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

Ano de publicación: 2012

Ano: 2012

Páxinas: 419-447

Tipo: Artigo

Outras publicacións en: Anuari de l'envelliment: Illes Balears

Resumo

L’estenosi valvular aòrtica degenerativa és la valvulopatia més freqüent en la població vella i l’envelliment poblacional en els països desenvolupats comporta que la prevalença d’aquesta patologia s’hagi incrementat considerablement els darrers anys, fins al punt de convertir-se en un problema de salut pública. A la present revisió s’analitzen alguns aspectes sobre l’epidemiologia, les característiques clíniques, el diagnòstic, l’avaluació de la severitat i el pronòstic d’aquesta patologia i es fa especial menció de les opcions terapèutiques disponibles a l’actualitat, en què l’aparició i el desenvolupament de l’implant de pròtesis percutànies transcatèter en posició aòrtica com a nova eina terapèutica ha suposat una extensió del tractament invasiu fins a poblacions més velles o amb una comorbiditat més gran, generalment excloses del tractament quirúrgic pel risc excessiu que comporta la intervenció i manejades de manera més conservadora. El registre PEGASO aporta dades sobre el maneig real de l’estenosi aòrtica severa de l’octogenari al nostre medi.

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.