Mirando a Lua e acertando as Estrelas : TAVR

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= Alain Cribier

https://academic.oup.com/eurheartj/article/38/9/615/3061853

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In 2017, we are far from the end of the TAVR’s odyssey and the potential of this disruptive technology remains explosive. If we believe our crystal ball, in 2022, for the 20th anniversary of TAVR, new reports in the Journal will confirm TAVR as the predominant therapy for the treatment of patients with severe aortic stenosis.

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AQUI

https://www.sciencedirect.com/science/article/pii/S0735109717373217

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Não existe alguém mais fã da TAVR que o professor Alain Cribier.

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Mesmo assim, ele levanta uma questão importante:

A further and broad expansion of TAVR in low-risk or younger patients may come from the expected results of 3 ongoing major randomized trials in this population. However, long-term durability of the valves is the unanswered question that remains to be addressed before extension of indication to patients with long life expectancy.

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Ao realizar o procedimento em indivíduos com expectativa de vida superior a 10, 15 ou até 20 anos, precisamos estar convictos da duração da prótese!!!

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TAVI precisa de TEE?

1a

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http://spo.escardio.org/eslides/view.aspx?eevtid=49&fp=71

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Enquanto debatemos a obrigatoriedade do TEE na TAVI, (Transesophageal echocardiography guidance decreased from 60.7% to 32.3% of cases, whereas more recent procedures were increasingly performed in hybrid operating rooms (15.8% vs. 35.7%)) ainda existe a polêmica do uso em pacientes de risco cirúrgico aceitável:

Temporal Trends in Transcatheter Aortic Valve Replacement in France: FRANCE 2 to FRANCE TAVI

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https://www.sciencedirect.com/science/article/pii/S0735109717372467?via%3Dihub

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Mas o uso do TEE está em debate. Pior, está em queda.

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Mais um procedimento que escapa da área de ecocardiografia…

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