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Resultados de la repetición de la sustitución de la válvula aórtica transcatéter por válvulas expandibles por globo:

Raj R Makkar¹, Samir Kapadia², Tarun Chakravarty¹

¹Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Lancet (London, England)

|September 3, 2023

Resumen

El reemplazo de la válvula aórtica con redotranscatéter (TAVR) utilizando válvulas expandibles por globo es seguro y efectivo para la TAVR fallida. Los resultados, incluidas las tasas de mortalidad y accidente cerebrovascular, fueron similares a los procedimientos iniciales de TAVR en pacientes emparejados.

Área de la Ciencia:

Medicina cardiovascular
Cardiología intervencionista
Dispositivos médicos

Sus antecedentes:

El uso creciente del reemplazo de la válvula aórtica transcatéter (TAVR) requiere un manejo comprensivo de la TAVR fallida.
La repetición de TAVR (redo-TAVR) es una opción emergente para el fallo de TAVR.

Objetivo del estudio:

Para evaluar la seguridad y eficacia de la redo-TAVR utilizando válvulas expandibles por globo.
Para comparar los resultados de la TAVR redo con la TAVR inicial para las válvulas nativas.

Principales métodos:

Análisis de pacientes del registro TAVT de STS/ACC (2011-2022).
Comparación de la TAVR redo con las cohortes de TAVR nativas mediante el emparejamiento de la puntuación de propensión.
Evaluación de los resultados del procedimiento, ecocardiográfico y clínico.

Principales resultados:

Bajas tasas de complicaciones de procedimiento en la Redo-TAVR, similares a la Native-TAVR.
No hay diferencias significativas en las tasas de mortalidad y accidente cerebrovascular a los 30 días o al año entre el TAVR redo y el TAVR nativo.
Redo-TAVR redujo los gradientes de la válvula aórtica pero se mantuvo más alto que el TAVR nativo a 1 año.

Conclusiones:

Redo-TAVR con válvulas expandibles es eficaz para el TAVR fallido, con pocas complicaciones.
Los resultados son comparables a la TAVR inicial en pacientes seleccionados.
Redo-TAVR puede ser una opción de tratamiento razonable para el TAVR fallido.

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