Implante transcateter de valva aórtica versus troca valvar aórtica para estenose aórtica importante em pacientes de alto risco: revisão sistemática e metanálise

• Ano de defesa: 2014
• Autor(a) principal: Araujo, Andre Telis de Vilela [UNIFESP]
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Aortic stenosis; Heart surgery; Cardiac prostheses; High risk; Meta-analysis; Estenose aórtica; Cirurgia cardíaca; Próteses cardíacas; Alto risco metanálise
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=2068697; http://repositorio.unifesp.br/handle/11600/46246

Background: stenosis of the aortic valve is the main valvulopathy in patients undergoing valve replacement. Despite the evidence of surgery procedure could offer best results, just one third of patient didn´t undergo valve replacement. Transcatheter aortic valve implantation (TAVI) is the use of a valve device, which is either expanded by balloon or self-expandable, in which a porcine valve or bovine pericardium is incorporated inside the catheter. To address a share of the population with high prevalence of aortic stenosis TAVI is been used as less risk procedure. Objective: to assess the effectiveness and safety of TAVI compared with aortic valve replacement in patients with severe aortic stenosis with high-risk of death. Methods: Cochrane Systematic Review of Randomized Control Trials. We searched CENTRAL, MEDLINE, EMBASE, LILACS and Web of Science. The search is current to May 2014. Two studies involving 1446 participants, participants were aged over 78 years old, proportion of male varied in 52.74% to 57.08%. Logistic EuroSCORE varied from 17.6±13.0 to 29.3±16.5. One study used balloon expandable device (Edwards Sapiens Lifesciences) via transapical or transfemoral access and the other study used self-expandable device (CoreValve - Medtronic) just from transfemoral access. No significant difference was found to mortality, neurologic events, peri-procedure myocardial infarction and acute kidney injury. Bleeding complications occurred less significantly in the TAVI was used. Vascular complications and paravalvar regurgitation was less significant in the control group. Authors' conclusions: the number of trials investigating the use of TAVI for aortic stenosis is small, and the number of participants and outcomes in these RCTs is limited. Furthermore, the included trials are at a high risk of bias. More RCTs are needed to assess the benefits and harms of TAVI for high-risk patients with aortic stenosis. Such trials ought to be conducted with low risks of systematic and random error.