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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
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Pacientes con riesgo quirúrgico intermedio sometidos a implantación intervencionista o quirúrgica aislada de la
Nicolas Werner1, Ralf Zahn2, Andreas Beckmann3
1Medizinische Klinik B, Klinikum Ludwigshafen, Germany (N.W., R.Z.).
Circulation
|December 21, 2018
Resumen
El reemplazo de la válvula aórtica transcatéter (TAVR) y el reemplazo quirúrgico de la válvula aórtica (SAVR) mostraron una mortalidad hospitalaria similar para pacientes de riesgo intermedio. Después del emparejamiento, la mortalidad a 1 año no difería significativamente entre TAVR y SAVR, lo que sugiere resultados comparables.
Área de la Ciencia:
- Cardiología
- Cardiología intervencionista
- Cirugía cardíaca
Sus antecedentes:
- El reemplazo de la válvula aórtica transcatéter (TAVR) se utiliza cada vez más para la estenosis aórtica grave en pacientes de riesgo intermedio.
- Los datos del mundo real que comparan la TAVR y el reemplazo quirúrgico de la válvula aórtica (SAVR) en esta población son limitados.
Objetivo del estudio:
- Comparar las características clínicas y los resultados de los pacientes de riesgo intermedio sometidos a TAVR aislado frente a SAVR.
- Evaluar la seguridad y eficacia de TAVR en comparación con SAVR en un entorno real.
Principales métodos:
- Análisis de 7613 pacientes del Registro Alemán de la Válvula Aórtica (2012-2014).
- Los pacientes se sometieron a TAVR aislado (n=6469) o SAVR aislado (n=1144) con riesgo quirúrgico intermedio (puntuación STS 4% - 8%).
- Se utilizó el emparejamiento de la puntuación de propensión para ajustar las diferencias basales.
Principales resultados:
- Los pacientes con TAVR eran mayores y tenían puntuaciones de riesgo iniciales más altas que los pacientes con SAVR.
- La mortalidad hospitalaria fue similar (3,6%) tanto para TAVR como para SAVR.
- La mortalidad no ajustada a 1 año fue más alta después de TAVR (17,5%) pero no significativamente diferente después de la coincidencia de la puntuación de propensión (17,1% frente a 15,7%).
Conclusiones:
- Los pacientes de riesgo intermedio sometidos a TAVR difieren significativamente en edad y características basales de los sometidos a SAVR.
- Tanto el TAVR como el SAVR demostraron tasas de mortalidad hospitalaria similares.
- El análisis de la puntuación de propensión no indicó diferencias significativas en la mortalidad a 1 año entre TAVR y SAVR, lo que sugiere resultados comparables a largo plazo.
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