Review
Aortic stenosis. Indications and results of percutaneous aortic valve implantation (TAVI)
Estenosis aórtica. Indicaciones y resultados del implante de válvula aórtica percutánea (TAVI)
L. Salido Tahoces
, R.A. Hernández Antolín, J.L. Zamorano Gómez
Corresponding author
Servicio de Cardiología. Hospital Ramón y Cajal, Madrid, Spain
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Indications and results of percutaneous aortic valve implantation (TAVI)" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 630 "Ancho" => 2000 "Tamanyo" => 210776 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Modelos de prótesis percutáneas aórticas.</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A) Edwards SAPIEN; B) Edwards SAPIEN XT; C) Edwards SAPIEN 3; D) Edwards Centera; E) Medtronic Core Valve; F) Medtronic Core Valve Evolut R; G) Medtronic Engager; H) Boston Lotus; I) Direct Flow Medical; J) St. Jude Portico; K) Symetis Acurate; L) Jena Valve; M) Heart Leaflet Technologies; N) Colibri Heart Valve.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. 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Indications and results of percutaneous aortic valve implantation (TAVI)" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "478" "paginaFinal" => "483" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L. Salido Tahoces, R.A. Hernández Antolín, J.L. Zamorano Gómez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Salido Tahoces" "email" => array:1 [ 0 => "luisasalido@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "R.A." "apellidos" => "Hernández Antolín" ] 2 => array:2 [ "nombre" => "J.L." "apellidos" => "Zamorano Gómez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Cardiología. Hospital Ramón y Cajal, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estenosis aórtica. Indicaciones y resultados del implante de válvula aórtica percutánea (TAVI)" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 630 "Ancho" => 2000 "Tamanyo" => 210776 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Models of aortic percutaneous prostheses.</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">(A) Edwards SAPIEN; (B) Edwards SAPIEN XT; (C) Edwards SAPIEN 3; (D) Edwards Centera; (E) Medtronic Core Valve; (F) Medtronic Core Valve Evolut R; (G) Medtronic Engager; (H) Boston Lotus; (I) Direct Flow Medical; (J) St. Jude Portico; (K) Symetis Acurate; (L) Jena Valve; (M) Heart Leaflet Technologies; (N) Colibri Heart Valve.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Aortic stenosis (AS) is the most common valve disease in Europe and North America, with a growing prevalence due to the aging of the population. Transcatheter aortic valve implantation (TAVI) is a percutaneous technology that has become a recognized therapy for severe symptomatic calcified AS for patients with a high risk of morbidity and mortality with conventional surgery. In 2002, the first aortic valve was successfully implanted in humans.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">1</span></a> Almost 15 years later, more than 200,000<span class="elsevierStyleHsp" style=""></span>TAVI procedures have been performed in more than 1200 centers that use balloon-expandable and self-expanding transcatheter aortic prostheses (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). In the Spanish registry, a total of 1586<span class="elsevierStyleHsp" style=""></span>patients were treated with TAVI from 2009 to 2015, reflecting an exponential increase in recent years. Of these procedures, 85.3% were performed through the transfemoral route,<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">2</span></a> 52% with the Edwards balloon-expandable prosthesis, 41% with the Core Valve self-expanding prosthesis and 7% with other third-generation valves (Lotus, Symetis, Direct Flow and Portico).<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">2</span></a> In terms of results, the procedure was performed successfully in 94% of cases, 5.9% of cases presented an adverse event (infarction, stroke, vascular complication, conversion to surgery), and hospital mortality was 3.2%.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">2</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Many of the problems during the pioneering phase of this therapy have been overcome. Although still indicated mainly for high-risk patients, the focus of development has shifted to greater durability and safety, which has allowed the treatment to be employed for low-intermediate risk patients.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Patient assessment for transcatheter aortic valve implantation</span><p id="par0015" class="elsevierStylePara elsevierViewall">Early treatment of symptomatic AS is highly recommended given the poor prognosis when symptoms appear (dyspnea, syncope and angina).<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a> The diagnosis of severe aortic valve disease should be based on integrating the clinical symptoms and echocardiographic indices. Echocardiography is the imaging modality of choice for assessing the severity of the AS and the presence of other valvular heart diseases (mitral regurgitation), left ventricular ejection fraction (LVEF), pulmonary pressure and thickness of the left ventricular (LV) wall. Doppler measurement of the transaortic gradient is the preferred technique for assessing the severity of the AS (transaortic mean gradient ≥40<span class="elsevierStyleHsp" style=""></span>mm Hg or peak velocity ≥4<span class="elsevierStyleHsp" style=""></span>m/s). It is important not to rely on a single measurement but rather on a combination of measurements.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We can define the following categories of severe AS:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1)</span><p id="par0025" class="elsevierStylePara elsevierViewall">high-gradient AS (valve area <1<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>, mean gradient >40<span class="elsevierStyleHsp" style=""></span>mm Hg). With these data, we can assume that the AS is severe, regardless of LVEF and flow.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2)</span><p id="par0030" class="elsevierStylePara elsevierViewall">low-flow, low-gradient AS with reduced LVEF (area <1<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>, mean gradient <40<span class="elsevierStyleHsp" style=""></span>mm Hg and LVEF <40%). In this context, echocardiography with low-dose dobutamine is recommended to differentiate truly severe AS from pseudo-severe AS.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3)</span><p id="par0035" class="elsevierStylePara elsevierViewall">normal-flow, low-gradient AS with preserved LVEF (area <1<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>, mean gradient <40<span class="elsevierStyleHsp" style=""></span>mm Hg and LVEF<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>50%). This modality is typically found in the elderly and is associated with a small ventricular size, pronounced LV hypertrophy and, frequently, a history of arterial hypertension. The diagnosis of severe AS in this context remains difficult and requires a careful ruling-out of measurement errors.</p></li></ul></p><p id="par0040" class="elsevierStylePara elsevierViewall">Stress echocardiography can provide prognostic information for patients with severe asymptomatic AS by assessing the increase in the mean pressure gradient and the change in LV function during exercise.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The study prior to the TAVI procedure should properly assess the valve ring and vascular accesses. The technique of choice is currently multidetector (multislice) computed tomography due to its speed, availability and excellent spatial resolution, making it highly accurate in quantifying the ring size and for selecting the prosthesis. Multidetector computed tomography also helps with the study of vascular accesses, determining the gauge of the femoral arteries and their degree of tortuosity and calcification, thereby enabling better planning for the access in each patient.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">5</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Current indications for transcatheter aortic valve implantation</span><p id="par0050" class="elsevierStylePara elsevierViewall">Aortic valve surgery should only be performed in centers with cardiology and heart surgery specialties. Current European and American clinical practice guidelines attribute a central role to the cardiology team for the individualized assessment of patients with symptomatic AS and surgical risk.<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">6–8</span></a> This team should consist of at least one clinical cardiologist, an interventional cardiologist, a heart surgeon and other practitioners such as imaging specialists, anesthesiologists, internists and geriatricians. This team should assess the patient's individual risks, the technical feasibility of TAVI and the most indicated approach for this patient group. The clinical and anatomical contraindications should be identified, the candidates should have a life expectancy ≥1 year and a chance to improve their quality of life, considering their comorbidities.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The following is a list of proposed indications for TAVI:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">1)</span><p id="par0060" class="elsevierStylePara elsevierViewall">Patients with a high surgical risk and a logistic EuroSCORE<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>10%. However, the EuroSCORE tends to overestimate perioperative mortality. A score greater than 8% using the Society of Thoracic Surgeons (STS) system could therefore be more realistic.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">2)</span><p id="par0065" class="elsevierStylePara elsevierViewall">In certain clinical scenarios (such as patient frailty, porcelain aorta, a history of thoracic radiation and the presence of previous aortocoronary grafts) and in the absence of high surgical risk, TAVI is considered an attractive option versus valve replacement with conventional surgery.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">3)</span><p id="par0070" class="elsevierStylePara elsevierViewall">A recently published update on valvular heart disease by the American Heart Association/American College of Cardiology considered TAVI a reasonable alternative to conventional surgery for patients of low-intermediate risk. This indication is based on studies such as the Surgical Replacement and Transcatheter Aortic Valve Implantation (SURTAVI, CoreValve) and PARTNER II (Edwards Sapiens XT) studies that demonstrated that TAVI is not inferior to surgery for intermediate-risk patients (STS 4–8%).<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">9–12</span></a> Recently, the Nordic Aortic Valve Intervention Trial (NOTION) compared TAVI (CoreValve) with surgery for low-risk patients (STS<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>4) and obtained similar results in the 1-year follow-up.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">11</span></a> Moreover, the PARTNER II S3i study showed lower mortality at 30 days and a lower incidence of stroke among intermediate-risk patients treated with TAVI.<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">13</span></a> Based on these studies, both prostheses have recently been given the European Conformity (CE) marking for intermediate-risk patients, and the Edwards Sapien 3 prosthesis has been approved by the Food and Drug Administration for this indication.</p></li></ul></p><p id="par0075" class="elsevierStylePara elsevierViewall">Although current data favors TAVI for elderly patients who are at low surgical risk, particularly when a transfemoral access is possible, the decision between TAVI and conventional surgery should always be taken by the multidisciplinary team, following a careful comprehensive patient assessment.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Special indications for transcatheter aortic valve implantation</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Aortic regurgitation</span><p id="par0080" class="elsevierStylePara elsevierViewall">The percutaneous treatment of pure native aortic regurgitation is problematic because there is often a coexisting impairment in the aortic root and ascending aorta, which require open surgery. Additionally, the absence of calcium in aortic regurgitation limits the possibility of properly anchoring the conventional prosthesis within the valve ring.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">14</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Biological valve degeneration</span><p id="par0085" class="elsevierStylePara elsevierViewall">Taking into account the considerable number of patients older than 65 years with AS who were treated surgically with biological prostheses (whose durability is limited), we frequently see prosthesis degeneration and dysfunction with the passage of time due to stenosis or regurgitation. TAVI is a much less invasive therapeutic alternative to surgical reoperation, which until now has been the standard treatment for bioprosthetic degeneration (also known in the literature as valve-in-valve).<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">15</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Bicuspid aortic valve</span><p id="par0090" class="elsevierStylePara elsevierViewall">The bicuspid aortic valve (BAV) is the most common congenital valve disorder, with an estimated prevalence of 1–2%. In the initial studies of TAVI, BAV was considered an exclusion criterion; however, technological advances and the large accumulated experience opened new perspectives in this field. Currently, BAV is considered a relative contraindication for TAVI, especially regarding the greater risk of residual aortic regurgitation. Nevertheless, series have been published with good results from selected patients with AS and BAV treated with TAVI.<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">16</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Patients with coronary artery atherosclerosis</span><p id="par0095" class="elsevierStylePara elsevierViewall">Patients with severe symptomatic AS and diffuse coronary artery atherosclerosis, who cannot be revascularized, should not be excluded from treatment by conventional surgery or TAVI. Percutaneous coronary intervention combined with TAVI has been shown to be a feasible therapy, but more data are required before a firm recommendation can be made.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">17</span></a></p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Results and complications of transcatheter aortic valve implantation</span><p id="par0100" class="elsevierStylePara elsevierViewall">The results of randomized clinical trials (PARTNER) initially demonstrated improved survival and functional class when comparing medical treatment with TAVI in inoperable patients, as well as similar results to surgical valve replacement in high-risk patients.<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">18,19</span></a> In recent years, new clinical trials (PARTNER 2) have confirmed the noninferiority of TAVI versus surgery in intermediate-risk patients, in terms of mortality in the 2-year follow-up (19.3% vs. 21.1%, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001 for noninferiority).<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">12</span></a> Mortality in the first year is mainly related to the development of complications, whose frequency and severity have decreased considerably. Long-term survival with TAVI is acceptable, as shown by a number of published series in which more than half of the patients survived more than 5 years. Although the main cause of mortality is cardiovascular in the first year, other causes predominate in the subsequent follow-up, such as infections and malignancies.<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">20</span></a></p><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Periprocedural complications</span><p id="par0105" class="elsevierStylePara elsevierViewall">The most common complications related to the TAVI procedure are vascular (iliofemoral artery dissection, pseudoaneurysm and leakage in the puncture area), periprosthetic aortic regurgitation, cerebral infarction and conduction disorders. These complications are associated with increased mortality, except for the conduction disorders.<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">21,22</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The gauge reduction in the catheter valve release of up to 14<span class="elsevierStyleHsp" style=""></span>F (compatible with a minimum arterial gauge of 5<span class="elsevierStyleHsp" style=""></span>mm) has drastically decreased the procedure's vascular and hemorrhagic complications. The concern for residual paravalvular aortic regurgitation has been almost completely eliminated with the arrival of second and third-generation prostheses.<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">23</span></a> However, there is still a high rate of conduction disorders that require the permanent implantation of a pacemaker, especially with self-expanding devices.<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">24</span></a> It is important to note that aortic valve disease, even without treatment, is associated with conduction disorders due to the anatomical proximity of the atrioventricular conduction system to the aortic ring. Observational studies have not detected an association between permanent pacemaker implantation and poorer clinical results.<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">25</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The rate of brain embolisms, related to atrial fibrillation or intravascular manipulation during the procedure, has decreased since the start of the TAVI era, due to the introduction of smaller gauge catheters and improved techniques for navigating the catheter through the aorta, which has contributed to the broadening of the indication to patients at low to intermediate risk of AS. There has also been a surge in the development of cerebral protection devices, although none of them have yet shown a significant reduction in the rate of events.<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">26–29</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Other rare but severe complications include coronary occlusion, aortic ring rupture, valve malposition with embolization to the ascending aorta and, more rarely, to the left ventricle. The rupture of the ring or aortic root is more common with the balloon-expandable prostheses and could be due to overestimating the size of the ring or to a highly asymmetric distribution of the calcium.<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">22</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the results and complications of the main currently available percutaneous aortic prostheses, according to various published registries.<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">30–34</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Complications during follow-up</span><p id="par0130" class="elsevierStylePara elsevierViewall">The incidence of valvular degeneration in these prostheses is crucial when extending this therapy to low to intermediate-risk patients. The mechanisms that precipitate the bioprosthesis degeneration have not been elucidated. In surgical valves, calcification by mechanical stress, glutaraldehyde fixation, immunologic reactions and generalized atherosclerosis have been identified as contributing factors. Although similar mechanisms can act in TAVI deterioration, other specific factors can be of influence, such as valve stent underexpansion and interaction with the immobilized native leaflets.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Prosthetic endocarditis in the context of TAVI is uncommon, with an incidence rate of 0.3–3.4%/patient/year. The use of hybrid rooms (hemodynamics rooms that meet the conditions of sterility for an operating room) could be an effective preventive measure, although there are still no data that confirm this. To prevent hematogenous bacterial propagation, standard prophylaxis of endocarditis is required for patients with TAVI, before each dental operation associated with the handling of the gingival or periapical region of the teeth or perforation of the oral mucosa.</p><p id="par0140" class="elsevierStylePara elsevierViewall">The phenomenon of reduced aortic leaflet motion has recently been observed in various types of devices (including surgical bioprosthesis) using 4-dimensional computed tomography with volume.<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">35,36</span></a> In all cases, the resolution occurred spontaneously or after starting oral anticoagulation. Cases of patients with clinically symptomatic valve thrombosis are rare. Currently, the antiplatelet therapy recommended after TAVI is dual antiplatelet therapy for 6<span class="elsevierStyleHsp" style=""></span>months, followed by single antiplatelet therapy indefinitely.<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">37</span></a> In this context, it remains to be determined whether some patients with a greater risk of thrombosis should be indicated an initial treatment with oral anticoagulant therapy following TAVI.</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conclusions</span><p id="par0145" class="elsevierStylePara elsevierViewall">With the current data, we can confirm that TAVI is the treatment of choice for patients with severe symptomatic AS considered inoperable or with high surgical risk. There are promising data on the therapy using TAVI for patients at lower risk. The results appear to indicate that, in the medium term, TAVI will progressively substitute conventional surgery for treating most patients with severe AS.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interests</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres932899" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec907307" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres932898" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec907306" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Patient assessment for transcatheter aortic valve implantation" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Current indications for transcatheter aortic valve implantation" ] 7 => array:3 [ "identificador" => "sec0020" "titulo" => "Special indications for transcatheter aortic valve implantation" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Aortic regurgitation" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Biological valve degeneration" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Bicuspid aortic valve" ] 3 => array:2 [ "identificador" => "sec0040" "titulo" => "Patients with coronary artery atherosclerosis" ] ] ] 8 => array:3 [ "identificador" => "sec0045" "titulo" => "Results and complications of transcatheter aortic valve implantation" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Periprocedural complications" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "Complications during follow-up" ] ] ] 9 => array:2 [ "identificador" => "sec0060" "titulo" => "Conclusions" ] 10 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflict of interests" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-11-30" "fechaAceptado" => "2017-05-17" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec907307" "palabras" => array:2 [ 0 => "Aortic stenosis" 1 => "TAVI" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec907306" "palabras" => array:2 [ 0 => "Estenosis aórtica" 1 => "TAVI" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Aortic stenosis (AS) is the most common valvular heart disease in developed countries. Its prevalence increases progressively due the aging of the population. Transcatheter aortic valve implantation (TAVI), however, has revolutionized the treatment of AS. With the current data, we can confirm that TAVI is the treatment of choice for patients with severe symptomatic AS considered inoperable or with high surgical risk. In recent years, the use of TAVI has grown exponentially and is spreading to patients of intermediate surgical risk due to the procedure's good results, the reduced number of complications and the low incidence of prosthetic degeneration. The results appear to indicate that, in the medium term, TAVI will progressively substitute conventional surgery for treating most patients with severe AS.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La estenosis aórtica (EA) es la valvulopatía cardíaca más frecuente en los países desarrollados. Su prevalencia aumenta progresivamente debido al envejecimiento de la población. El implante transcatéter de la válvula aórtica (TAVI) ha revolucionado su tratamiento. Con los datos actuales se puede afirmar que el TAVI es el tratamiento de elección para los pacientes con EA grave sintomática, considerados inoperables o con alto riesgo quirúrgico. En los últimos años, el uso del TAVI ha crecido exponencialmente y se está extendiendo a pacientes de riesgo quirúrgico intermedio debido a los buenos resultados del procedimiento, la disminución del número de sus complicaciones y la baja incidencia de degeneración protésica. Todo parece indicar que, a medio plazo, el TAVI sustituirá progresivamente a la cirugía convencional en el tratamiento de la mayoría de los pacientes con EA grave.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Salido Tahoces L, Hernández Antolín RA, Zamorano Gómez JL. Estenosis aórtica. Indicaciones y resultados del implante de válvula aórtica percutánea (TAVI). Rev Clin Esp. 2017;217:478–483.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 630 "Ancho" => 2000 "Tamanyo" => 210776 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Models of aortic percutaneous prostheses.</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">(A) Edwards SAPIEN; (B) Edwards SAPIEN XT; (C) Edwards SAPIEN 3; (D) Edwards Centera; (E) Medtronic Core Valve; (F) Medtronic Core Valve Evolut R; (G) Medtronic Engager; (H) Boston Lotus; (I) Direct Flow Medical; (J) St. Jude Portico; (K) Symetis Acurate; (L) Jena Valve; (M) Heart Leaflet Technologies; (N) Colibri Heart Valve.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviation</span>: AR, aortic regurgitation.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Prosthesis \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Success<br>% \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Major vascular complications<br>% \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Need for pacemaker<br>% \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Moderate-severe postimplantation AR<br>% \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SAPIEN III<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">30</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">94–100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0–6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.7–13.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0–3.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">EVOLUT<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">31</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">95–98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.9–10.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10–38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LOTUS<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">32</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">99.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DIRECT FLOW<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">33</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3–17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PÓRTICO<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">34</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">95.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1576666.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Comparison of the results of the various percutaneous aortic prostheses in published registries.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:37 [ 0 => array:3 [ "identificador" => "bib0190" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. 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| Year/Month | Html | Total | |
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| 2023 March | 7 | 5 | 12 |
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