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Transcatéter vs. reemplazo quirúrgico de la válvula aórtica en pacientes con estenosis aórtica y enfermedad renal
Maneeth Mylavarapu1, Israel Garcia2, Niharika Tanwar3
1Department of Public Health, Adelphi University, NY, USA.
Annals of medicine and surgery (2012)
|September 3, 2025
Resumen
El reemplazo de la válvula aórtica transcatéter (TAVR) muestra mejores resultados que el reemplazo quirúrgico de la válvula aórtica (SAVR) en pacientes con estenosis aórtica y enfermedad renal crónica, incluida una menor mortalidad y menos complicaciones. Sin embargo, TAVR aumenta los riesgos de implantación de marcapasos y problemas vasculares.
Área de la Ciencia:
- Medicina cardiovascular
- Nefrología
- Cardiología intervencionista
Sus antecedentes:
- El tratamiento de la estenosis aórtica (SA) implica el reemplazo de la válvula aórtica transcatéter (TAVR) y el reemplazo quirúrgico de la válvula aórtica (SAVR).
- Existen datos limitados sobre los resultados postoperatorios en pacientes con EA con enfermedad renal crónica (ERC) coexistente.
Objetivo del estudio:
- Comparar los resultados clínicos postoperatorios de la TAVR frente a la SAVR en pacientes diagnosticados con EA y ERC.
Principales métodos:
- Se realizó una búsqueda sistemática de la literatura siguiendo las pautas de PRISMA en PubMed, EMBASE, Scopus y Google Scholar.
- Los estudios incluidos compararon los resultados clínicos de TAVR y SAVR específicamente en pacientes con ERC.
- Metaanálisis de 23 estudios en los que participaron 69.017 pacientes.
Principales resultados:
- La TAVR se asoció con una mortalidad hospitalaria significativamente menor (OR 0, 54), lesión renal aguda (AKI) (OR 0, 41), AKI que requirió diálisis (OR 0, 66) y complicaciones postoperatorias generales (OR 0, 34) en comparación con la SAVR.
- El TAVR también mostró una reducción significativa en la incidencia de IAC (P < 0,00001) y en las complicaciones postoperatorias (P < 0,0001).
- Por el contrario, TAVR tenía probabilidades significativamente más altas de implantación permanente del marcapasos (PPI) (OR 2,69) y complicaciones vasculares mayores (OR 2,56) que SAVR.
Conclusiones:
- En pacientes con EA y ERC, la TAVR demuestra resultados superiores con respecto a la mortalidad hospitalaria, la incidencia de IAC y las complicaciones postoperatorias en comparación con la SAVR.
- La TAVR está relacionada con un mayor riesgo de IPP y complicaciones vasculares importantes, lo que requiere una evaluación de riesgo individualizada.
- El TAVR representa una alternativa favorable al SAVR para pacientes con ERC cuidadosamente seleccionados con SA.
Palabras clave:
SAVR (en inglés)TAVR (por sus siglas en inglés)lesión renal agudamortalidad por todas las causasEnfermedad renal crónicaMetanálisisMás Videos Relacionados
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