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Impacto del volumen de reemplazo de la válvula aórtica transcatéter en los resultados en pacientes con enfermedad
Esteban Aguayo1, Oh Jin Kwon1, Mitchell Won1
1Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA; Department of Surgery, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
The Annals of thoracic surgery
|August 29, 2025
Resumen
Los pacientes con enfermedad renal terminal (ESRD, por sus siglas en inglés) se enfrentan a un mayor riesgo de mortalidad y readmisión después de un reemplazo de válvula aórtica transcatéter (TAVR, por sus siglas en inglés). Estos riesgos persisten independientemente del volumen hospitalario, enfatizando la necesidad de una selección cuidadosa de los pacientes.
Área de la Ciencia:
- Medicina cardiovascular
- Nefrología
- Cardiología intervencionista
Sus antecedentes:
- Los pacientes con enfermedad renal terminal tienen un mayor riesgo de estenosis aórtica calcificada.
- Existen datos limitados sobre la eficacia del reemplazo transcatéter de la válvula aórtica (TAVR) en pacientes con DRE.
Objetivo del estudio:
- Examinar la mortalidad aguda, las complicaciones y las readmisiones a los 30 días en pacientes con ESRD sometidos a TAVR.
- Comparar los resultados entre las cohortes de la ESRD y las que no lo son.
Principales métodos:
- Utilizó la base de datos nacional de readmisiones 2016-2021 para las admisiones de TAVR (≥18 años).
- Los pacientes fueron estratificados en grupos de ESRD y no ESRD.
- Se evaluó la mortalidad hospitalaria, los reingresos de 30 días, las complicaciones perioperatorias, la duración de la estancia y los costos.
- Se empleó regresión logística multivariable y análisis de Nelson-Aalen, estratificado por volumen TAVR institucional (hospitales de bajo volumen frente a hospitales de alto volumen).
Principales resultados:
- El 7,3% de los 411 311 pacientes con TAVR presentaron ERC.
- La ESRD se asoció con una mortalidad significativamente mayor (AOR 1,79) y readmisiones (AOR 1,87) después del ajuste de riesgo.
- Los pacientes con ESRD experimentaron una mayor duración de la estancia (+1,3 días) y mayores costos (+1,0 mil dólares).
- El volumen TAVR institucional no mitigó los riesgos de mortalidad o de readmisión para los pacientes con ESRD.
Conclusiones:
- Los pacientes con ESRD sometidos a TAVR tienen un mayor riesgo de mortalidad posoperatoria y readmisiones.
- Los centros de volumen procedimental TAVR más altos no redujeron estos riesgos elevados para los pacientes con ESRD.
- La selección y optimización cuidadosas de los pacientes son críticas para los pacientes con ESRD sometidos a TAVR debido al aumento de los riesgos.
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