Análisis de la interacción ventriculo-valvulo-arterial en pacientes con estenosis aórtica

Résumé

Aortic stenosis is probably the most important valvular disease in the Western World, due to its high prevalence and its serious impact on life expectancy and quality of the patients who suffer from it, so much so that survival is as low as 50% at two years for patients with severe aortic stenosis who are treated medically. For decades now, surgical aortic valve replacement has been the only treatment able to change the clinical course of the disease, and yet, around 30% of patients with severe symptomatic aortic stenosis are not referred to surgery due to various reasons. In the past years, transcatheter aortic valve implantation (TAVI) has emerged as a treatment option for inoperable or high risk patients with aortic stenosis. TAVI is superior to medical therapy, reducing mortality and improving symptoms; furthermore, in patients at high risk for surgery, TAVI has results at least as good as those of surgery. Over the last decade there have been great advances in devices and techniques available for TAVI, which has contributed to improve its results and lower its complications. The opposition to systolic blood flow in aortic stenosis is determined by the sum of the valvular obstruction and the vascular load. The latter is often abnormally high in patients with aortic stenosis, due to hypertension and a high prevalence of vascular disease in these patients, which contributes importantly to the total afterload of the left ventricle. Furthermore, there is an interdependence between the valvular and vascular load, so that when one of the components is reduced, the other increases, and viceversa...