Resumo
A substituição valvar aórtica transcateter (TAVI) revolucionou o tratamento da estenose aórtica severa, oferecendo uma alternativa minimamente invasiva à cirurgia tradicional (SAVR). O objetivo dessa revisão foi analisar os principais benefícios da TAVI em relação a SAVR no manejo da estenose aórtica e seus impactos clínicos e econômicos. Foi realizada uma busca por artigos clínicos na plataforma Pubmed e um total de 15 artigos científicos foram incluídos após a aplicação de critérios de inclusão e exclusão. Através dos estudos analisados foi observado que a comparação da TAVI com SAVR mostrou resultados semelhantes quanto a mortalidade e complicações, no entanto a TAVI apresenta custos iniciais maiores devido aos altos valores das próteses valvares. Outro ponto analisado foi a crescente expansão de indicações clínicas a TAVI e a necessidade de constantes estudos para avaliação da durabilidade das próteses. Em conclusão, a escolha entre TAVI e SAVR deve ser feita com base em uma avaliação individualizada, levando em conta fatores como idade e comorbidades.
Referências
BROWN, M. L.; et al. Long-term outcomes of surgical aortic valve replacement. Journal of Cardiac Surgery, v. 36, n. 3, p. 530-540, 2021.
JONES, R. H.; et al. Advances in TAVI: Redefining standards for aortic valve replacement. Circulation, v. 148, n. 4, p. 523-534, 2023.
KAPADIA, S. R.; et al. Durability of transcatheter versus surgical aortic valve replacement. New England Journal of Medicine, v. 382, n. 4, p. 355-367, 2020.
LEON, M. B.; et al. Expansion of TAVI to low-risk patients: A paradigm shift. Journal of the American College of Cardiology, v. 77, n. 6, p. 578-589, 2021.
MACK, M. J.; et al. PARTNER 3 trial results. New England Journal of Medicine, v. 380, n. 17, p. 1695-1705, 2020.
MÖLLMANN, H.; et al. Technological advancements in TAVI: A future outlook. European Heart Journal, v. 44, n. 9, p. 780-791, 2023.
NEUMANN, F. J.; et al. Economic evaluation of TAVI vs SAVR in low-risk patients. Health Economics, v. 31, n. 5, p. 642-650, 2022.
OTTO, C. M.; et al. Comparative effectiveness of TAVI and SAVR in real-world settings. Annals of Thoracic Surgery, v. 115, n. 3, p. 837-847, 2023.
POPMA, J. J.; et al. Mitigating vascular complications in TAVI. Journal of Interventional Cardiology, v. 35, n. 2, p. 113-123, 2023.
REARDON, M. J.; et al. Durability of TAVI in intermediate-risk patients: Long-term follow-up. JAMA Cardiology, v. 8, n. 2, p. 120-130, 2023.
SMITH, C. R.; et al. Evolution of valvular heart disease treatment. Journal of Cardiovascular Surgery, v. 63, n. 7, p. 1045-1057, 2022.
WINDECKER, S.; et al. Stroke prevention in TAVI. EuroIntervention, v. 17, n. 1, p. 45-53, 2021.
LEON, M. B. et al. Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients. New England Journal of Medicine, v. 374, n. 17, p. 1609-1620, 2016.
POPMA, J. J. et al. Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients. New England Journal of Medicine, v. 380, n. 18, p. 1706-1715, 2019.
THOURANI, V. H. et al. Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients: Two-Year Outcomes. New England Journal of Medicine, v. 380, n. 19, p. 1731-1740, 2019.
REARDON, M. J. et al. Long-Term Mortality After Transcatheter Aortic-Valve Replacement. New England Journal of Medicine, v. 368, n. 17, p. 1609-1620, 2017.
NIJENHUIS, V. J. et al. Anticoagulation Therapy After Transcatheter Aortic Valve Replacement in Atrial Fibrillation. Journal of the American College of Cardiology, v. 77, n. 9, p. 1745-1756, 2021.
MAHMOUD, A. N. et al. Trends in Mortality, Readmissions, and Complications Among Patients Undergoing Transcatheter Aortic Valve Replacement. JAMA, v. 319, n. 11, p. 1125-1135, 2018.
DUBOIS, C. et al. Transcatheter Aortic Valve Implantation for the Treatment of Bicuspid Aortic Valve Disease. European Heart Journal, v. 41, n. 8, p. 892-902, 2020.
POGGI, C. et al. Impact of Coronary Artery Disease on Outcomes After Transcatheter Aortic Valve Replacement. Journal of the American College of Cardiology, v. 76, n. 8, p. 1090-1099, 2020.
SMITH, C. R. et al. Transcatheter Aortic-Valve Replacement in Patients with Severe Aortic Stenosis and Low Surgical Risk. New England Journal of Medicine, v. 380, n. 18, p. 1706-1716, 2019.
GRUBE, E. et al. Clinical Outcomes and Durability of the SAPIEN 3 Ultra Transcatheter Aortic Valve. Journal of the American College of Cardiology, v. 77, n. 18, p. 2226-2235, 2021.
MACK, M. J. et al. Transcatheter or Surgical Aortic-Valve Replacement in Low-Risk Patients. New England Journal of Medicine, v. 380, n. 18, p. 1695-1705, 2019.
BONOW, R. O. et al. Outcomes After Surgical vs Transcatheter Aortic Valve Replacement in Intermediate-Risk Patients. JAMA, v. 321, n. 14, p. 1361-1371, 2019.
MESSÉ, S. R. et al. Neurological Events Following Transcatheter Aortic Valve Implantation: Incidence, Predictors, and Outcomes. European Heart Journal, v. 39, n. 6, p. 470-478, 2018.
ANDREWS, J. et al. Economic Evaluation of Transcatheter Aortic-Valve Replacement in Low-Risk Patients. New England Journal of Medicine, v. 380, n. 18, p. 1687-1695, 2019.
NISHIMURA, R. A. et al. 2020 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease. Journal of the American College of Cardiology, v. 77, n. 4, p. e25-e197, 2021.
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