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Trombosis subclínica del prospecto y trombosis subclínica del complejo de la válvula aórtica en TAVR

Benjamin Marchandot¹, Antonin Trimaille¹, Shinnosuke Kikuchi²

¹Department of Cardiology, University Hospital of Strasbourg, Strasbourg, France; Research Unit - UR3074 - Translational Cardiovascular Medicine, University of Strasbourg, Strasbourg, France; GERCA (Groupe pour l'Enseignement et la Recherche Cardiologique en Alsace), Strasbourg, France.

|August 21, 2025

Resumen

La trombosis subclínica del prospecto (SLT) después del reemplazo de la válvula aórtica transcatéter es común. La optimización de las estrategias de anticoagulación equilibra la reducción de la SLT con los riesgos de hemorragia para mejores resultados en los pacientes.

Área de la Ciencia:

Cardiología
Ingeniería biomédica

Sus antecedentes:

La trombosis subclínica del prospecto (SLT) afecta al 10-30% de los pacientes después del reemplazo de la válvula aórtica transcatéter (TAVR).
SLT puede extenderse a las áreas perivalvulares, formando una trombosis subclínica del complejo de la válvula aórtica.
Comprender las causas multifactoriales de SLT es crucial para el manejo de las complicaciones de TAVR.

Objetivo del estudio:

Revisar los factores que contribuyen a la SLT después del TAVR.
Para analizar el impacto de la terapia antitrombótica en la incidencia de SLT.
Proponer estrategias personalizadas de anticoagulación para pacientes de alto riesgo.

Principales métodos:

Revisión exhaustiva de la literatura sobre los factores que contribuyen al TLS.
Análisis de los parámetros específicos de la válvula: dinámica de flujo, dimensionamiento de la prótesis, despliegue y alineación.
Evaluación de la actividad retenida del prospecto calcificado y de los efectos de la terapia antitrombótica.

Principales resultados:

La incidencia de SLT oscila entre el 10 y el 15% a un mes y el 30% un año después del TAVR.
La anticoagulación oral reduce la SLT detectada pero aumenta los riesgos de sangrado y mortalidad.
La geometría del dispositivo, el flujo sinusal y la actividad del tejido nativo son determinantes clave de SLT.

Conclusiones:

Se necesitan estrategias de anticoagulación personalizadas y limitadas en el tiempo para los pacientes con TAVR de alto riesgo.
La optimización del equilibrio trombosis-sangrado es esencial para mejorar los resultados de la TAVR.
La integración del dispositivo, el flujo y los factores de tejido pueden guiar la anticoagulación a medida.

Palabras clave:

Válvula aórtica Trombosis Sustitución de la válvula aórtica mediante catéter Válvula cardíaca transcatéter

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