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Asociación entre el reemplazo de la válvula aórtica transcatéter para la estenosis aórtica bicúspide versus
Raj R Makkar1, Sung-Han Yoon1, Martin B Leon2
1Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
JAMA
|June 12, 2019
Resumen
El reemplazo transcatéter de la válvula aórtica (TAVR) en pacientes con estenosis aórtica bicúspide muestra una mortalidad similar a la de la estenosis aórtica tricúspide, pero un mayor riesgo de accidente cerebrovascular. Se necesitan ensayos aleatorizados adicionales para confirmar estos hallazgos para la estenosis aórtica bicúspide.
Área de la Ciencia:
- Medicina cardiovascular
- Cardiología intervencionista
- Ingeniería biomédica
Sus antecedentes:
- Las indicaciones para el reemplazo de la válvula aórtica transcatéter (TAVR) se están expandiendo.
- Un número creciente de pacientes con estenosis aórtica bicúspide se someten a TAVR.
- Los ensayos de TAVR fundamentales excluyeron a los pacientes con anatomía aórtica bicúspide.
Objetivo del estudio:
- Para comparar los resultados de TAVR utilizando una válvula expandible en globo en pacientes con estenosis aórtica bicúspide versus tricúspide.
- Evaluar la seguridad y eficacia de TAVR en una población con estenosis aórtica bicúspide.
Principales métodos:
- Un estudio prospectivo de cohorte basado en registros.
- Análisis de 2691 pares de pacientes con estenosis aórtica bicúspide y tricúspide emparejados por puntuación de propensión del Registro de Terapias de Válvulas Transcatéter STS/ACC (junio 2015-noviembre 2018).
- Los resultados primarios incluyeron mortalidad a 30 días y a 1 año y accidente cerebrovascular.
Principales resultados:
- No hubo diferencias significativas en la mortalidad por cualquier causa a los 30 días o al año entre los grupos de estenosis aórtica bicúspide y tricúspide.
- Significativamente mayor tasa de ictus a los 30 días en el grupo de estenosis aórtica bicúspide (2,5% frente a 1,6%).
- Mayor riesgo de complicaciones del procedimiento que requieren cirugía a corazón abierto en el grupo de bicúspide (0,9% frente a 0,4%).
Conclusiones:
- La TAVR en la estenosis aórtica bicúspide está asociada con una mortalidad similar, pero un mayor riesgo de accidente cerebrovascular en comparación con la estenosis aórtica tricúspide.
- No se observaron diferencias significativas en la hemodinámica valvular ni en la fuga paravalvular.
- Los ensayos aleatorizados son necesarios para evaluar completamente la eficacia y la seguridad de TAVR en la estenosis aórtica bicúspide debido al potencial sesgo de selección.
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