Cirugia Cardiovascular最新文献

英文中文

Best evidence topic: implante valvular aórtico transcatéter en pacientes con estenosis aórtica grave asintomática 最佳临床证据：无症状严重主动脉狭窄患者的经传主动脉瓣膜植入物

IF 0.3 Q4 SURGERY

Cirugia Cardiovascular

Pub Date : 2025-03-01 DOI: 10.1016/j.circv.2024.04.004

Elio Martín Gutiérrez , Pasquale Maiorano , Laura Castillo Pardo , Blanca Meana Fernández , Belén Ramos Barragán , Javier Gualis Cardona , Mario Castaño Ruiz , José Manuel Martínez Comendador , José Manuel Garrido Jiménez

Background

Transcatheter aortic valve implantation (TAVI) has become the most frequent option for severe aortic stenosis treatment. Patients with severe aortic stenosis may present an increased risk of mortality in the asymptomatic phase. Furthermore, the progression of their heart disease may have prognostic implications. It is proposed to carry out a bibliographic review to assess the benefit of TAVI in this context.

Methods

A systematic search in Pubmed and Cochrane was conducted, identifying comparative studies on surgery and/or TAVI versus conservative management in asymptomatic patients. Thus, an algorithm of better management of patients with severe aortic stenosis would be developed according to the available evidence.

Results

After the selection of papers and elimination of duplicates, 34 studies were full-text analyzed, among which we remark: 6 meta-analyses, 4 reviews, 14 original articles and 4 ongoing clinical trials were identified. Early surgery was unanimously superior to conservative management in terms of survival. In the case of TAVI, two studies demonstrated a better prognosis for asymptomatic patients compared to symptomatic patients when their valve disease was corrected with TAVI, and a sub-analysis of the Evolut Low Risk trial demonstrated superior survival results for TAVI compared to surgery and conservative treatment.

Conclusions

In the absence of a solid evidence, TAVI can be considered a valid treatment alternative for patients with asymptomatic aortic stenosis, although this indication relies on indirect evidence. More research is needed in this field.

背景：经导管主动脉瓣植入术（TAVI）已成为严重主动脉瓣狭窄治疗中最常见的选择。严重主动脉瓣狭窄的患者在无症状期死亡风险增加。此外，他们心脏病的进展可能具有预后意义。在此背景下，建议进行文献综述，以评估TAVI的效益。方法在Pubmed和Cochrane进行系统检索，确定手术和/或TAVI与保守治疗无症状患者的比较研究。因此，根据现有证据，可以开发出一种更好地管理严重主动脉瓣狭窄患者的算法。结果在选择论文并消除重复后，对34项研究进行了全文分析，其中我们发现：6项meta分析，4篇综述，14篇原创文章和4项正在进行的临床试验。在生存率方面，早期手术一致优于保守治疗。在TAVI的病例中，两项研究表明，与有症状的患者相比，无症状患者在用TAVI矫正瓣膜疾病时预后更好，Evolut低风险试验的一项亚分析表明，与手术和保守治疗相比，TAVI的生存结果更好。结论在缺乏确凿证据的情况下，TAVI可以被认为是无症状主动脉狭窄患者的一种有效的治疗选择，尽管这一适应症依赖于间接证据。在这个领域需要做更多的研究。

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引用次数: 0

Complicaciones en el implante transcatéter de la válvula aórtica. Prevención, resolución y morbimortalidad asociada 经导管主动脉瓣植入术的并发症。预防、解决及相关发病率和死亡率。

IF 0.3 Q4 SURGERY

Cirugia Cardiovascular

Pub Date : 2025-03-01 DOI: 10.1016/j.circv.2024.02.013

Pilar Garrido-Martín

Introduction

Degenerative aortic stenosis is the most common valvular pathology in the population over 65 years of age, incidence of 2-7%. Currently, transcatheter aortic valve implantation is a standard therapy in these symptomatic patients. This procedure is associated with relatively high rates of complications, which can be serious. The objective of this work is to provide an update and detailed description of the most important complications of the transcatheter aortic valve procedure in terms of etiology, prevalence, diagnosis, prognosis, prevention and treatment.

Methods

Bibliographic review of current evidence on the most important complications of transcatheter aortic valve implantation, their prevention and resolution.

Results

Rhythm disorders, vascular complications, prosthetic regurgitation, cardiac perforation..., are among others some of the possible complications that appear in 2-10% of cases, and are associated with an increase mortality of up to 2 or 3 times.

Conclusions

Complications of the transcatheter aortic valve procedure are frequent and often serious, so it is essential to know the predisposing factors, prevention and treatment strategies. Careful patient selection, quality infrastructure, training and accreditation, multidisciplinary collaboration are essential for optimal prognosis and a decrease in possible complications.

退行性主动脉瓣狭窄是65岁以上人群中最常见的瓣膜病变，发病率为2-7%。目前，经导管主动脉瓣植入术是这些症状患者的标准治疗方法。这种手术的并发症发生率相对较高，而且可能很严重。这项工作的目的是提供一个最新的和详细的描述，最重要的并发症经导管主动脉瓣手术的病因，患病率，诊断，预后，预防和治疗。方法对经导管主动脉瓣植入术的主要并发症及其预防和解决方法进行文献综述。结果心律失常、血管并发症、假体反流、心脏穿孔…在2-10%的病例中出现一些可能的并发症，并与死亡率增加2至3倍有关。结论经导管主动脉瓣置换术并发症多且严重，了解其易感因素及防治策略十分重要。谨慎的患者选择、高质量的基础设施、培训和认证、多学科合作对于获得最佳预后和减少可能的并发症至关重要。

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引用次数: 0

TAVI: implante coplanar vs overlapping-cusp TAVI：共面植入与重叠尖头植入

IF 0.3 Q4 SURGERY

Cirugia Cardiovascular

Pub Date : 2025-03-01 DOI: 10.1016/j.circv.2024.02.009

Francisco Estévez-Cid , Victor X. Mosquera Rodríguez , Consuelo M. Sisinni Ganly , Carmen Iglesias Gil , Jose J. Cuenca Castillo , Juan J. Legarra Calderón

In recent years, TAVI using the cusp overlap projection, or cups-overlap technique (POC), has been postulated as a new alternative for the higher implantation of self-expanding bioprostheses.

The aim of this review is to describe the POC technique and to analyze the reported experience in comparison with the coplanar or standard technique.

TAVI procedures with self-expanding bioprostheses using the POC technique have been shown to be safe and have been associated with better commissural alignment and a higher prosthetic implantation depth, which leads to lower rates of conduction disorders and permanent pacemaker implantation. However, this technique has been associated with higher radiation doses during the procedure.

近年来，采用尖端重叠投影或杯部重叠技术（POC）的TAVI被认为是自膨胀生物假体植入术的一种新的选择。本综述的目的是描述POC技术，并分析报道的经验，与共面或标准技术进行比较。使用POC技术的自膨胀生物假体的TAVI手术已被证明是安全的，并且与更好的关节对齐和更高的假体植入深度相关，这导致更低的传导障碍和永久性起搏器植入率。然而，这种技术在手术过程中伴随着较高的辐射剂量。

引用次数: 0

Implante valvular aórtico transcatéter transfemoral paso a paso 经导管经股动脉主动脉瓣植入术步骤

IF 0.3 Q4 SURGERY

Cirugia Cardiovascular

Pub Date : 2025-03-01 DOI: 10.1016/j.circv.2024.02.010

Miguel Ángel Gómez Vidal

The transfemoral implantation technique of a transcatheter Aortic valve (TAVI) is the most widespread of all, and although it is basically the same as the rest of the retrograde transarterial implantation techniques, it has its peculiarities, and practically all devices are adapted to this access, being currently the most used in the world.

Talking about transfemoral TAVI implant with everything that is currently written and protocolized by different authors is a bit repetitive, but in general the current descriptions usually refer to a specific device, adapting it to its specific peculiarities, being the most popular. devices from Medtronic (Corevalve and evolut-pro) and Edwards (Sapiens 3 and ultra).

For this reason, I am going to try to give this document an eminently general and practical nature, trying to provide you with the technical possibilities and tricks that experience has allowed me to know and learn.

经导管主动脉瓣（transcatheter Aortic valve， TAVI）经股主动脉瓣植入术（transcatheter Aortic valve， TAVI）是其中应用最广泛的一种，虽然它与其他逆行经动脉主动脉瓣植入术基本相同，但它有其特殊性，几乎所有的装置都适应于这种途径，是目前世界上应用最多的一种。谈论经股TAVI植入物和目前由不同作者撰写和制定的所有内容有点重复，但总的来说，目前的描述通常指的是特定的设备，使其适应其特定的特性，成为最受欢迎的。来自美敦力（Corevalve和evolut-pro）和爱德华兹（Sapiens 3和ultra）的设备。出于这个原因，我将尽量使这份文件具有非常普遍和实用的性质，试图向您提供经验允许我了解和学习的技术可能性和技巧。

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TAVI frente a cirugía convencional aórtica. ¿Dónde están los límites? TAVI 与传统主动脉手术：极限在哪里？

IF 0.3 Q4 SURGERY

Cirugia Cardiovascular

Pub Date : 2025-03-01 DOI: 10.1016/j.circv.2024.01.011

Miguel Piñón

Transcatheter aortic valve implantation (TAVI) has experienced an increase in the number of procedures of 50% with its expansion to low risk, over the numbers obtained with high and intermediate risks. Recently, updates have been made public in the follow-up of the main randomized clinical studies (RCTs) in this group of patients. Although the results of these studies have served as a basis for recommending TAVI in elderly patients with intermediate or high risks, there are still several aspects that need to be clarified before expanding, in an indiscriminate or unselected manner to low-risk young patients. This review's aim is to analyze the results available in the published evidence, as well as the most significant variables that can affect their consistency, both in early and long term; for consideration in individualized patient-centered decision making.

经导管主动脉瓣植入术（TAVI）的手术数量随着其扩展到低风险而增加了50%，高于高风险和中度风险的手术数量。最近，对这组患者的主要随机临床研究（rct）的随访进行了更新。虽然这些研究的结果已经成为推荐TAVI用于中高危老年患者的基础，但在以不加区分或不加选择的方式扩展到低危年轻患者之前，仍有几个方面需要澄清。本综述的目的是分析已发表证据中的现有结果，以及可能影响其早期和长期一致性的最重要变量；以患者为中心的个体化决策。

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Credits 学分

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Cirugia Cardiovascular

Pub Date : 2025-03-01 DOI: 10.1016/S1134-0096(25)00037-3

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La importancia de la planificación en el tratamiento transcatéter de la estenosis aórtica severa 规划在经导管治疗重度主动脉瓣狭窄中的重要性

IF 0.3 Q4 SURGERY

Cirugia Cardiovascular

Pub Date : 2025-03-01 DOI: 10.1016/j.circv.2024.01.009

Omar A. Araji-Tiliani

Angio CT has become an essential tool for choosing the size and type of prosthesis to use, as well as the best approach, for the treatment of severe transcatheter aortic stenosis (TAVI).

In this article we describe the important points that must be considered for the correct planning and execution of this technique, with the use of angio CT.

血管CT已经成为选择假体的大小和类型以及治疗严重经导管主动脉瓣狭窄（TAVI）的最佳方法的重要工具。在本文中，我们描述了使用血管CT正确规划和执行该技术必须考虑的要点。

引用次数: 0

Tips and tricks in the prevention and management of vascular complications in TAVI TAVI血管并发症的预防和处理技巧

IF 0.3 Q4 SURGERY

Cirugia Cardiovascular

Pub Date : 2025-03-01 DOI: 10.1016/j.circv.2024.09.001

Antonella Tommasino , Pasqualino Sirignano , Federico Dell’Aquila , Vincenzo Fiorentini , Matteo Casenghi , Francesca Giovannelli , Stefano Rigattieri , Andrea Berni , Maurizio Taurino , Emanuele Barbato

Transcatheter aortic valve implantation (TAVI) has become a standard treatment for severe aortic stenosis, especially in elderly patients or those considered high-risk for surgery. Despite its increasing success, TAVI still presents challenges, particularly in the management of access site. Advances in procedure planning, device miniaturization and operator experience have mitigated these issues, but vascular complications are still common.

The transfemoral approach is the most common for TAVI, although it varies widely depending on operator experience and center protocols, ranging from surgical to fully percutaneous methods. Minimally invasive techniques are increasingly favored to improve the results of the procedure. Effective management of access site complications is critical and requires careful pre-procedure planning and skilled intervention.

Recent developments in ultrasound-guided access and the refinement of vascular closure devices have shown promise in reducing complications. It has also been shown that radial access as an axillary approach has a lower complication rate compared to contralateral femoral access. The integration of new devices and techniques, such as the less invasive approach, will further improve patient outcomes.

This review emphasizes the importance of a comprehensive, multidisciplinary approach to TAVI and highlights the need for continued innovation and collaboration to further reduce vascular complications and improve the safety and efficacy of the procedure. As TAVI indications expand to younger populations, refinement of access management strategies and incorporation of advanced imaging and predictive tools will be critical to optimizing patient care and outcomes.

经导管主动脉瓣植入术（Transcatheter aortic valve implantation， TAVI）已成为重度主动脉瓣狭窄的标准治疗方法，尤其适用于老年患者或手术高危患者。尽管取得了越来越多的成功，但TAVI仍然面临着挑战，特别是在访问站点的管理方面。手术计划、设备小型化和操作人员经验的进步缓解了这些问题，但血管并发症仍然很常见。经股入路是TAVI最常见的入路，尽管它根据操作员经验和中心方案而有很大差异，从外科手术到完全经皮方法。微创技术越来越受到青睐，以改善手术结果。有效管理接入点并发症是至关重要的，需要仔细的术前规划和熟练的干预。超声引导下的最新进展和血管闭合装置的改进在减少并发症方面显示出了希望。也有研究表明，与对侧股骨入路相比，桡骨入路作为腋窝入路的并发症发生率较低。新设备和技术的整合，如微创方法，将进一步改善患者的治疗效果。这篇综述强调了TAVI综合多学科治疗方法的重要性，并强调了持续创新和合作的必要性，以进一步减少血管并发症，提高手术的安全性和有效性。随着TAVI适应症扩展到更年轻的人群，改进准入管理策略并结合先进的成像和预测工具将对优化患者护理和结果至关重要。

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引用次数: 0

Credits 学分

IF 0.3 Q4 SURGERY

Cirugia Cardiovascular

Pub Date : 2025-01-01 DOI: 10.1016/S1134-0096(24)00208-0

引用次数: 0

Análisis de los datos del Registro Español de Cirugía Cardiaca (RECC) 2021-2023 西班牙心脏手术登记处（RECC）数据分析（2021-2023年）

IF 0.3 Q4 SURGERY

Cirugia Cardiovascular

Pub Date : 2025-01-01 DOI: 10.1016/j.circv.2024.07.003

Lourdes Montero-Cruces , Manuel Carnero-Alcázar , Rafael Rodríguez-Lecoq , José C. Sureda-Barbosa , Jorge Rodríguez-Roda-Stuart , Fabrizio Sbraga , Juan J. Legarra-Calderón , Juan M. Gracia-Baena , Alejandro Adsuar-Gómez , Félix Gómez-Blasco , José F. Valderrama-Marcos , Nuria Arce-Ramos , Carlos E. Martín-López , Stefano Urso , José A. Hernández-Campos , Nora García-Borges , Álvaro Pedraz-Prieto , Marta Matamala-Adell , Jorge Rivas Oyarzabal , Diego Macías-Rubio , José López-Menéndez

More than three years ago, the Spanish Society of Cardiovascular and Endovascular Surgery started the Spanish Registry of Cardiac Surgery (RECC) in order to offer all cardiac surgery services nationwide a patient-level registry. The objective of this study is to offer a global vision of the data entered into the RECC in the period between february 8, 2021 and february 8, 2024 of the participating centers that have contributed data from at least 40 interventions. The information has been analyzed anonymously at the patient, hospital and province level. To estimate risk-adjusted mortality, the EuroSCORE II preoperative risk estimation scale was used. A total of 10,852 interventions have been included in the RECC, of which 9,236 were major cardiac surgeries. 53.4% (n = 4,935) of major procedures were valve surgeries, 25.2% (n = 2,324) myocardial revascularization surgeries and 15.0% (n = 1,387) aorta procedures. The mean EuroSCORE II of major cardiac surgeries was 5.5% (SD 8.6), the overall mortality was 5.1% and the RAMR of major procedures was 0.92. In 2023, the mean EuroSCORE II was 5.4%, the observed mortality was 6.4% and the RAMR was 1.18. In 2023, the EuroSCORE II underestimated low-risk patients.

三年多前，西班牙心血管和血管内外科学会启动了西班牙心脏外科登记（RECC），以便在全国范围内提供所有心脏手术服务。本研究的目的是为参与中心在2021年2月8日至2024年2月8日期间输入RECC的数据提供全球视野，这些中心提供了至少40项干预措施的数据。这些信息在患者、医院和省一级进行了匿名分析。为了估计风险调整死亡率，使用EuroSCORE II术前风险评估量表。RECC共进行了10 852次干预，其中9 236次为大型心脏手术。53.4% （n = 4935）为瓣膜手术，25.2% （n = 2324）为心肌血运重建术，15.0% （n = 1387）为主动脉手术。心脏大手术的平均EuroSCORE II为5.5% (SD 8.6)，总死亡率为5.1%，大手术的RAMR为0.92。2023年，平均EuroSCORE II为5.4%，观察死亡率为6.4%，RAMR为1.18。2023年，EuroSCORE II低估了低风险患者。

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