. Patients A total of 157 white pregnant women (median age, 32 years; range, 14 to 47 years) undergoing routine ultrasound exams. Main Outcome Measure(s) Description of the fetal tooth germs, as visualized by two-dimensional ultrasonography, including results from prior fetal biometry and detailed screening for malformations. Results In the first trimester group, ultrasonography identified 10 tooth germs in the maxilla and 10 tooth germs in the mandible in all fetuses except for one who presented eight maxillary tooth germs. This case was associated with a chromosomal abnormality (trisomy 13) with a bilateral cleft palate. In the second and third trimesters group, ultrasonography identified a larger range of tooth germs: 81.2% of fetuses showed 10 tooth germs in the maxilla and 85.0% of fetuses had 10 tooth germs in the mandible. Hypodontia was more prevalent in the maxilla than in the mandible, which led us to use qualitative two-dimensional ultrasonography to analyze the possible association between hypodontia and other variables such as fetal pathology, markers, head, nuchal, face, and spine. Conclusions We recommend using this method as the first exam to evaluate fetal morphology and also to help establish accurate diagnosis of abnormalities in pregnancy.
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Teixeira, Diogo, Jorge Lopes, Ana Cristina Sousa, Miguel Costa, Eduardo O. Ferreira, Armando Baptista e Paulo Varela. "Grau de Satisfação do Doente e do MGF com a Consulta de Teledermatologia do CHVNG/E". Journal of the Portuguese Society of Dermatology and Venereology 78, n.º 3 (27 de setembro de 2020): 221–27. http://dx.doi.org/10.29021/spdv.78.3.1190.
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Introdução: A Teledermatologia (store and forward) tem sido usada para melhorar a triagem de pedidos no âmbito do Serviço Nacional de Saúde, e para dar resposta, numa minoria de casos, a situações simples. O pedido de consulta de Dermatologia via Consulta Tempo e Horas passou a ser obrigatoriamente acompanhado de foto(s) clínica(s), de acordo com o Despacho 6280/2018 de 28 de junho de 2018. Pretendemos avaliar a satisfação de doentes e médicos de família relativamente à consulta de teledermatologia em tempo diferido.
Material e Métodos: Foi realizado um inquérito aos doentes sujeitos a consulta de teledermatologia durante o primeiro trimestre de 2018, com posterior análise retrospetiva do registo clínico. Foi também realizado um inquérito online aos médicos de Medicina Geral e Familiar pertencentes aos Agrupamentos de Centros de Saúde da área de referência do Centro Hospitalar Vila Nova de Gaia/Espinho.
Resultados: Dos 153 doentes inquiridos, obteve-se resposta em 27,5% (n=42). Lesões pigmentadas corresponderam a 54,8% (n=23) do total das consultas. Foi proposto tratamento em 42,9% (n=18). Os doentes referiram preferir a consulta presencial em 90,2% (n=38). Obtiveram-se 82 respostas por parte dos médicos de família. Metade dos inquiridos concorda com a obrigatoriedade de anexação de fotografias clínicas, ainda que esta leva a um acréscimo de 11.21 ± 8.84 minutos ao tempo de referenciação. Quando é feita uma consulta de Teledermatologia, 47,6% (n=39) dos médicos referem que o problema do doente fica apenas parcialmente tratado.
Conclusão: A utilização da Teledermatologia para consulta não presencial apenas resolve uma minoria das situações clínicas e não se apresenta como uma medida satisfatória para os doentes.
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Costa Campos, Manuel António, António Fernandes Massa, Paulo Varela, Ana Moreira, Agostinho Sanches, Helena Pópulo, Paula Soares e Armando Baptista. "Tendências do carcinoma espinocelular cutâneo no Hospital de Gaia (2004-20013)". Journal of the Portuguese Society of Dermatology and Venereology 76, n.º 3 (5 de outubro de 2018): 279–86. http://dx.doi.org/10.29021/spdv.76.3.919.
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Introdução: O carcinoma espinocelular cutâneo é o segundo cancro cutâneo mais comum e a sua incidência tem crescido. O objetivo do nosso estudo foi realizar uma análise descritiva e analítica dos carcinoma espinocelular cutâneo excisados no Centro Hospitalar Vila Nova de Gaia e Espinho (CHVNGE) num período de 10 anos e estabelecer tendências (incidência, sobrevida e mortalidade).Materiais e Métodos: A informação foi retrospetivamente recolhida nos Registos Oncológico e Histológico do CHVNGE entre o período de Janeiro de 2004 e Dezembro de 2013. O objetivo do nosso estudo foi descrever as características e tendências (incidência, associação a queratoses actínicas e carcinomas basocelulares, sobrevida e mortalidade) do carcinoma espinocelular cutâneo.Resultados: Foram removidas 485 lesões em 380 pacientes (56,1% homens e 43,9% mulheres). 361 pacientes apresentavam doença invasora e 124 doença in situ. O serviço de Dermatologia removeu a maioria das lesões (70,4%), seguido pelo serviço de Cirurgia Plástica (16,4%) e Cirurgia Geral (4,7%). A faixa etária ≥ 75 anos foi a mais atingida por carcinoma espinocelular cutâneo em ambos os sexos (p < 0,001). A média de idades dos pacientes com carcinoma espinocelular cutâneo invasor foi de 76,7anos (± 11,5), sendo mais elevada no sexo feminino (79,0 vs 74,0 anos, p < 0,001). A face foi a localização topográfica mais comum (42,1%) nos dois sexos (p = 0,002). Houve um aumento da taxa de incidência ajustada à idade em ambos os sexos, particularmente no último período do estudo (16,2/100 000 pessoas). A sobrevida aos 5 anos foi de 98,7%. A idade média do carcinoma espinocelular cutâneo in situ foi inferior à da doença invasora (75,5 anos ± 11,3). Dos doentes com carcinoma espinocelular cutâneo in situ, 20,6% tinham antecedentes de carcinoma basocelular e as mulheres apresentaram mais queratoses actínicas (p = 0,040). A face foi o local mais comum (30,8%). A taxa de incidência de carcinoma espinocelular cutâneo in situ aumentou, sendo maior nas mulheres e na faixa etária ≥75 anos.Conclusão: Este estudo demonstra um rápido aumento da incidência do carcinoma espinocelular cutâneo numa população portuguesa envelhecida e realça a necessidade de melhorar os registos oncológicos em Portugal.
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Oliveira, Ana, Daniela Ferreira, António Caiado, Susana Ferreira, Paula Ferreira, Lino Santos, Manuel Gonçalves e Teresa Shiang. "Hipertensão arterial pulmonar – Experiência do Centro Hospitalar de Vila Nova de Gaia". Revista Portuguesa de Pneumologia 13, n.º 2 (março de 2007): 239–54. http://dx.doi.org/10.1016/s0873-2159(15)30346-9.
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Oliveira, Ana, Daniela Ferreira, António Caiado, Susana Ferreira, Paula Ferreira, Lino Santos, Manuel Gonçalves et al. "Pulmonary arterial hypertension – Experience of Centro Hospitalar de Vila Nova de Gaia". Revista Portuguesa de Pneumologia (English Edition) 13, n.º 2 (março de 2007): 239–54. http://dx.doi.org/10.1016/s2173-5115(07)70331-7.
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e Sá, João Moura, Ana Oliveira, António Caiado, Sofia Neves, Ana Barroso, José Almeida e José Miguel Ferraz. "Corpos estranhos traqueobrônquicos no adulto – Experiência da Unidade de Broncologia do Centro Hospitalar de Vila Nova de Gaia". Revista Portuguesa de Pneumologia 12, n.º 1 (janeiro de 2006): 31–44. http://dx.doi.org/10.1016/s0873-2159(15)30417-7.
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Moura e Sá, João, Ana Oliveira, António Caiado, Sofia Neves, Ana Barroso, José Almeida e José Miguel Ferraz. "Tracheobronchial foreign bodies in adults – Experience of the Bronchology Unit of Centro Hospitalar de Vila Nova de Gaia". Revista Portuguesa de Pneumologia (English Edition) 12, n.º 1 (janeiro de 2006): 31–43. http://dx.doi.org/10.1016/s2173-5115(06)70386-4.
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Castro, Bárbara Neto, Catarina Costa, Daniel Martins, Andreia Amado, Mariana Santos, Susana Graça, Amélia Tavares et al. "Prognostic impact of thrombocytosis in gastric cancer—A retrospective study". Porto Biomedical Journal 9, n.º 2 (março de 2024). http://dx.doi.org/10.1097/j.pbj.0000000000000247.
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Abstract BACKGROUND: Solid tumors are a common cause of secondary thrombocytosis, which has been identified as a prognostic factor in various cancers. However, the impact of thrombocytosis on the prognosis of gastric cancer is not yet well defined. The aim of this study was to assess the prevalence and prognostic value of thrombocytosis in patients with gastric cancer. METHODS: This was a retrospective study of patients with gastric carcinoma treated surgically, with curative intent, in our hospital, Centro Hospitalar Vila Nova de Gaia/Espinho, between January 2009 and December 2019. Clinical files were consulted and clinicopathological characteristics were analyzed. RESULTS: In the present sample (n = 352), the prevalence of pretreatment thrombocytosis was 16.5%. Thrombocytosis was associated with more advanced T stage, greater number of metastatic nodes, and more frequent lymphatic and venous permeation. The presence of thrombocytosis had a negative impact on disease-free survival (hazard ratio [HR] 3.54, 95% confidence interval [CI] 2.35–5.33, P < .001) and overall survival (HR 4.45, 95% CI 2.95–6.71, P < .001). CONCLUSIONS: The presence of pretreatment thrombocytosis had a negative impact on overall survival and disease-free survival and thus could be used as an independent prognostic factor.
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Dr. Débora C, Araújo, Maciel Dr. Rui, Bastos Dr. Samuel, Oliveira Dr. Vitor, Dias Dr. Jorge, Marramaque Dr. Carolina, Gromicho Dr. Alexandre e Xambre Dr. Luis. "(230) MICROSURGICAL VASECTOMY REVERSAL: THE EXPERIENCE OF THE SINGLE CENTER". Journal of Sexual Medicine 20, Supplement_4 (julho de 2023). http://dx.doi.org/10.1093/jsxmed/qdad062.033.
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Abstract Objectives We report our experience with microsurgical VR and identify predictive factors of success. Methods We retrospectively reviewed all patients submitted to VR by a single surgeon from 2008 to 2021 at Centro Hospitalar Vila Nova de Gaia e Espinho. Patency and pregnancy rates were evaluated. The main outcome was procedure success rate, defined by a natural pregnancy with a healthy baby. The secondary objective was to identify predictive factors of success and patient satisfaction with the procedure. Results Forty VRs were performed with a patency rate of 97.2%. Among those who became patent, pregnancy occurred in 14 of 35 couples by natural conception (40%). Twelve of them had a healthy delivery (34.3%). Two-layer anastomosis was significantly associated with a successful procedure (p=0.0001). We did not identify significant association between any of the other variables and successful outcome. Even without successful surgery most of the patients would do the procedure again and were very satisfied with the results (p=0.58 and p=0.46, respectively). Conclusions This is the largest national cohort regarding the outcomes of VR. In our study, the observed patency rate was 97.2%, resulting in a pregnancy by natural conception with a healthy delivery in 34.3%. We believe that VR is a useful technique to restore fertility in men after vasectomy wishing children by natural conception. A significant association was found between the two-layer anastomosis and a successful surgery. Conflicts of Interest The authors declare that they have followed the protocols of their work center on the publication of patient data.
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Ribeiro Gomes, Ana Catarina, Rolando Pinho, João Carlos Silva, Edgar Afecto, João P. Correia e João Carvalho. "Impact of the COVID-19 Pandemic on Gastroenterology Department Activity: The Gastroenterologist’s Perspective Nationwide and the Real Impact in a Portuguese Center". GE - Portuguese Journal of Gastroenterology, 21 de julho de 2021, 1–9. http://dx.doi.org/10.1159/000516962.
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<b><i>Background:</i></b> Several gastroenterology societies have created recommendations in order to reduce nonessential exposure to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Our aim is to evaluate the national gastroenterologists’ perspective on the impact of COVID-19 and the impact of reorganization of a gastroenterology department during the COVID-19 pandemic. <b><i>Methods:</i></b> For the first purpose, an online survey was distributed to gastroenterologists nationwide. For the second purpose, the authors conducted an analysis of some endoscopic procedures performed at the Gastroenterology Department of the Centro Hospitalar Vila Nova de Gaia/Espinho (CHVNG/E) between March 16 and May 8 during the years 2019 and 2020. <b><i>Results:</i></b> Sixty-seven gastroenterologists answered our survey. Only 14.9% were residents and 86.6% worked in a hospital with COVID-19 patients, with 16.4% assigned to assist those patients. All of the departments suffered modifications. Ninety percent of the residents affirmed that their activity had changed. Ninety-four percent declared having nonessential endoscopic procedures postponed, and 85.1% maintained in-person medical visits, 88.1% were already having remote consultations, and 11.9% did not have any clinical visit. In our gastroenterology unit, the number of endoscopic procedures decreased by 73.1% from 2019 to 2020. In 2020, the proportion of urgent procedures was higher compared to 2019. <b><i>Conclusion:</i></b> The advent of COVID-19 has led to important changes in gastroenterology activities in Portugal, and national gastroenterology units are complying with the recommendations. Furthermore, Portuguese gastroenterologists believed that the decrease in endoscopic activity can compromise residents’ education and training. The gastroenterology department at CHVNG/E has shown a significant reduction in the number of endoscopic procedures.
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Silva, G., C. Espada Guerreiro, P. Goncalves Teixeira, P. Queiros, M. Ribeiro Da Silva, D. Ferreira, M. Brandao et al. "Prognostic impact of coronary artery disease severity and revascularization in TAVI patients". European Heart Journal 42, Supplement_1 (1 de outubro de 2021). http://dx.doi.org/10.1093/eurheartj/ehab724.2108.
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Abstract Background Coronary artery disease (CAD) is highly prevalent in patients with severe aortic stenosis. In patients who undergo surgical aortic valve replacement, the presence of CAD and the need for CABG adversely influences short- and long-term outcomes. However, the impact of concomitant CAD and its revascularization in patients undergoing transcatheter aortic valve implantation (TAVI) is still a matter of debate. Purpose The aim of this study was to evaluate the prognostic impact of CAD severity in 1-year all-cause mortality of patients undergoing TAVI and whether prior complete or incomplete reasonable revascularization can improve prognosis after TAVI. Methods and results Retrospective analysis of a total of 575 patients (51,3% female, mean age 79,7±7,7 years) who underwent TAVI from August 2007 to November 2018. 50,3% of patients had significant CAD (at least one stenosis >50%) which 54,2% of these had history of prior revascularization (64,8% complete or incomplete reasonable revascularization and 35,2% incomplete revascularization). Pre-TAVI CAD severity was defined by the SYNTAX Score (SS) and reasonable revascularization by the residual SYNTAX Score (rSS). Patients without history of revascularization were stratified into 3 groups: no CAD (SS=0); nonsevere CAD (SS between 1 and 22); and severe CAD (SS ≥23); Patients who had undergone revascularization prior to TAVI were separated into 2 categories based on their residual SS: complete or incomplete reasonable revascularization (rSS<8) and incomplete revascularization (rSS≥8). The primary end point was an all-cause mortality. 1 year, patients with severe CAD had significantly higher rates of mortality (no CAD: 9,8%, nonsevere CAD: 12,6%, severe CAD: 38,9%; P=0.001) without significant differences between patients with no CAD and nonsevere CAD (p=1,00). Patients with high rSS had significantly higher rates of mortality comparing to no CAD or rSS<8 (no CAD: 9,8%, rSS<8: 8,6%; rSS≥8: 28,0%, p=0.001). Conclusions In our study, only the presence of severe CAD (SS≥23) prior to TAVI was associated with increased 1-year all-cause mortality. In patients with previous history of revascularization, a complete/reasonable revascularization (lower rSS) was associated with lower long-term mortality, which may attenuate the association of severe CAD and mortality and therefore improve the prognosis of these patients. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Centro Hospitalar Vila Nova de Gaia / Espinho Figure 1. Prognostic Impact of CAD severityFigure 2. Prognostic Impact of Revascularization
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Silva, G., F. Sampaio, C. Espada Guerreiro, P. Goncalves Teixeira, P. Ribeiro Queiros, M. Ribeiro Da Silva, M. Brandao, D. Ferreira e R. Fontes-Carvalho. "Staging cardiac damage in aortic valve disease: one size fits all?" European Heart Journal 42, Supplement_1 (1 de outubro de 2021). http://dx.doi.org/10.1093/eurheartj/ehab724.1616.
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Abstract Background Nowadays, in patients with aortic regurgitation (AR), aortic valve surgery is indicated when severe and symptomatic or those with depressed LVEF. However, clinical outcomes of patients with significant aortic regurgitation are not influenced by these factors only. Recently, a new staging system for severe aortic stenosis has been proposed by Généreux on the basis of the extent of anatomic and functional cardiac damage. If this model could be applicable to an unselected significant AR population has not been tested. Purpose The aim of our study was to evaluate the prevalence of the different stages of extra-aortic valvular cardiac damage by the application of Généreux staging and its impact on prognosis in a large, real world cohort of significant AR patients. Methods This study retrospectively analysed the clinical, Doppler echocardiographic and outcome data in patients with grade III or greater AR between January 2014 and September 2019. According to the extent of cardiac damage on echocardiography, patients were classified as Stage 0 (no cardiac damage), Stage 1 (left ventricular damage), Stage 2 (mitral valve or left atrial damage), Stage 3 (tricuspid valve or pulmonary artery vasculature damage) or Stage 4 (right ventricular damage). Exclusion criteria were severe aortic stenosis and previous valve repair or replacement. The primary end-point was all-cause mortality. Results A total of 572 patients, aged 70.1±13.9 years, 294 (51.3%) men were enrolled. One third of patients were in NYHA I. Based on the proposed classification, 82 patients (14.3%) were classified in stage 0, 130 (22.7%) in stage 1, 276 (48.2%) in stage 2, 68 (11.8%) in stage 3 and 17 (3.0%) in stage 4. Median follow-up time was 3.3±1.9 years. There was a progressive increase in mortality rates according to staging: 8.5% in stage 0, 10.8% in stage 1, 24.9% in stage 2, 42.6% in stage 3 and 52.9% in stage 4 (p<0.001). On multivariable analysis, the extent of cardiac damage was independently associated with excess mortality (HR 1.69, 95% CI 1.29 to 2.21) Conclusion Our study demonstrated that this new staging system studied for aortic stenosis also provides increased prognostic value to patients with significant aortic regurgitation. This staging system can be helpful to identify the degree of extra-aortic valvular cardiac damage and to optimize the time of valvular intervention. Further prospective studies are needed to confirm the benefit of the applicability of this model in clinical practice. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Centro Hospitalar Vila Nova de Gaia / Espinho Distribution of stages of cardiac damageSurvival analysis according to stage
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Silva, G., C. Espada Guerreiro, P. Goncalves Teixeira, P. Ribeiro Queiros, M. Ribeiro Da Silva, M. Brandao, D. Ferreira et al. "Feasibility of coronary angiography after TAVR". European Heart Journal 42, Supplement_1 (1 de outubro de 2021). http://dx.doi.org/10.1093/eurheartj/ehab724.2082.
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Abstract Background The prevalence of coronary artery disease (CAD) is high among patients with severe aortic stenosis who undergo transcatheter aortic valve replacement (TAVR). Indications for TAVR are now expanding to younger and lower risk patients. During their lifetime, these patients will be at risk of developing CAD and it is expected an increase in coronary angiography and percutaneous coronary intervention (PCI). Aortic prosthesis, particularly if in supra-annular position, may pose important technical difficulties in coronary re-engagement after TAVR. Purpose To evaluate the feasibility to reengage the coronary ostia after TAVR, describe complications and compare technical differences between coronary procedures performed before and after TAVR. Methods Retrospective analysis of 714 patients submitted to TAVR from August 2007 to December 2019. Patients who needed coronary angiography after TAVR were selected. The primary endpoint was the rate of successful coronary ostia cannulation after TAVR, defined by the possibility to selectively cannulate and inject both coronary ostia. Secondary endpoint was complications associated with coronary catheterization after TAVR. Results Among 714 patients, 25 (3.5%) patients were submitted to a total of 28 coronary angiography after TAVR. 14 patients were male (56%), mean age 78.2±6.2 years and 9 (36%) had history of previous coronary revascularization. From the 28 coronary angiographies (balloon-expandable Edwards-Sapien n=11, 44%; self-expandable CoreValve n=10, 40%; Portico n=2, 8%; Symetis n=2, 8%), 25 (89%) met the primary endpoint. Only three was semiselective (Symetis, CoreValve Evolut R and CoreValve TAVR in TAVR), with impossibility to cannulate both coronary arteries, right coronary artery and left coronary artery, respectively. 13 (46%) patients had also indication for PCI and all were successfully performed (Edwards-Sapien n=4, 31%; CoreValve n=6, 46%; Portico n=2, 15%; Symetis n=1, 8%). The main indications for coronary angiography was chronic coronary syndrome (n=12, 43%) and acute coronary syndrome without ST segment elevation (n=7, 25%). Circumflex artery was the most frequently treated vessel (n=6), followed by left anterior descending artery (n=4), right coronary artery (n=3) and left main (n=2). There were no complications reported during or post-procedure. Comparing coronary angiographies before and after TAVR, there were no significant differences regarding arterial access site, catheter diameter, fluoroscopy time and quantity of contrast used in coronary angiography. Conclusion Although the need for coronary angiography was rare in patients after TAVR, selective diagnostic coronary angiographies were possible in 89% (25/28) and PCI was feasible in all patients in whom it was indicated, without any reported complications. Further prospective studies are needed to confirm the great feasibility of performing coronary angiography after TAVR. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Centro Hospitalar Vila Nova de Gaia / Espinho
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Ribeiro Queiros, P., P. Fonseca, J. Almeida, G. Silva, M. Silva, R. Teixeira, M. Oliveira et al. "Cryoballoon versus radiofrequency guided by ablation index for atrial fibrillation ablation: a retrospective propensity-matched study". European Heart Journal 42, Supplement_1 (1 de outubro de 2021). http://dx.doi.org/10.1093/eurheartj/ehab724.0376.
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Abstract Background/Introduction Radiofrequency (RF) and cryoballoon (CB) ablation are established techniques for the treatment of atrial fibrillation (AF). Randomized trials comparing both techniques show similar levels of success; however, studies comparing CB with RF guided by ablation index (AI) are lacking. Purpose To compare the treatment success of CB with RF guided by AI, in patients with paroxysmal or persistent AF undergoing their first ablation procedure. Methods Patients undergoing AF ablation between 2017 and 2019 were retrospectively analysed. Primary success outcome was freedom from recurrence (defined as any episode of AF, atrial flutter or atrial tachycardia lasting >30 seconds and occurring after 91 days from ablation, or need for antiarrhythmic drugs (AAD), cardioversion or redo procedure). Secondary end-point was a composite of adverse cardiovascular outcomes (stroke/TIA, emergency room visit for AF, hospitalization for AF or cardiovascular death). Analysis was done before and after propensity score matching. Results A total of 316 patients were included. Mean age was 56.9±11.7 years. Sixty-two percent were male (n=196). Paroxysmal AF was present in 80.7% (n=255), with no difference between groups. RF was used in 57.9% (n=183) and CB in 42.1% (n=133), with isolation of all pulmonary veins accomplished in 95.9% (n=302), without differences between groups. Mean CHA2DS2-VASc score was 1.5±1.3, being higher in the RF group (1.7±1.3 vs 1.2±1.1; p=0.03); these patients were also older (mean age 58.1±12.0 vs. 55.17±11.0 years; p=0.007) and more likely to be in AF at the ablation (26.7% vs. 16.5%; p=0.006), have chronic kidney disease (40.2% vs. 23.2%; p=0.002), anaemia (11.8% vs. 2.7%; p<0.001), moderate/severe mitral disease (17.5% vs. 7.4%; p=0.012) or history of atrial flutter (17.7% vs. 3.1%; p<0.001). Patients in the CB group had a longer history of AF (3.8±3.5 vs. 3.0±2.9 years; p=0.041), received treatment with AAD more often (60.9% vs. 55.9%; p=0.049) and had longer follow-up time (889±397 vs. 601±239 days; p<0.001). Mean freedom from recurrence was not significantly different between groups (1106 days for CB vs. 889 days for RF; p=0.793), and recurrence rates were also similar (27.8% for CB vs. 23.5% for RF; p=0.291); however, patients treated with CB were more likely to need a redo procedure (38.3% vs. 17.4%; p=0.025). There were no differences in the composite of adverse cardiovascular events or in individual outcomes. Propensity score matching was done, and 154 patients were matched 1:1 for each treatment group. Survival free from recurrence showed no differences (1060 days for CB vs. 864 days for RF; p=0.912), and neither did the recurrence rate. CB patients with recurrence were still more likely to need a redo procedure (37.9% vs. 11.1%; p=0.021). Conclusion RF and CB result in similar survival free from AF and AF recurrence; however, recurrence in CB seems more significant, leading to higher rates of redo procedures. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Centro Hospitalar de Vila Nova de Gaia/Espinho