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Percutánea versus revascularización quirúrgica en pacientes con regurgitación mitral isquémica
Duk-Hyun Kang1, Byung Joo Sun, Dae-Hee Kim
1Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, 388-1, Poongnap-dong, Songpa-ku, Seoul, Korea 138-736. dhkang@amc.seoul.kr
Circulation
|September 14, 2011
Resumen
La revascularización quirúrgica, particularmente con la annuloplastia mitral, ofrece una mejor supervivencia sin eventos a largo plazo para la regurgitación mitral isquémica (RMI) en comparación con la intervención coronaria percutánea (ICP). Esto sugiere que la cirugía es una estrategia de revascularización preferida para los pacientes con RMI.
Área de la Ciencia:
- Cardiología Cardiología.
- Cirugía cardíaca Cirugía cardíaca.
- Cardiología Intervencionista Cardiología intervencionista.
Sus antecedentes:
- La gestión de la regurgitación mitral isquémica (RMI) sigue siendo un desafío clínico.
- Se debate la estrategia de revascularización óptima para la RMI.
- Se comparan la intervención coronaria percutánea (PCI) y la revascularización quirúrgica.
Objetivo del estudio:
- Para comparar los resultados a largo plazo de la PCI frente a la revascularización quirúrgica en pacientes con RMI significativa.
- Para evaluar el impacto de la annuloplastia mitral concomitante durante la cirugía.
Principales métodos:
- Análisis retrospectivo de 185 pacientes con RMI desde 1996 hasta 2008.
- Los pacientes se sometieron a una ICP (n=66) o a una cirugía de injerto de derivación de la arteria coronaria (grupo de OP, n=119).
- Para comparar los resultados se utilizó el emparejamiento del puntaje de propensión, con un seguimiento mediano de 54 meses.
Principales resultados:
- No hay diferencias significativas en la supervivencia o la mortalidad cardíaca entre los grupos de PCI y quirúrgicos.
- La revascularización quirúrgica mostró tasas de supervivencia sin eventos significativamente más altas.
- En parejas con propensión coincidente, la revascularización quirúrgica redujo significativamente el riesgo de eventos cardíacos (HR, 0,499).
- La anuloplastia mitral adicional durante la cirugía mejoró aún más la supervivencia libre de eventos.
Conclusiones:
- La revascularización quirúrgica se asocia con una supervivencia libre de eventos a largo plazo superior en comparación con la ICP para la RMI.
- Se debe considerar la annuloplastia mitral concomitante en pacientes con RMI significativa sometidos a cirugía.
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