Transcatheter aortic valve replacement for advanced valvular disease in active SLE and APS

Abstract

Valvular heart disease is a relatively common finding in systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS), sometimes necessitating valve surgery. Valve replacement may result in significant early and late morbidity and mortality. Surgical risks are even greater when co-morbid conditions including active SLE and renal involvement are present. This is the first report of the successful use of transcatheter aortic valve replacement (TAVR) for severe critical aortic stenosis in a patient with active SLE, renal failure and APS. TAVR may represent an additional, safer, approach to cardiac valve replacement in appropriately selected patients particularly where surgical risk is high and active disease present.

Accidente cerebrovascular embolico por endocarditis trombotica no bacteriana en pacientes con síndrome antifosfolipido

“…Su uso se basa en reportes de casos clínicos aislados por lo que no se establece ningún grado de recomendación por el momento (1,4,5,17) . De acuerdo al daño valvular muchas requieren de cirugía para su tratamiento definitivo (11,12) en calidad de urgencia pero con alto riesgo inmediato por la friabilidad del tejido cardíaco cuando la enfermedad inflamatoria se encuentra en actividad y alta tasa de complicaciones del procedimiento a corto y mediano plazo, mucho mayor que para la población general (12,18) . Nuestra paciente presentó un cuadro grave como es la embolia encefálica con una ETNB, destacándose la buena respuesta al tratamiento y la necesidad seguramente de sustitución valvular en el futuro, como tratamiento definitivo.…”

Conventional AVR and TAVR in patients with autoimmune disease

“…We read with interest the reply of Fuentes-Alexandro et al 1 to the report of Bert et al 2 on transcatheter aortic valve replacement (TAVR) in patients for advanced valvular disease in active systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). The authors raise several issues to open the discussion of a topic, concerned with a very specific subset of patients undergoing TAVR procedure.…”

Transcatheter Aortic Valve Replacement (TAVR) in patients with systemic autoimmune diseases

“…In fact, the number needed to treat (NNT) to prevent one death was five (20% absolute risk reduction) and the NNT to prevent one death from cardiovascular causes was four (24% absolute risk reduction). However, as Bert et al 1 clearly stress, not all patients fit in clinical trials, particularly a patient with immunosuppression, dialysis, a functionally bicuspid valve, which can pose geometrical issues that can affect appropriate valve deployment, hypercoagulable state, and acute decompensation of chronic disease.…”

“…We read with interest the report by Bert et al. 1 They described a severe critical case where a young woman with systemic lupus erythematosus (SLE) presented with New York Heart Association (NYHA) class IV, acute renal failure and active SLE. During the initial evaluation she was also found to have worsened aortic stenosis (aortic valve area, 0.88 cm 2 ; mean aortic valve gradient, 37 mm Hg; and peak systolic velocity, 3.7 m/s) and systolic dysfunction with an ejection fraction (EF) of 30%.…”

“…However, as Bert et al. 1 clearly stress, not all patients fit in clinical trials, particularly a patient with immunosuppression, dialysis, a functionally bicuspid valve, which can pose geometrical issues that can affect appropriate valve deployment, hypercoagulable state, and acute decompensation of chronic disease.…”