AB0549 THE RELEVANCE OF AORTIC STENOSIS AND OUTCOME OF TAVI PROCEDURE FOR VALVE REPAIR IN SCLERODERMA PATIENTS. (13th June 2020)

• Record Type: Journal Article
• Authors: Balbir-Gurman, A.; Braun-Moscovici, Y.
• Is Part Of: Annals of the rheumatic diseases. Volume 79(2020)Supplement 1
• Page Start: 1571
• Page End: 1571
• Publication Date: 2020-06-13
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2020-eular.6372
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Patients with systemic sclerosis (SSc) are at risk for developing aortic valve changes. The prevalence of aortic valve stenosis (AS) in SSc patients is unknown. Previously, patients with AS were treated with valve replacement; in recent years, Trans Catheter Aortic Valve Implantation (TAVI) is widely used in general population. The safety of Trans Catheter Aortic Valve Implantation (TAVI) in SSc has not been assessed. Objectives: A retrospective study on aortic valve pathology and treatments including TAVI performance. Methods: We reviewed 374 records of SSc patients at our site EUSTAR cohort and extracted cases with reported AS confirmed by ECHO cardiography and heart catheterization. Results: We found data on 13 (3.4%) patients with AS: 12 females (92.3%); mean age 70.3 (SD 7.7) years, disease duration 15.4 (SD 6.3) years. Ten patients had limited SSc (76.9%, all cared anti-centromere antibodies) and 3 diffuse SSc (1 patient had RNAP3 and 2 had anti-topoisomerase antibodies); 5 (38.5%) patients had significant coronary disease (3 underwent CABG, 2 had several PTCA). Eight (61.5%) patients dead during years 2004 - 2019. Aortic valve replacement was performed in 5 patients (4 – metal and 1 – biological); 2 patients did not undergo AS repair due to impaired general condition; 6 patients underwent TAVI between January 2013 and December 2019 (5 at Rambam Cardiology Institute). All SSc patients underwent trans femoral TAVI under conscious sedation. The procedure was successful in all patients. The length of hospitalization was 5-14 days (mean 8.2 days); 3 (50%) patients needed pacemaker implantation (they did not have previous conduction abnormalities). The follow-up duration after TAVI was between 5 and 67 months (mean 20.7). During follow-up one patient developed bacterial endocarditis related to pacemaker device two months after the procedure; the event resolved after removing the device and according antibiotics treatment; the same patient had transient ischemic attack two years later and another pacemaker implantation 3 years later due to complete AV block. One patients dead from urosepsis 11 months after TAVI, the death was not related to procedure. One patient developed anemia due to large hematoma after the procedure. Conclusion: Screening for aortic valve pathology is essential as AS is not rare in SSc patients especially in those with long standing limited disease and positivity to centromere antibodies. AS in SSc patients may be associated with clinically significant coronary artery disease. TAVI was safe in our SSc patients without in-hospital mortality and benign long-term outcome. Disclosure of Interests: Alexandra Balbir-Gurman Consultant of: Novartis, Yolanda Braun-Moscovici: None declared