Editorial

Temas no resueltos en TAVI

Dr. Rodrigo Bagur

Division of Cardiology, London Health Sciences Centre, Departments of Medicine and Epidemiology & Biostatistics, Western University, London, Ontario, Canada.

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Bienvenidos a un nuevo Boletín ProEducar, en esta oportunidad, nos focalizamos en temas no resueltos en implante de válvula aórtica por catéter (TAVI).

La prevalencia de enfermedad coronaria significativa en pacientes con estenosis aórtica severa varía entre 50 y 70%. En el capítulo inicial del boletín, los Dres. Sergio Pérez y Mauricio Cohen (Miami School of Medicine, Miami, USA) comparten una revisión que es motivo de discusión y controversia acerca de si debemos revascularizar pacientes con enfermedad coronaria significativa antes de un procedimiento TAVI.

Como todos saben, la valvuloplastia aórtica fue durante mucho tiempo el tratamiento alternativo para determinados pacientes con estenosis aórtica severa sintomática, y que no podían recibir cirugía de reemplazo valvular debido a un alto riesgo quirúrgico. En la era TAVI, la valvuloplastia aórtica es considerada parte rutinaria en el pre-implante de TAVI. Sin embargo, data emergente sugiere que es seguro y eficaz hacer TAVI obviando la valvuloplastia, al menos, de forma rutinaria. En su artículo de revisión, el Dr. Miguel Ballarino (Hospital Privado de Córdoba) hace una puesta al día del rol de la valvuloplastia aórtica pre-implante de TAVI.

Es sabido que aproximadamente 60% de los pacientes que reciben una TAVI están asociados a embolias cerebrales silentes evaluadas por resonancia magnética cerebral. Sin embargo, y afortunadamente, este porcentaje no se traduce con accidentes cerebrovasculares clínicos. Para disminuir estos eventos se han creado dispositivos de protección cerebral, filtros y deflectores, para tratar de disminuir el número y/o volumen de estas lesiones isquémicas. Los Dres. Germán Armijo y Luis Nombela-Franco (Hospital Clínico, Madrid) hacen una revisión sobre sistemas de protección cerebral en TAVI.

Con el correr del tiempo y el avance de la tecnología, actualmente tratamos pacientes más jóvenes y con menos enfermedades en comparación a 10 o 15 años atrás. Sin embargo, un tema que es de debate cotidiano al momento de elegir el tipo de bioprótesis en estos pacientes, es la durabilidad de las TAVI. Para cerrar, entonces, con la Dra. Lucía Vera-Pernasetti hacemos un sumario de la data sobre durabilidad a largo plazo de las TAVI y la incidencia de degeneración valvular.

Quiero agradecer a los autores de los artículos presentados en este Boletín de ProEducar por su esfuerzo y disponibilidad para colaborar. Finalmente, un especial agradecimiento al Dr. Leandro Martínez-Riera, por su consideración y confianza para dirigir el Boletín, como así también a Marisa Desiervi, por su ayuda y profesionalismo para coordinar y llevar a cabo este proyecto.

Espero que encuentren útil la información del presente boletín.

 

Saludos cordiales,

 

Rodrigo Bagur
Cardiólogo Intervencionista
London Health Sciences Centre, Western University
London, Ontario, Canada
Director Asociado del Boletín 111 de ProEducar: "Temas no Resueltos en TAVI"

En esta edición

Editorial

Temas no resueltos en TAVI

Dr. Rodrigo Bagur
Artículo de Revision

Rol de la Valvuloplastia Aórtica en TAVI

Dr. Miguel Ballarino
Artículo de Revision

Sistemas de protección cerebral en TAVI

Dr. Luis Nombela Franco, Dr. Germán Armijo
Artículo de Revision

Degeneración de prótesis valvular percutánea y durabilidad

Dr. Rodrigo Bagur, Dr. Lucia Vera-Pernasetti
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