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Deformación de las prótesis de válvulas aórticas transcatéter: implicaciones para el engrosamiento del prospecto

Miho Fukui^1,2, Vinayak N Bapat^3,2, Santiago Garcia^3,2

¹Cardiovascular Imaging Research Center and Core Laboratory (M.F., G.H., J.L.C.), Minneapolis Heart Institute Foundation, MN.

|July 21, 2022

Resumen

La deformación del marco de la prótesis después del reemplazo de la válvula aórtica transcatéter (TAVR) está relacionada con el engrosamiento del prospecto hipoatenuante (HALT), lo que aumenta el riesgo de mortalidad. La optimización del despliegue de TAVR y el diseño de la válvula puede mejorar los resultados del paciente.

Área de la Ciencia:

Imágenes cardiovasculares
Cardiología intervencionista
Ciencia de los biomateriales

Sus antecedentes:

El reemplazo de la válvula aórtica transcatéter (TAVR) es una terapia creciente con preocupaciones con respecto al engrosamiento del prospecto hipoatenuante (HALT).
HALT puede afectar negativamente la función de la prótesis y su durabilidad a largo plazo.
Este estudio investiga la relación entre los factores de marco de la prótesis TAVR y la ocurrencia de HALT.

Objetivo del estudio:

Examinar los factores del marco de la prótesis en el TAVR.
Para correlacionar estos factores con la incidencia de HALT.
Evaluar la asociación entre HALT y los resultados clínicos.

Principales métodos:

Estudio prospectivo de 565 pacientes sometidos a SAPIEN3 o EVOLUT TAVR.
Tomografía computarizada cardíaca para la detección de HALT 30 días después del procedimiento.
Análisis de la deformación de la prótesis TAVR, la asimetría del prospecto, los volúmenes sinusales y la alineación comisural.

Principales resultados:

HALT se produjo en el 21% de los pacientes con SAPIEN3 y en el 16% de los pacientes con EVOLUT.
HALT se asoció significativamente con una mayor deformación del marco de la prótesis, asimetría del prospecto y menores volúmenes de neosino (P< 0,001).
La deformación de la prótesis TAVR predijo HALT, independiente de los factores clínicos. HALT se relacionó con un aumento de la mortalidad al año (de todas las causas, cardíaca) y la hospitalización por insuficiencia cardíaca.

Conclusiones:

La expansión de la prótesis TAVR no uniforme, que conduce a la deformación del marco, folletos asimétricos y volúmenes de neosino más pequeños, está asociada con HALT.
Estos hallazgos sugieren implicaciones para el diseño de prótesis TAVR y las técnicas de despliegue.
La mejora de la expansión de la prótesis puede mejorar los resultados clínicos en pacientes con TAVR.

Palabras clave:

Estenosis de la aorta tomografía computarizada Hipoatenuación del espesor del prospecto Sustitución de la válvula aórtica mediante catéter

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