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Sustitución de la válvula aórtica transcatéter o quirúrgica en pacientes con estenosis aórtica grave y pequeño anular

Josep Rodés-Cabau¹, Henrique Barbosa Ribeiro², Siamak Mohammadi¹

¹Cardiology Department, Quebec Heart & Lung Institute, Laval University, Quebec City, Canada (J.R.-C., S.M., J.-M.P., E.D., D.K., C.G., M.A., E.P.-B., P.P.).

|October 26, 2023

Resumen

El reemplazo transcatéter de la válvula aórtica (TAVR) y el reemplazo quirúrgico de la válvula aórtica (SAVR) muestran resultados hemodinámicos y clínicos similares en pacientes con estenosis aórtica grave y pequeño anillo aórtico. La elección del tratamiento debe ser individualizada, ya que ni el TAVR ni el SAVR demostraron superioridad.

Área de la Ciencia:

Cardiología
Cardiología intervencionista
Cirugía cardíaca

Sus antecedentes:

La estenosis aórtica grave con un pequeño anillo aórtico (SAA) presenta desafíos de tratamiento únicos.
Las estrategias de manejo óptimas para comparar el reemplazo de la válvula aórtica transcatéter (TAVR) y el reemplazo quirúrgico de la válvula aórtica (SAVR) en pacientes con AAS no están bien definidas.

Objetivo del estudio:

Comparar los resultados hemodinámicos y clínicos de TAVR frente a SAVR en pacientes con estenosis aórtica severa y AAS.

Principales métodos:

Un ensayo prospectivo, internacional y aleatorizado en el que participaron 151 pacientes con AAS (diámetro medio < 23 mm) aleatorizados a TAVR o SAVR.
Resultado primario: deterioro de la hemodinámica de la válvula a los 60 días (desajuste entre prótesis y paciente o regurgitación aórtica).
Resultados secundarios: mortalidad, accidente cerebrovascular y hospitalización cardíaca evaluados durante una mediana de seguimiento de 2 años.

Principales resultados:

No se observaron diferencias significativas entre los grupos TAVR y SAVR en el desajuste grave de la prótesis con el paciente o en la regurgitación aórtica de moderada a grave a los 60 días.
Los resultados a corto plazo (30 días) y a largo plazo (2 años), incluida la mortalidad, el accidente cerebrovascular y la hospitalización cardíaca, fueron comparables entre los grupos TAVR y SAVR.
La población del estudio consistía predominantemente en mujeres (93%) con un riesgo quirúrgico de bajo a intermedio.

Conclusiones:

El TAVR y el SAVR contemporáneos demuestran un rendimiento hemodinámico valvular y resultados clínicos comparables en pacientes con estenosis aórtica grave y AAS.
Las decisiones de tratamiento para los pacientes con AAS deben ser individualizadas, teniendo en cuenta las características y preferencias del paciente.
Se necesitan estudios más amplios para confirmar estos hallazgos debido al tamaño y la potencia limitados de la muestra del estudio actual.

Palabras clave:

Estenosis de la aorta Desajuste entre prótesis y paciente Implantación transcatéter de la válvula aórtica

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