Blog - INTERNET MÉDICA

Implante de Valva Aórtica Transcateter Online (Transcatheter Aortic Valve Implantation)

Por Paulo Leite 22/04/2019

¨O implante de valva aórtica transcateter (TAVI, do inglês transcatheter aortic valve implantation) constitui tratamento alternativo para pacientes com estenose aórtica de alto risco cirúrgico ou inoperáveis. A indicação de implante por cateter de prótese aórtica (TAVI, do inglês transcatheter aortic valve implantation) já encontra-se estabelecida em diretrizes nacionais e internacionais para o tratamento das valvopatias. Recomenda-se que o TAVI seja o tratamento de escolha para pacientes portadores de estenose aórtica grave e considerados inoperáveis (classe I, nível de evidência B) e que deva ser considerado uma estratégia alternativa à cirurgia de troca valvular naqueles indivíduos com alto risco cirúrgico (classe IIa, nível de evidência B). Estimativas apontam que mais de 100 mil pacientes já tenham sido tratados em todo o mundo, e os resultados atuais em centros com vasta experiência demonstraram elevadas taxas de sucesso do procedimento (acima de 95%), com índices de mortalidade aos 30 dias < 5%. O TAVI deve ser desenvolvido dentro de um programa para o tratamento da estenose aórtica, e não encarado meramente como um procedimento.¨

■ Comparison of transcatheter aortic valve implantation with other approaches to treat aortic valve stenosis: a systematic review and meta-analysis

G Wagner, S Steiner, G Gartlehner et al

Systematic Reviews 2019, vol 8: 44

https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-019-0954-3

■ Aortic stenosis and transcatheter aortic valve implantation

Kim C, Hong MK.

Korean Circ J. 2019 Apr;49(4):283-297.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6428950/

■ Papel da Avaliação Aortográfica Quantitativa da Regurgitação Aórtica por Videodensitometria na Orientação do Implante da Valva Aórtica Transcateter

Miyazaki, Yosuke et al.

Arq. Bras. Cardiol., Aug 2018, vol.111, no.2, p.193-202

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2018001400193&lng=pt&nrm=iso&tlng=pt (portuguese)

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2018001400193&lng=pt&nrm=iso&tlng=en (english)

■ Analysis of electrocardiographic intervals before and after transcatheter aortic valve implantation predict the need for permanent pacing

Ball TN, Vasudevan A, Mi Ko J, Assar MD, McCullough PA, Stoler RC.

Proc (Bayl Univ Med Cent). 2018 Sep 11;31(4):407-413

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6413979/

■ Comprehensive geriatric assessment in patients undergoing transcatheter aortic valve implantation – results from the GGA-TAVI multicentre registry

Andrea Ungar, Giulio Mannarino, Nathalie van der Velde et al

BMC Cardiovasc Disord. 2018; 18: 1

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5755352/

■ Early versus newer generation devices for transcatheter aortic valve implantation in routine clinical practice: a propensity score matched analysis

Thomas Pilgrim, Joe K T Lee, Crochan J O’Sullivan et al

Open Heart. 2018; 5(1): e000695

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5786915/

■ Otimal antiplatelet strategy after transcatheter aortic valve implantation: a meta-analaysis

Yousif Ahmad, Ozan Demir, Christopher Rajkumar et al

Open Heart. 2018; 5(1): e000748.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5786926/

■ Impact of transcatheter aortic valve implantation on the risk of mortality in patients with severe aortic valve diseases: a health insurance-based analysis

Alexander Barth, Seyrani Yücel, Hüseyin Ince, Gabriele Doblhammer

Open Heart. 2018; 5(1): e000756

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5922570/

■ Outcome after transvascular transcatheter aortic valve implantation in 2016

L Gaede, J Blumenstein, C Liebetrau et al

European Heart Journal 2018, vol 39 (8): 667-675

https://academic.oup.com/eurheartj/article/39/8/667/4710062

■ Transcatheter aortic valve replacemnt: optimizing outcomes for healthy recovert

Goel, Kashish; Holmes, David R. Jr

Journal of Cardiopulmonary Rehabilitation and Prevention 2018, vol 38 (1): 1-7

https://journals.lww.com/jcrjournal/Fulltext/2018/01000/Transcatheter_Aortic_Valve_Replacement__OPTIMIZING.1.aspx

■ Cost effectiveness of transcatheter aortic implantation in patients arotic stenosis in Japan

S Kodera, A Kiyosue, J Ando, I Komuro

Journal of Cardiology 2018, vol 71 (3): p223-229

https://www.journal-of-cardiology.com/article/S0914-5087(17)30277-0/fulltext

■ Transcatheter aortic valve replacement: Suitable for all?

K Minakata

Journal of Cardiology 2018, vol 71 (3): p221-p222

https://www.journal-of-cardiology.com/article/S0914-5087(17)30311-8/fulltext

■ Outcomes in transcatheter aortic valve replacement for bicuspid versus tricuspid aortic valve stenosis

S Yoon, S Bleiziffer, O De Backer et al

Journal of the American College of Cardiology 2017, vol 69 (21): 2579-2589

http://www.onlinejacc.org/content/69/21/2579

■ Increased mortality from complications of pulmonary hypertension in patients indergoing transcatheter aortic valve replacement

Raj Parikh, Benson Varghese, Huma N. Khatoon et al

Pulm Circ. 2017 Jun; 7(2): 391–398

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5467925/

■ Retinal embolic events: frequency and impact following transcatheter aortic valve implatation (TAVI) for aortic stenosis

William J Fusi-Rubiano, Yit C Yang, Andrew F Smallwood et al

BMJ Open Ophthalmol. 2017; 1(1): e000033

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5721649/

■ SOURCE 3: 1-year outcomes post-transcatheter aortic valve implantation using the latest generation of the ballon-expandable transcatheter heart valve

O Wendler, G Schymik, H Treede et al

European Heart Journal 2017, vol 38 (36): 2117-2722

https://academic.oup.com/eurheartj/article/38/36/2717/3866739

■ Pre- and post-surgical evaluation of the inflammatory response in patients with aortic stenosis treated with different types of prosthesis

Maria Elena Soto, Jose Luis Salas, Jesus Vargas-Barron et al

BMC Cardiovasc Disord. 2017; 17: 100

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5391573/

■ Transfemoral transcatheter aortic valve implantation in patients with end-stage renal disease and kidney transplant recipients

F Al-Rashid, A Binholz, H A Hildebrandt et al

Scientific Reports 2017, vol 7 , article number: 14397

https://www.nature.com/articles/s41598-017-14486-7

■ Assessment of aortic valve disease – a clinician oriented review

A D Margulescu

World J Cardiol 2017, vol 9 (6): 481-495

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5491466/

■ Conservative management of aortic root rupture complicated with cardiac tamponade following aortic valve implantation

Luca Vannini, Rut Andrea, Manel Sabaté

World J Cardiol. 2017 Apr 26; 9(4): 391–395

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5411975/

■ Evolução e Prognóstico da Regurgitação Paravalvar Após Implante de Valva Aórtica

Meneguz-Moreno, Rafael Alexandre et al

Arq. Bras. Cardiol., Dec 2017, vol.109, no.6, p.590-598

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2017001500590&lng=pt&nrm=iso&tlng=pt (portuguese)

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2017001500590&lng=pt&nrm=iso&tlng=en (english)

■ Surgical or transcatheter aortic-valve replacement in intermediate-risk patients

Michael J. Reardon, Nicolas M. Van Mieghem, Jeffrey J. Popma et al

for the SURTAVI Investigators*

N Engl J Med 2017; 376:1321-1331

http://www.nejm.org/doi/full/10.1056/NEJMoa1700456

■ Reversibility of cardiac function predicts outcomes after transcatether aortic valve replacement in patients with severe aortic stenosi

K Sato, A Kumar, B M Jones et al

Journal of the American Heart Association 2017, vol 6: e005798

http://jaha.ahajournals.org/content/6/7/e005798

■ Transcatheter aortic valve implantation with or without percutanous coronary artery revascularization strategy: a systematic review and meta-analysis

R A Kotronias, C S Kwok, S George et al

Journal of the American Heart Association 2017, vol 6: e005960

http://jaha.ahajournals.org/content/6/6/e005960

■ Long-term outcomes of patients with mediastinal radiation – associated severe aortic stenosis and subsequente surgical aortic valve replacemnt: a matched cohort study

E Donnellan, A Masri, D R Johnston et al

Journal of the American Heart Association 2017, vol 6: e005396

http://jaha.ahajournals.org/content/6/5/e005396

■ Traditional cardiovascular risk factors and their relation to future surgery for valvular heart disease or ascending aortic disease: a case-referent study

J Ljungberg, B Johansson, K G Engström et al

Journal of the American Heart Association 2017, vol 6: e005133

http://jaha.ahajournals.org/content/6/5/e005133

■ Effect of body mass index on clinical outcome and all-cause mortality in patients undergoing transcatheter aortic valve implantation

Abawi, R. Rozemeijer, P. Agostoni, et al

Neth Heart J. 2017 Sep; 25(9): 498–509

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5571592/

■ Thrombo-embolic prevention after transcatheter aortic valve implantation

P Vranckx, S Windecker, R C Welsh et al

European Heart Journal 2017, vol 38 (45): 3341-3350

https://academic.oup.com/eurheartj/article/38/45/3341/4036296

■ Surgical classification of aortic stenosis on the extend of cardiac damage

P Généreux, P Pibarot, B Redfors et al

European Heart Journal 2017, vol 38 (45): 3351-3358

https://academic.oup.com/eurheartj/article/38/45/3351/4002776

■ High risk aortic valve replacement – The challenges of multiple treatment strategies with an evolving technology

K Booth, R Beattie, M McBride, G Manoharan, M Spence, J M Jones

Ulster Med J. 2016 Jan; 85(1): 18–22.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4847840/

■ Apical acess and closure devices for transapical transcatheter heart valve procedures

E Ferrari

Swiss Med Wkly 2016, vol 146: w14237

https://smw.ch/resource/jf/journal/file/view/article/smw/en/smw.2016.14237/f251c13b270b8b1c37d5c115fcd9e81a1921048b/smw_2016_14237.pdf/

■ Transcatheter aortic valve implantation tody and tomorrow

P Wenawesera, F Praza, S Stortckya

Swiss Med Wkly 2016, vol 146: w14299

https://smw.ch/resource/jf/journal/file/view/article/smw/en/smw.2016.14299/0ae51f3fd22f93a2a37c16ef58e1c45feacc490d/smw_2016_14299.pdf/

■ Severe concerns in transcatheter aortic valve replacement in Japanese elderly

H Kanzaki

Journal of Cardiology 2015, vol 65 (2): p89-90

https://www.journal-of-cardiology.com/article/S0914-5087(14)00188-9/fulltext

■ Dr Paulo Fernando Leite

Cardiologia/Prevenção Cardiovascular

Estratificação de Risco Cardiovascular

Novo endereço:

Consultório: Rua Padre Rolim 815/sala 815

Tel: 33245518 (Consulta Particular/Unimed)

– Centro Médico Unimed BH/Contagem/Pedro I

Belo Horizonte/MG/Brasil

CRMMG: 7026

Email: pfleite1873@gmail.com

Doença de Kawasaki: Artigos de Revisão Online (Kawasaki Disease: Review)

Por Paulo Leite 20/04/2019

¨A doença de Kawasaki é uma vasculite sistêmica aguda que afeta predominantemente pacientes com menos de cinco anos. Representa a causa mais proeminente de doença arterial coronariana adquirida na infância. Nos Estados Unidos, 19 por 100.000 crianças menores de cinco anos são hospitalizadas anualmente com a doença de Kawasaki. De acordo com as diretrizes americanas e japonesas, a doença de Kawasaki é um diagnóstico clínico. A doença clássica (típica) Kawasaki é diagnosticada com base na presença de febre com cinco ou mais dias, acompanhada por quatro dos cinco achados: inflamação conjuntival bilateral, alterações orais como lábios ¨rachados¨ e eritematosos e língua de cor morango, linfadenopatia cervical, alterações nas extremidades como eritema ou palma e descamação única e erupção polimorfa. A doença de Kawasaki incompleta (atípica) ocorre em pessoas com febre que duram cinco ou mais dias e com dois ou três destes achados. A ecocardiografia transtorácica é a modalidade diagnóstica de imagem de escolha para rastreamento de aneurismas coronarianos, embora outras técnicas estejam sendo avaliadas para diagnóstico e tratamento. O tratamento para doença aguda é imunoglobulina intravenosa e aspirina. Se não houver resposta ao tratamento, os pacientes receberão uma segunda dose de imunoglobulina intravenosa com ou sem corticosteróides ou outros tratamentos adjuvantes. A presença e a gravidade dos aneurismas coronarianos e a obstrução no diagnóstico determinam as opções de tratamento e a necessidade, periodicidade e intensidade do monitoramento cardiovascular em longo prazo para aterosclerose em potencial. A característica clínica mais importante da DK é o acometimento prevalente das artérias coronárias, que pode variar desde dilatação e estenose à formação de aneurismas (incidência de 5% nos pacientes adequadamente tratados e de 25% nos não tratados). Esses aneurismas de artérias coronárias (AAC), quando gigantes (definidos pelo diâmetro > 8 mm), estão associados a elevado risco de trombose, infarto agudo do miocárdio (IAM), rotura e morte súbita¨.

■ Kawasaki disease: guidelines of the Italian Society of Pediatric, part I – definition, epidemiology, etiopathogenesis, clinical expression and management of the acute phase

Alessandra Marchesi, Isabella Tarissi de Jacobis, Donato Rigante et al

Ital J Pediatr. 2018; 44: 102

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6116535/

■ Kawasaki disease: guidelines of the Italian Society of Pediatric, part II – treatment of resistant forms and cardiovascular complications, follow-up, lifestyle and prevention of cardiovascular risks

Alessandra Marchesi, Isabella Tarissi de Jacobis, Donato Rigante et al

Ital J Pediatr. 2018; 44: 103

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6116479/

■ Kawasaki disease: etiopathogenesis and novl treatmnt strategies

Shreya Agarwal, Devendra K. Agrawal

Expert Rev Clin Immunol. 2017 Mar; 13(3): 247–258

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5542821/

■ Controversies in diagnosis and management of Kawasaki disease

Rakesh Kumar Pilania, Dharmagat Bhattarai, Surjit Singh

World J Clin Pediatr. 2018 Feb 8; 7(1): 27–35

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5803562/

■ Adjunctive therapies in Kawasaki Diseas

Adriana H. Tremoulet

Int J Rheum Dis. 2018 Jan; 21(1): 76–79

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5777888/

■ Kawasaki disease: a comprehensive review

Kamleshun Ramphul, Stephanie Gonzalez Mejias

Arch Med Sci Atheroscler Dis. 2018; 3: e41–e45

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6374576/

■ How should we classify Kawasaki disease?

Edoardo Marrani, Jane C. Burns, Rolando Cimaz

Front Immunol. 2018; 9: 2974

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6302019/

■ Kawasaki disease

Christian M. Hedrich, Anja Schnabel, Toni Hospach

Front Pediatr. 2018; 6: 198

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6048561/

■ Pregnancy in Woman with Kawasaki Disease and Multiple Coronary Artery Aneurysms.

Avila, Walkiria Samuel et al.

Arq. Bras. Cardiol., Jan 2018, vol.110, no.1, p.97-100

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2018000100097&lng=en&nrm=iso

■ Dissecting Kawasaki disease: a stat-of-the-art review

M. Dietz, D. van Stijn, D. Burgner et al

Eur J Pediatr. 2017; 176(8): 995–100

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5511310/

■ Dissecting Kawasaki disease: a state-of-the-art review

S M Dietz, D van Stijn, D Burgner et al

Eur J Pediatr 2017, vol 176 (8): 995-1009

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5511310/

■ Diagnosis, treatment, and long-term management of Kawasaki disease: A Scientific Statement for Health Professionals From the American Heart Association

B W McCrindle, A H Rowley, J W Newburger et al

Circulation 2017, vol 135:e927-e999

https://www.ahajournals.org/doi/full/10.1161/cir.0000000000000484

■ Diagnosis and management of Kawasaki diseas

A Saguil, M Fargo, S Grogan

Am Fam Physician 2015, vol 91 (6): 365-771

https://www.aafp.org/afp/2015/0315/p365.html