Implante transapical de valva aórtica: resultados de uma nova prótese brasileira

Diego Felipe Gaia, José Honório Palma, Carolina Baeta Neves Duarte Ferreira, José Augusto Marcondes de Souza, Guilherme Agreli, José Cícero Stocco Guilhen, André Telis, Enio Buffolo
2010 Brazilian Journal of Cardiovascular Surgery  
Objective: The aortic valve replacement is a routine procedure with acceptable risk, but in some cases, such a risk can justify contraindication. The minimally invasive transcatheter aortic valve implantation has been viable, with lower morbidity and mortality. The aim of this study was to develop a national catheter-mounted aortic bioprosthesis for the aortic position implant. Methods: After animal studies, 14 patients with high EuroSCORE underwent transcatheter aortic valve implantation.
more » ... implantation. Median Logistic EuroSCORE was 43.7%. Four patients presented with dysfunctional bioprosthesis, remaining ones presented calcified aortic stenosis. All patients presented symptoms. Procedures were performed in a hybrid OR under fluoroscopic and echocardiography guidance. Using a left minithoracotomy the prosthesis was implanted through the ventricular apex under ventricular pacing or hemorrhagic shock, after aortic valvoplasty. Echocardiograph and angiograph controls were performed, and the patients were referred to ICU. Results: Implant was feasible in 13 cases. There were no intra-operative deaths. Median peak transvalvular aortic gradient reduced to 25.0 mmHg, and left ventricular function improved in the first seven post-operative days. Paravalvular aortic regurgitation was mild and present in 71%. No definitive pacemaker was needed. There was no peripheral vascular complication. Overall mortality was 42%. Conclusion: The transapical implantation of cathetermounted bioprosthesis was a feasible procedure. Long term follow-up is mandatory in order to access efficacy and indications. Descriptors: Aortic valve stenosis. Heart catheterization. Extracorporeal circulation. Resumo Objetivo: A troca valvar aórtica é procedimento rotineiro com risco aceitável. Em alguns casos, a mortalidade é elevada, levando à contraindicação do procedimento, apesar dos sintomas. O implante minimamente invasivo transcateter de valva aórtica parece ser uma alternativa, reduzindo a morbi-mortalidade. O objetivo deste estudo foi o desenvolvimento e implante de nova prótese transcateter. 294 GAIA, DF ET AL -Transapical aortic valve implantation: results of a Brazilian prosthesis Bras Cir Cardiovasc 2010; 25(3): 293-302 treatment. The survival rate with the technique was not satisfactory with a mortality rate of 65% at 1 year. Only 40% of patients at 1 year were free of reintervention, aortic valve replacement surgery, heart block, or death [6] . Rev
doi:10.1590/s0102-76382010000300004 pmid:21103736 fatcat:prtasu6ntjajzncwd2yrch3g44