El intervencionismo estructural se refiere a las técnicas intervencionistas que van dirigidas a enfermedades cardiacas no coronarias. En los últimos años está teniendo un interés muy considerable, aunque todavía representa un porcentaje muy pequeño del volumen total de intervencionismo de un departamento de terapia endovascular. A pesar del pequeño volumen relativo, el interés es muy grande, probablemente debido a las características peculiares que rodean a estas técnicas: a) necesidad de equipos multidisciplinarios; b) formación y entrenamiento específicos; c) requiere habilidades especiales derivadas de la formación y experiencia, y d) escaso volumen en el momento actual que aconseja centros de referencia. En este capítulo desarrollamos cuatro apartados específicos: a) cierre percutáneo del leak perivalvular (LP); b) obliteración percutánea de la orejuela; c) tratamiento percutáneo de la insuficiencia mitral, y d) implantación transcatéter de prótesis valvulares aórticas. Exploramos las razones de la técnica, los procedimientos específicos y los resultados obtenidos. Rapidly Evolving Techniques for Structural Heart Disease Interventions
Palabras clave
Estructural
Prótesis
Orejuela
Mitral
Aórtica
Dehiscencia
Este artículo solo puede leerse en
pdf
Bibliografía
[1]
Intracardiac valvulotomyby means of a catheter. Arch Inst Cardiol Mex. 1953; 23:183-92.
[2]
Creation of an atrial septal defect without thoracotomy. A palliative approach to complete transposition of the great arteries. JAMA. 1966; 196:991-2.
[3]
Porstman W, Wierry L, Warnke H. The closure of the patent ductus arteriosus without thoracotomy. Thoraxchir Vask Chir. 1967;15:199-203.
[4]
Secundum atrial septal defect. Nonoperative closure during cardiac catheterization. JAMA. 1976; 235:2506-9.
[5]
Transcatheter closure of ventricular septal defects. Circulation. 1988; 78:361-8.
[6]
Double umbrela closure of atrial defects. Initial clinical applications. Circulation. 1990; 82:751-8.
[7]
Transcatheter closure of large ductus arteriosus with the clamshell septal umbrela. J Am Coll Cardiol. 1991; 18:1297-302.
[8]
Transcatheter closure of secundum atrial septal defects using the new slf-centering amplatzer septal occluder: initial human experience. Cath Cardiovsc Diag. 1997; 42:388-93.
[9]
Percutaneous closure of atrial septal defect with a new self centering device (angel wings). Heart. 1998; 80:517-21.
[10]
Percutaneous transcatheter closure of prosthetic mitral paravalvular leaks: are we there yet?. JACC Cardiovasc Interv. 2009; 2:81-90.
[11]
Natural history of early aortic paraprosthetic regurgitation: a five-year follow-up. Am Heart J. 1999; 138:351-7.
[12]
Detection of prosthetic mitral valve leak: a comparative study using transesophageal echocardiography, transthoracic echocardiography, and auscultation. J Clin Ultrasound. 1990; 18:557-61.
[13]
Paraprosthetic leak: a complication of cardiac valve replacement. J Cardiovasc Surg (Torino). 1991; 32:503-8.
[14]
Reoperation for bioprosthetic valve dysfunction. A decade of clinical experience. Eur J Cardiothorac Surg. 1991; 5:523-6.
[15]
Percutaneous closure of prosthetic paravalvular leaks: case series and review. Catheter Cardiovasc Interv. 2006; 68:528-33.
[16]
Utility of real-time three-dimensional transesophageal echocardiography in evaluating the success of percutaneous transcatheter closure of mitral paravalvular leaks. J Am Soc Echocardiogr. 2010; 23:26-32.
[17]
Usefulness of transesophageal echocardiography in percutaneous transcatheter repairs of paravalvular mitral regurgitation. Am J Cardiol. 2008; 101:382-6.
[18]
Transcatheter umbrella closure of valvular and paravalvular leaks. J Am Coll Cardiol. 1992; 20:1371-7.
[19]
Novel use of the Amplatzer duct occluder to close perivalvar leak involving a prosthetic mitral valve. Catheter Cardiovasc Interv. 2004; 61:548-51.
[20]
Coil embolization of a periprosthetic mitral valve leak associated with severe hemolytic anemia. Circulation. 2001; 104:E85-6.
[21]
Percutaneous closure of mitral paravalvular leak. J Interv Cardiol. 2003; 16:153-5.
[22]
Percutaneous closure of an aortic prosthetic paravalvular leak with an Amplatzer duct occluder. Catheter Cardiovasc Interv. 2005; 65:69-72.
[23]
Percutaneous closure of a complex prosthetic mitral paravalvular leak using transesophageal echocardiographic guidance. Can J Cardiol. 2004; 20:452-5.
[24]
Successful percutaneous repair of perivalvular prosthetic regurgitation. Catheter Cardiovasc Interv. 2007; 70:815-23.
[25]
Percutaneous closure of perivalvular leaks with Amplatzer occluders: feasibility, safety, and short-term results. J Heart Valve Dis. 2007; 16:305-13.
[26]
Percutaneous closure of paravalvular leaks with Amplatzer Vascular Plug III device: immediate and midterm results. J Am Coll Cardiol. 2011; 57:E1685.
[27]
Appendage oblitaration to reduce stroke in cardiac surgical patients with atrial fibrilation. Ann Thorac Surg. 1996; 61:755-9.
[28]
Throracoscopic extracardiac obliteration of the left atrial appendage for stroke risk reduction in atrial fibrilation. J Am Coll Cardiol. 2003; 42:1249-52.
[29]
Percutaneous left atrial appendage transcatheter occlusion to prevent stroke in high risk patients with atrial fibrilation: early clinical experience. Circulation. 2002; 105:1887-9.
[30]
Transcatheter left atrial appendage occlusion with amplatzer devices to obviate anticoagulation in patients with atrial fibrilation. Catheter Cardiovasc Interv. 2003; 60:417-22.
[31]
Percutaneous left atrial appendage occlusion for patients in atrial fibrilation suboptimal for warfarin therapy: 5 year results of the PLAATO (Percutaneous Left Atrial Appendage Transcatheter Occlusion) Study. JACC Cardiovasc Interv. 2009; 2:594-600.
[32]
for PROTECT AF Investigators. Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrilation: a randomized non inferiority trial. Lancet. 2009; 374:534-42.
[33]
Stroke prevention in atrial fibrilation investigators. Lessons from the stroke prevention in atrial fibrilation trials. Ann Intern Med. 2003; 138:831-8.
[34]
Atrial fibrilation and stroke: concepts and controversies. Stroke. 2001; 32:803-8.
[35]
Why do patients with atrial fibrilation not receive warfarin?. Arch Intern Med. 2000; 160:41-6.
[36]
Left atrial appendage: structure, function and role in thromboembolism. Heart. 1999; 82:547-54.
[37]
Percutaneous left atrial appendage transcatheter occlusion (PLAATO system) to prevent stroke un high risk patients with non-rheumatic atrial fibrilation: results from the international multicentre feasibility trials. J Am Coll Cardiol. 2005; 46:9-14.
[38]
Safety of percutaneous left atrial appendage closure. Results from the watchman left atrial appendage system for embolic protection in patients with AF (PROTECT AF) clinical trial and the continued access registry. Circulation. 2011; 123:417-24.
[39]
Meerkin D, Butnaru A, Dratva D, Tzivoni D. Initial experience with Amplatzer Cardiac Plug for left atrial appendage occlusion. ACC Congress, New Orleans, 2011.
[40]
Mitral regurgitation. Lancet. 2009; 373:1382-94.
[41]
Cardiac valve surgery – the “French correction” J Thorac Cardiovasc Surg. 1983; 86:323-37.
[42]
Percutaneous mitral annuloplasty for functional mitral regurgitation: results of the CARRILLON mitral annuloplasty device European union study. Circulation. 2009; 120:326-33.
[43]
Paneth suture annuloplasty abolishes acute ischemic mitral regurgitation but preserves annular and leaflet dynamics. Circulation. 2003; 108(Suppl 1):II128-33.
[44]
The double-orifice technique as a standardized approach to treat mitral regurgitation due to severe myxomatous disease: surgical technique. Eur J Cardiothorac Surg. 2000; 17:201-5.
[45]
The edge-to-edge technique: a simplified method to correct mitral insufficiency. Eur J Cardiothorac Surg. 1998; 3:240-5.
[46]
Mitral valve repair for isolated prolapse of the anterior leaflet: an 11-year follow-up. Eur J Cardiothorac Surg. 1999; 2:119-26.
[47]
Bow-tie” mitral valve repair: an adjuvant technique for ischemic mitral regurgitation. Ann Thorac Surg. 1998; 66:1640-6.
[48]
An effective technique to correct anterior mitral leaflet prolapse. J Card Surg. 1999; 14:468-70.
[49]
EVEREST II Investigators. Percutaneous repair or surgery for mitral regurgitation. N Engl J Med. 2011; 364:1395-406.
[50]
EVEREST investigators. Percutaneous mitral repair with the Mitraclip system: safety and midterm durability in the initial EVEREST cohort. J Am Coll Cardiol. 2009; 54:686-94.
[51]
Percutaneous transcatheter implantation o fan aortic valve prótesis for calcific aortic stenosis. First human case descreiption. Circulation. 2002; 106:3006-8.
[52]
Treatment of calcific aortic stenosis with the percutaneous heart valve: mid-term follow-up from the initial feasibility studies: the French experience. J Am Coll Cardiol. 2006; 47:1214-23.
[53]
Percutaneous aortic valve implantation retrograde from the femoral artery. Circulation. 2006; 113:842-50.
[54]
Percutaneous transarterial aortic valve replacement in selected high-risk patients with aortic stenosis. Circulation. 2007; 116:755-63.
[55]
Transapical transcatheter aortic valve implantation in humans: initial clinical experience. Circulation. 2006; 114:591-6.
[56]
Transapical minimally invasive aortic valve implantation: multicenter experience. Circulation. 2007; 116:I240-5.
[57]
Percutaneous implantation of the CoreValve self-expanding valve prosthesis in high-risk patients with aortic valve disease: the Siegburg first-in-man study. Circulation. 2006; 114:1616-24.
[58]
Schächinger V, Lefevre T, De Bruyne B, et al. Results from the PARTNER EU trial: Prospective Multicentric European Registry of Transcatheter Aortic Valve Implantation. Paper presented at EuroPCR; May 19-22, 2009; Barcelona, Spain. Available at: http://www.pcronline.com/Lectures/2009.
[59]
A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on valvular heart disease. Eur Heart J. 2003; 24:1231.
[60]
Variability in treatment advice for elderly patients with aortic stenosis: a nationwide survey in The Netherlands. Heart. 2001; 85:196-201.
[61]
Decision making and outcomes in severe symptomatic aortic stenosis. J Heart Valve Dis. 2006; 15:312-21.
[62]
Unoperated patients with severe aortic stenosis. J Am Coll Cardiol. 2007; 50:2018-9.
[63]
PARTNER Trial Investigators. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010; 363:1597-607.
[64]
Smith CR, o n behalf of the Partner Investigators. Transcatheter vs Surgical Aortic Valve Replacement in High Risk Patients with Severe Aortic Stenosis. Results from the PARTNER Trial. ACC Congress. New Orleans. March, 2011. Available at: http://www.cardiosure.org/acc11coverage.
[65]
Gurvitch R, Wood DA, Tay EL, Leipsic J, Ye J, Lichtenstein SV, et al Transcatheter aortic valve implantation durability of clinical an hemodynamic outcomes beyond 3 years in a large patient cohort. Circulation. 2010; 122;1319-27.
[66]
Procedural and 30 day outcomes following transcather aortic valve implantation using the third generation (18F) Core Valve Revalving system-results from the multicenter expanded evaluation registry 1 year following CE mark approval. Eurointervention. 2008; 4:242-9.