Artículo originalRevisión sistemática de la trombosis protésica tras implante percutáneo de válvula aórticaValve Thrombosis Following Transcatheter Aortic Valve Implantation: A Systematic Review
Section snippets
INTRODUCCIÓN
La trombosis protésica (TP) tras una sustitución valvular quirúrgica es una complicación que puede poner en peligro la vida del paciente, se da principalmente en prótesis mecánicas y a menudo se asocia con una terapia de anticoagulación oral (ACO) subterapéutica1. Las bioprótesis en posición aórtica rara vez presentan trombosis, cuya incidencia estimada es de un 0,01-1,26%2, 3, 4, 5. El implante percutáneo de válvula aórtica (TAVI) es un tratamiento bien establecido de la estenosis valvular
MÉTODOS
Se llevó a cabo una búsqueda exhaustiva y sistemática en PubMed, Google Scholar, Cochrane Library y BioMedCentral de todos los artículos publicados en lengua inglesa que abordaran la trombosis como complicación del TAVI, utilizando las siguientes palabras clave: «transcatheter aortic valve», «transcatheter prostheses», «TAVI», «transcatheter aortic valve replacement», «thrombosis», «thrombus», «dysfunction», «obstruction», «degeneration», «stenosis». Se realizó también una búsqueda manual en
RESULTADOS
Se identificaron 13 publicaciones que describían 18 casos de trombosis como complicación de TAVI10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, incluidos 2 sujetos con TP periintervención que se incluyen y se describen por separado como TP «agudas»12, 20.
En la tabla 1 se describen los datos basales y las características de la intervención de los pacientes con TP después de TAVI. La media de edad era 80 ± 5 años y predominaron los pacientes varones. No se registró fibrilación auricular en
DISCUSIÓN
Las bioprótesis valvulares se consideran generalmente menos trombógenas que las válvulas mecánicas, lo que en muchos casos permite obviar la necesidad de ACO a largo plazo. No obstante, el riesgo de episodios tromboembólicos no es desdeñable, sobre todo en los 3 meses siguientes a la sustitución valvular aórtica quirúrgica (SVAQ)23, 24. Se estima que la incidencia de TP después de SVAQ es de 0,03 episodios/100 años-paciente25, y la incidencia en 15 años es de un 0,37-1,26%3, 26. Desde la
CONCLUSIONES
A medida que la aceptación mundial del TAVI para tratar la estenosis aórtica grave continúe creciendo de manera exponencial, se observarán con mayor frecuencia algunas complicaciones muy poco comunes de este paradigma terapéutico en evolución. Dada la actual incertidumbre respecto al régimen óptimo de tratamiento durante y después del TAVI, los clínicos deben tener una mayor concienciación respecto a la TP después del TAVI. La visualización directa del trombo no es necesaria para un diagnóstico
CONFLICTO DE INTERESES
J. Rodés-Cabau y E. Dumont son consultores de Edwards Lifesciences. J.G. Córdoba-Soriano recibió apoyo de Abbot Vascular y Fundación Biotyc, Albacete, España.
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Cited by (55)
Late Transcatheter Aortic Valve Thrombosis Leading to Cardiogenic Shock
2022, JACC: Case ReportsThe role of flow stasis in transcatheter aortic valve leaflet thrombosis
2022, Journal of Thoracic and Cardiovascular SurgeryAnalysis of Bioprosthetic Aortic Valve Thrombosis—Implications and Management Strategies
2019, Journal of Cardiothoracic and Vascular AnesthesiaMeta-Analysis Comparing Single Versus Dual Antiplatelet Therapy Following Transcatheter Aortic Valve Implantation
2018, American Journal of CardiologyCitation Excerpt :There have been some concerns about bioprosthetic valve thrombosis within the weeks and months after TAVI. However, the occurrence of clinically relevant valve thrombosis is a rare event (incidence <1%) and does not seem to be influenced by the presence thienopyridine therapy.20,21 More recently, there has been much attention given on the occurrence of subclinical valve thrombosis post-TAVI.22
Implantation Depth and Rotational Orientation Effect on Valve-in-Valve Hemodynamics and Sinus Flow
2018, Annals of Thoracic SurgeryMechanolytic management of transcatheter aortic valve thrombosis
2018, Journal of the Saudi Heart AssociationCitation Excerpt :The timing (6 months) and the absence of valve calcification and valve insufficiency on echocardiography are certainly unusual for early bioprosthesis degeneration, while the formation of pannus should take a longer time. The literature on the incidence and characteristics of a TAVI thrombosis remains scarce and limited mostly to case reports or small case series [3,4]. Anticoagulation therapy using heparin and/or a vitamin K antagonist forms the cornerstone of management of this complication, with most patients showing resolution of thrombosis within 2 months [3].