Estenosi aòrtica greu de la persona grannoves opcions terapèutiques

  1. Villa Redondo, Bernardo García de la
  2. Martínez-Sellés dOliveira Soares, Manuel
  3. Cornide Santos, Luis
Revista:
Anuari de l'envelliment: Illes Balears

ISSN: 2174-7997

Año de publicación: 2012

Año: 2012

Páginas: 419-447

Tipo: Artículo

Otras publicaciones en: Anuari de l'envelliment: Illes Balears

Resumen

La estenosis valvular aórtica degenerativa es la valvulopatía más frecuente en la población anciana y el envejecimiento poblacional en los países desarrollados conlleva que la prevalencia de esta patología se haya incrementado considerablemente en los últimos años hasta el punto de convertirse en un problema de salud pública. En la presente revisión se analizan algunos aspectos acerca de la epidemiología, características clínicas, diagnóstico, evaluación de la severidad y pronóstico de dicha patología, haciendo especial hincapié en las opciones terapéuticas disponibles en la actualidad, donde la aparición y desarrollo del implante de prótesis percutáneas transcatéter en posición aórtica como nueva arma terapéutica ha supuesto una extensión del tratamiento invasivo hacia poblaciones más ancianas o con mayor comorbilidad, generalmente excluidas del tratamiento quirúrgico por el excesivo riesgo que conlleva la intervención, y manejadas de forma más conservadora. El registro PEGASO aporta datos acerca del manejo real de la estenosis áortica severa del octogenario en nuestro medio.

Referencias bibliográficas

  • Aronow, W. S. (2007): «Recognition and management of aortic stenosis in the elderly». Geriatrics; 62 (12): 23-32.
  • Aronow, W. S. [et al.] (2001): «Association of coronary risk factors and use of statins with progression of mild valvular aortic stenosis in older persons». American Journal of Cardiology; 88: 693-695.
  • Aronow, W. S.; Ahn, C.; Kronzon, I. (2001): «Comparison of echocardiographic abnormalities in African-American, Hispanic, and white men and women aged >60 years». American Journal of Cardiology; 87: 1131-1133.
  • Aronow, W. S.; Ahn, C.; Shirani, J. (1998); [et al.]: «Comparison of frequency of new coronary events in older persons with mild, moderate, and severe valvular aortic stenosis with those without aortic stenosis». American Journal of Cardiology; 81: 647-649.
  • Aronow, W. S.; Kronzon, I. (1987): «Correlation of prevalence and severity of valvular aortic stenosis determined by continuous-wave Doppler echocardiography with physical signs of aortic stenosis in patients aged 62 to 100 years with aortic systolic ejection murmurs». American Journal of Cardiology; 60: 399-401.
  • Asimakopoulos, G.; Edwards, M. B.; Taylor, K. M. (1997): «Aortic valve replacement in patients 80 years of age and older: survival and cause of death based on 1.100 cases: collective results from the UK Heart Valve Registry». Circulation; nov. 18; 96 (10): 3403-3408.
  • Avanzas, P. [et al.] (2010): «Implante percutáneo de la prótesis valvular aórtica autoexpandible CoreValveW en pacientes con estenosis aórtica severa: experiencia inicial en España». Revista Española de Cardiología; 63: 141-148.
  • Baumgartner, H. (2005): «Aortic stenosis. Medical and surgical management». Heart; 91: 1483-1488.
  • Bellamy, M. F. [et al.] (2002): «Association of cholesterol levels, hydroxymethylglutaryl coenzyme-A reductase inhibitor treatment, and progression of aortic stenosis in the community». Journal of the American College of Cardiology; 40: 1723-1730.
  • Bessou, J. P. [et al.] (1999): «Aortic valvular replacement in octogenarians. Short-term and mid-term results in 140 patients». Cardiovascular Surgery; 7 (3) 355-362.
  • Bonow, R. O. [et al.] (2006): «ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines». Circulation; 114: e84-231.
  • Bouma, B. J. [et al.] (1999): «To operate or not on elderly patients with aortic stenosis: the decision and its consequences». Heart; 82: 143-148.
  • Bouma, B. J. [et al.] (2004): «Which elderly patients with severe aortic stenosis benefit from surgical treatment? An aid to clinical decision making». Journal of Heart Valve Disease; 13: 374-381.
  • Chambers, J. (2006): «The left ventricle in aortic stenosis: evidence for the use of angiotensin-converting enzyme inhibitors». Heart; 92: 420-423.
  • Chan, K. L. [et al.] (2010): «Effect of Lipid Lowering With Rosuvastatin on Progression of Aortic Stenosis. Results of the Aortic Stenosis Progression Observation: Measuring Effects of Rosuvastatin (ASTRONOMER) Trial». Circulation; 121: 306-314.
  • Charlson, M. E. [et al.] (1987): «A new method of classifying prognostic comorbidity in longitudinal studies: development and validation». Journal of Chronic Diseases; 40: 373-383.
  • Cornide, L. (2011): Estenosis aórtica grave sintomática en octogenarios: características clínicas, tratamiento y determinantes de la sustitución valvular. Tesi doctoral. Facultat de Medicina. Universitat Autònoma de Madrid.
  • Cowell, S. J. [et al.] (2005): «A randomized trial of intensive lipid-lowering therapy in calcific aortic stenosis». New England Journal of Medicine; 352: 2389-2397.
  • Cribier, A. [et al.] (2002): «Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description». Circulation; 106: 3006-3008.
  • Eltchaninoff, H. [et al.] (1995): «Balloon aortic valvuloplasty in elderly patients at high risk for surgery, or inoperable. Immediate and mid-term results». European Heart Journal, agost, 16(8): 1079-1084.
  • Enríquez, F.: «Tratamiento quirúrgico de las valvulopatías en el anciano: Experiencia en Baleares». Ponència al VII Congreso de la Societat Balear de Cardiologia.
  • Freeman, R. V.; Otto, C. M. (2005): «Spectrum of calcific aortic valve disease. Pathogenesis, disease progression, and treatment strategies». Circulation; juny, 21; 111 (24) 3316-3326.
  • García de la Villa, B. (2010): «Nuevas alternativas terapéuticas en la estenosis aórtica». Comunicació oral a simposi. Hospital Son Dureta. Palma de Mallorca, 26 d’abril de 2010.
  • Hakki, A. H. [et al.] (1980): «Angina pectoris and coronary artery disease in patients with severe aortic valvular disease». American Heart Journal; 100: 441-449.
  • Hofmann, T. [et al.] (1987): «Determination of aortic valve orifice area in aortic valve stenosis by two-dimensional transesophageal echocardiography». American Journal of Cardiology; 59: 330-335.
  • Horstkotte, D.; Loogen, F. (1988): «The natural history of aortic valve stenosis». European Heart Journal; 9 (supl. E): 57-64.
  • Iung, B. (2008): «Management of the elderly patient with aortic stenosis». Heart; 94(4): 519-524.
  • Iung, B. [et al.] (2003): «A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease». European Heart Journal; 24: 1231-1243.
  • Iung, B. [et al.] (2005): «Decision-making in elderly patients with severe aortic: why are so many denied surgery?» European Heart Journal; 26: 2714-2720.
  • Iung, B.; Vahanian, A. (2006): «Valvular heart diseases in elderly people». Lancet; 368: 969-971.
  • Jassal, D. S. [et al.] (2011): «Evaluating the effectiveness of rosuvastatin in preventing the progression of diastolic dysfunction in aortic stenosis: A substudy of the aortic stenosis progression observation measuring effects of rosuvastatin (ASTRONOMER) study». Cardiovas Ultrasound; 9: 5.
  • Julius, B. K. [et al.] (1997): «Angina pectoris in patients with aortic stenosis and normal coronary arteries. Mechanisms and pathophysiologic concepts». Circulation; 95: 892-898.
  • Katz, S. [et al.] (1963): «Studies of illness in the aged. The index of adl: a standardized measure of biological and psychosocial function». Journal of American Medical Association; 185: 914-919.
  • Khot, U. N. [et al.] (2003): «Nitroprusside in critically ill patients with left ventricular dysfunction and aortic stenosis». New England Journal of Medicine; 348: 1756-1763.
  • Kodali, S. K. [et al.] for the PARTNER Trial Investigators (2012): «Two-Year Outcomes after Transcatheter or Surgical Aortic-Valve Replacement». New England Journal of Medicine; 366: 1686-1695.
  • Kolh, P. [et al.] (2001): «Cardiac surgery in octogenarians. Intra-operative outcome and long-term results». European Heart Journal; 22: 1235-1243.
  • Leon, M. B. [et al.] (2010): «Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery». New England Journal of Medicine; 363: 1597-1607.
  • Levinson, J. R. [et al.] (1989): «Octogenarians with aortic stenosis: outcome after aortic valve replacement». Circulation; 80 (supl. 1): 49-56.
  • Lichtenstein, S. V. [et al.] (2006): «Transapical transcatheter aortic valve implantation in humans. Initial clinical experience». Circulation; 114: 591-596.
  • Lindblom, D. [et al.] (1990): «Long-term relative survival rates after heart valve replacement». Journal of American College of Cardiology; 15: 566-573.
  • Livanainen, A. M. [et al.] (1996): «Natural history of aortic valve stenosis of varying severity in the elderly». Annals of Thoracic Surgery; 78: 97-101.
  • Makkar, R. R. [et al.] (2012): «Transcatheter aortic-valve replacement for inoperable severe aortic stenosis». The New England Journal of Medicine; DOI: 10.1056/NEJMoa1202277.
  • Marcus, M. L. [et al.] (1982): «Decreased coronary reserve: a mechanism for angina pectoris in patients with aortic stenosis and normal coronary arteries». The New England Journal of Medicine; 307: 1362-1366.
  • Martínez-Sellés, M. (2010): «Sustitución valvular aórtica: ¿es una solución a la epidemia de estenosis aórtica en el anciano?». Medicina Clínica; 134: 114-115.
  • Martínez-Sellés, M. [et al.] (2007): «Treatment and outcomes of severe cardiac disease with surgical indication in very old patients». International Journal of Cardiology; 119: 15-20.
  • Martínez-Sellés, M. [et al.] (2009): «Actualización en cardiología geriátrica». Revista Española de Cardiología; 62, supl. 1: 53-66.
  • Martínez-Sellés, M. [et al.] (2010): «Actualización en cardiología geriátrica». Revista Española de Cardiología; 63, supl. 1: 17-28.
  • Martínez-Sellés, M. [et al.] (2010): «Symptomatic severe aortic stenosis in patients over 80 years. Baseline characteristics, management and determinants of surgery in a prospective registry of 650 patients». Presentació de pòsters a ESC Congress 2010, Estocolm, 28 agost-1 setembre 2010.
  • Martínez-Sellés, M. [et al.] (2012): «Severe symptomatic aortic stenosis in octogenarians: a need for intervention». Presentació oral a ESC Congress 2012, Munic, Alemanya, 25-29 agost 2012.
  • Melby, S. J. [et al.] (2007): «Aortic valve replacement in octogenarians: risk factors for early and late mortality». Annals of Thoracic Surgery; 83: 1651-1657.
  • Moura, L. M. [et al.] (2007): «Rosuvastatin affecting aortic valve endothelium to slow the progression of aortic stenosis». Journal of the American College of Cardiology; 49: 554-561.
  • Nkomo, V. T. [et al.] (2006): «Burden of valvular heart diseases: a population-based study». Lancet; 368: 1005-1011.
  • Novaro, G. M. [et al.] (2001): «Effect of hydroxymethylglutaryl coenzyme A reductase inhibitors on the progression of calcific aortic stenosis». Circulation; 104: 2205-2209.
  • Olsson, M. [et al.] (1992): «Aortic valve replacement in octogenarians with aortic stenosis: a case-control study». Journal of the American College of Cardiology; 20: 1512-1516.
  • Paniagua, D. [et al.] (2005): «First human case of retrograde transcatheter implantation of an aortic valve prosthesis». Texas Heart Institute Journal; 32: 393-398.
  • Pellikka, P. A. [et al.] (2005): «Outcome of 622 adults with asymptomatic, hemodynamically significant aortic stenosis during prolonged follow-up». Circulation; 111: 3290-3295.
  • Piazza, N. [et al.] (2008): «Procedural and 30-day outcomes following transcatheter aortic valve implantation using the third generation (18 Fr) corevalve revalving system: results from the multicentre, expanded evaluation registry 1-year following CE mark approval». EuroIntervention; 4: 242-249.
  • Reynolds, M. R. [et al.] (2011): «Health-related quality of life after transcatheter aortic valve replacement in inoperable patients with severe aortic stenosis». Circulation; 124: 1964-1972.
  • Reynolds, M. R. [et al.] (2012): «Cost-effectiveness of transcatheter aortic valve replacement compared with standard care among inoperable patients with severe aortic stenosis: results from the placement of aortic transcatheter valves (PARTNER) trial (Cohort B)». Circulation; 125: 1102-1109.
  • Riera, M. [et al.] (2011): «Supervivencia a medio plazo de los pacientes operados en cirugía cardíaca mayor». Revista Española de Cardiología; 64 (6): 463-469.
  • Roberts, W. C.; Ko, J. M. (2005): «Frequency by decades of unicuspid, bicuspid, and tricuspid aortic valves in adults having isolated aortic valve replacement for aortic stenosis, with or without associated aortic regurgitation». Circulation; 111: 920-925.
  • Rodés-Cabau, J. [et al.] (2009): «Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk: acute and late outcomes of the multicenter Canadian experience». Journal of the American College of Cardiology; 55: 1080-1090.
  • Rodés-Cabau, J. [et al.] (2012): «Indicaciones de prótesis aórtica percutánea después del estudio PARTNER». Revista Española de Cardiología; 65 (3): 208-214.
  • Roques, F. [et al.] (2003): «The logistic EuroSCORE». European Heart Journal; 24: 881-882.
  • Rosenhek, R. [et al.] (2004): «Statins but not angiotensinconverting enzyme inhibitors delay progression of aortic stenosis». Circulation; 110: 1291-1295.
  • Ross, J. Jr.; Braunwald, E. (1968): «Aortic stenosis». Circulation; 38: 61-67.
  • Rossebø, A. B. [et al.] (2008): «Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis». New England Journal of Medicine; 359: 1343-1356.
  • Routledge, H. C.; Townend, J. N. (2001): «ACE inhibition in aortic stenosis: dangerous medicine or golden opportunity?». Journal of Human Hypertension; 15: 659-667.
  • Schwammenthal, E. [et al.] (2001): «Dobutamine echocardiography in patients with aortic stenosis and left ventricular dysfunction: Predicting outcome as a function of management strategy». Chest, 1766-1777.
  • Shroyer, A. L. [et al.] (2003): «The Society of Thoracic Surgeons: 30-day operative mortality and morbidity risk models». Annals of Thoracic Surgery; 75: 1856-1864.
  • Smith, C. R. [et al.] (2011): «Transcatheter versus surgical aortic-valve replacement in highrisk patients». New England Journal of Medicine; 364: 2187-2198.
  • Stewart, B. F. [et al.] (1997): «Clinical factors associated with calcific aortic valve disease Journal of the American College of Cardiology; 29: 630-634.
  • Tamburino, C. [et al.] (2011): «Incidence and predictors of early and late mortality after transcatheter aortic valve implantation in 663 patients with severe aortic stenosis». Circulation; 123: 299-308.
  • The National Institute of Clinical Excelence (NICE): Interventional procedure guidance 421. Transcatheter aortic valve implantation for aortic stenosis. Disponible a <http://www.nice. org.uk/nicemedia/live/11914/58611/58611.pdf>.
  • Thomas, M. (2012): «New NICE TAVI interventional procedure guidance: sense or nonsense, let the multidisciplinary team decide?». Heart. Doi:10.1136/heartjnl-2012-302510.
  • Thomas, M. [et al.] (2010): «Thirty day results of the SAPIEN aortic Bioprosthesis European Outcome (SOURCE) Registry: A European registry of transcatheter aortic valve implantation using the Edwards SAPIEN valve». Circulation; 122: 62-69.
  • Thomas, M. [et al.] (2011): «One-year outcomes of cohort 1 in the Edwards SAPIEN Aortic Bioprosthesis European Outcome (SOURCE) registry: the European registry of transcatheter aortic valve implantation using the Edwards SAPIEN valve». Circulation; 124: 425-433.
  • Turina, J. [et al.] (1987): «Spontaneous course of aortic valve disease». European Heart Journal; 8: 471-483.
  • Vahanian, A. [et al.] (2007): «Guidelines on the management of valvular heart disease. The task force on the management of valvular heart disease of the European Society of Cardiology». European Heart Journal; 28: 230-268.
  • Vahanian, A. [et al.] (2008): «European Association of Cardio-Thoracic Surgery; European Society of Cardiology; European Association of Percutaneous Cardiovascular Interventions. Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI)». European Heart Journal; 29: 1463-1470.
  • Vahanian, A.; Otto, C. M. (2010): «Risk stratification of patients with aortic stenosis». European Heart Journal; 31: 416-423.
  • Von Bibra, H. [et al.] (1995): «Clinical evaluation of left heart Doppler contrast enhancement by a saccharide-based transpulmonary contrast agent. The Levovist Cardiac Working Group». Journal of the American College of Cardiology; 25: 500-508.
  • Walther, T. [et al.] (2007): «Transapical minimally invasive aortic valve implantation. Multicenter experience». Circulation; 116 (supl. I): 240-245.
  • Watt, M. [et al.] (2012): «Cost-effectiveness of transcatheter aortic valve replacement in patients ineligible for conventional aortic valve replacement». Heart; 98: 370-376.
  • Webb, J. G. (2010): «Implantación percutánea de válvula aórtica. Equilibrio entre entusiasmo y precaución». Revista Española de Cardiología; 63: 131-133.
  • Zahn, R. [et al.] (2010): «Transcatheter aortic valve implantation: first results from a multi-centre real-world registry». European Heart Journal; 32: 198-204.
  • Zoghbi, W. A. (2011): «Low-Gradient “Severe” Aortic Stenosis With Normal Systolic Function. Time to Refine the Guidelines?». Circulation; 123: 838-840.