Transcatheter Aortic Valve Replacement for Severe Symptomatic Aortic Stenosis in Rheumatic Heart Disease: A Systematic Review.

Autor:	Fernandes ADF; From the Department of Internal Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL., Fernandes GC; Division of Cardiology, University of Miami/ Jackson Memorial Hospital, Miami, FL., Grant J; From the Department of Internal Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL., Knijnik L; From the Department of Internal Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL., Cardoso R; Division of Cardiology, Brigham and Women's Hospital, Boston, MA., Cohen MG; Division of Cardiology, University of Miami, Miami, FL., Ferreira AC; Division of Cardiology, Jackson Memorial Hospital, Miami, FL., Alfonso CE; Division of Cardiology, University of Miami, Miami, FL.
Jazyk:	angličtina
Zdroj:	Cardiology in review [Cardiol Rev] 2022 Nov-Dec 01; Vol. 30 (6), pp. 318-323. Date of Electronic Publication: 2021 Oct 18.
DOI:	10.1097/CRD.0000000000000425
Abstrakt:	Transcatheter aortic valve replacement (TAVR) is well-established for severe symptomatic aortic stenosis (AS), but its use in rheumatic heart disease (RHD) has been limited. We systematically review the use of TAVR for severe symptomatic AS in RHD. Pubmed, Embase, and Scopus were searched for TAVR for symptomatic severe AS and proven or suspected RHD. Procedure characteristics, efficacy, and safety endpoints were collected and all definitions were based on the Valve Academic Research Consortium-2 (VARC-2) criteria. We included 3 case series and 12 case reports, with a total of 43 patients. Mean age was 76 years, 75% were female, and 85% had NYHA class III-IV symptoms. Follow up ranged from 1 to 29 months. Patients were moderate to high risk, with Society of Thoracic Surgery score ranging from 6.1% to 17.6%. The approach was transfemoral in 30 (83%) cases. Procedural success occurred in 37 (86%) patients. Of the 7 patients with periprocedural complications, 4 had valve dislodgement, 1 deployment failure, 1 unplanned cardiopulmonary bypass, and 1 moderate aortic regurgitation. Paravalvular leak was reported in 5 (11.6%) patients. Only 1 patient had heart block requiring pacemaker. Among 13 studies (23 patients), 30-day mortality was 0%. One case series with 19 patients had a 30-day, 1-year, 2-year, and 5-year mortality of 5%, 11%, 31%, and 48%, respectively. TAVR appears feasible for selected patients with rheumatic severe AS, albeit our results indicate a 14% incidence of device failure. Future randomized clinical trials may clarify the role of TAVR in this group. Competing Interests: Disclosure: The authors declare no funding and conflict of interest. (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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