Enfoque minimalista en el implante de válvula aórtica percutánea

Self Cite

Transcatheter aortic valve implantation (TAVI) with conscious sedation and early discharge. Report of seven cases COVID-19 pandemic generated multiple challenges for the health system. Cardiovascular disease is associated with a worse prognosis of infections. Moreover, most hospital resources and operative rooms were destined to patients with COVID-19 infection, deferring the treatment of most valvular patients requiring surgery. We report seven patients with symptomatic severe aortic stenosis who underwent transcatheter aortic valve implantation (TAVI) with conscious sedation and early discharge. No patient required intensive care unit admission or mechanical ventilation. After a 90-day follow-up, there were no complications or unplanned readmissions.

Section: Discussionunclassified

“…Se utilizó el protocolo de sedación consciente, por lo que no se requiere anestesia general, cateter venoso central, línea arterial o ecocardiografía transesofágica 8 . El anestesista a cargo aplica sedación necesaria para mantener al paciente sedado, pero cooperador.…”

Section: Métodosunclassified

Abordaje del implante valvular aórtico transcateter durante la pandemia por COVID-19 con alta prevoz: reporte de una serie de casos

Veas¹,

Winter

Valdebenito

et al. 2022

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“…En cuanto a la experiencia nacional, Maluenda et al ya ha reportado la costo-efectividad de TAVI vs el manejo conservador 21 . El primer reporte en Chile del uso de SC corresponde a una serie de 10 pacientes por Hameau et al 20 . En esa publicación se describe un adecuado perfil de seguridad asociado a estadías hospitalarias reducidas (mediana de hospitalización: 2 días), si bien se trata exclusivamente de prótesis auto-expandibles.…”

Section: Discussionunclassified

Implante de válvula aórtica percutánea con técnica de sedación consciente

et al. 2021

Transfemoral transcatheter aortic valve implantation under conscious sedation. Experience in 15 patientsBackground: Transfemoral transcatheter aortic valve implantation (TAVI) is the standard of treatment for patients with symptomatic severe aortic stenosis (AE) and intermediate or high surgical risk. The use of conscious sedation (CS) could reduce complications and allow an early discharge of these patients. Aim: To report our experience with TAVI under conscious sedation. Material and Methods: Review of medical records of 15 patients aged 79 ± 6 years (53% women) undergoing a transfemoral TAVI implant under conscious sedation. Results: The indications for the procedure were severe AE in 13 patients and biological prosthetic dysfunction in two. The mean Thoracic Surgeons predicted risk of mortality score was 7.3. The valves used were Edwards Sapien 3 in three patients, Medtronic Evolut in five, Boston Acurate Neo in four and Meril Myval in three. A successful implant was achieved in all cases and there were no hospital mortality or pacemaker requirements. One patient had a stroke, and one patient had a vascular access complication. Early discharge (< 72 h) was achieved in 80% of patients. Conclusions: TAVI under conscious sedation was a safe procedure and associated with a complication rate similar to previous reports, allowing for an early hospital discharge in most patients.

“…Al momento del implante, utilizando sedación consciente según protocolo local 4 , se instala una vaina 6F en arteria femoral izquierda para el avance de un pigtail hacia el plano valvular y una vaina venosa femoral izquierda para posicionar una sonda marcapasos transitoria (SMPt) en el ventrículo derecho (Arrow ® temporary Pacing Catheter Kit).…”

Section: Caso Clínicounclassified

Implante de válvula aórtica percutánea en paciente con prótesis mitral previa: riesgos y consideraciones técnicas

et al. 2021

Successful deployment of a percutaneous aortic valve in a patient with a mitral prosthesis. risks and technical considerationsThe deployment of a percutaneous aortic valve is challenging in patients with a mitral prosthesis. The risk of prosthetic deformation, embolization or dysfunction is higher in this group of patients, which requires a series of technical considerations. We report a successful implantation of an Evolut Pro # 29 self-expanding valve in a 67-year-old female with a previous Starr-Edwards caged-ball mitral prosthesis.