Publication: Aspectos relevantes en el seguimiento clínico y hemodinámico de pacientes con estenosis aórtica severa sintomática tratados mediante implante transcatéter de prótesis aórtica
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Publication Date
2018-04-16
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Jiménez Quevedo, Pilar
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Universidad Complutense de Madrid
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Abstract
El reemplazo transcatéter de válvula aórtica (TAVR) es una técnica consolidada para el tratamiento de la estenosis aórtica severa en pacientes inoperables o de alto riesgo quirúrgico. Además, de acuerdo con los últimos estudios aleatorizados, también puede ser una alternativa en pacientes seleccionados de riesgo intermedio. Aunque el pronóstico tras TAVR sigue mejorando, continua habiendo aspectos sin resolver en relación a las nuevas válvulas para implante transcatéter, los procedimientos de TAVR en pacientes con implante previo de bioprótesis aórtica quirúrgica (procedimientos “Valve in Valve” –ViV-), los reingresos hospitalarios tras TAVR y la durabilidad de las bioprótesis transcatéter. El propósito de los cuatro artículos que componen esta tesis es aportar información a estas cuestiones aún sin resolver en el campo del TAVR. Artículo 1: “Self-expanding Portico Valve Versus Balloon-expandable SAPIEN XT Valve in Patients With Small Aortic Annuli: Comparison of Hemodynamic Performance.” El objetivo de este estudio fue comparar los resultados hemodinámicos de la válvula autoexpandible Portico con los de la válvula balón-expandible Sapien XT en un estudio de casos apareados con análisis en un laboratorio central de ecocardiografía. Para ello, se emparejó a 22 pacientes tratados mediante implante transcatéter de la válvula Pórtico de 23 mm con 40 pacientes tratados con la válvula Sapien XT de 23 mm, según los siguientes parámetros: área y diámetro medio del anillo aórtico por tomografía Computerizada (TC), fracción de eyección del ventrículo izquierdo (FEVI), área de superficie corporal e índice de masa corporal...
Transcatheter aortic valve replacement (TAVR) is well-established for treating patients with symptomatic severe aortic stenosis deemed at high or prohibitive risk for surgical aortic valve replacement (SAVR). Also, according to recent randomized clinical trials, TAVR may also be an alternative to SAVR in selected intermediate-risk patients. Although TAVR outcomes continue to improve, concerns remain with respect to new transcatheter valves, valve in valve (ViV) procedures, readmissions after TAVR and valve durability. The purpose of the four papers composing the present PhD Thesis is to provide new evidence on these current issues. Paper 1: “Self-expanding Portico Valve Versus Balloon-expandable SAPIEN XT Valve in Patients With Small Aortic Annuli: Comparison of Hemodynamic Performance.” The aim of this paper was to compare the hemodynamic performance of the selfexpanding Portico and balloon-expandable Sapien XT valves in a case-matched study with echocardiographic core laboratory analysis. Twenty-two patients underwent TAVR with the Portico 23 mm valve and were matched for aortic annulus area and mean diameter measured by computed tomography (CT), left ventricular ejection fraction, body surface area, and body mass index with 40 patients undergoing TAVR with the 23 mm Sapien XT. There were no significant between-group differences in residual mean transaortic gradients and effective orifice area. Rates of severe prosthesis-patient mismatch were low and similar between groups. Similarly, no differences were found in the occurrence and severity of moderate-severe paravalvular leaks...
Transcatheter aortic valve replacement (TAVR) is well-established for treating patients with symptomatic severe aortic stenosis deemed at high or prohibitive risk for surgical aortic valve replacement (SAVR). Also, according to recent randomized clinical trials, TAVR may also be an alternative to SAVR in selected intermediate-risk patients. Although TAVR outcomes continue to improve, concerns remain with respect to new transcatheter valves, valve in valve (ViV) procedures, readmissions after TAVR and valve durability. The purpose of the four papers composing the present PhD Thesis is to provide new evidence on these current issues. Paper 1: “Self-expanding Portico Valve Versus Balloon-expandable SAPIEN XT Valve in Patients With Small Aortic Annuli: Comparison of Hemodynamic Performance.” The aim of this paper was to compare the hemodynamic performance of the selfexpanding Portico and balloon-expandable Sapien XT valves in a case-matched study with echocardiographic core laboratory analysis. Twenty-two patients underwent TAVR with the Portico 23 mm valve and were matched for aortic annulus area and mean diameter measured by computed tomography (CT), left ventricular ejection fraction, body surface area, and body mass index with 40 patients undergoing TAVR with the 23 mm Sapien XT. There were no significant between-group differences in residual mean transaortic gradients and effective orifice area. Rates of severe prosthesis-patient mismatch were low and similar between groups. Similarly, no differences were found in the occurrence and severity of moderate-severe paravalvular leaks...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina, leída el 24-10-2017