Original article
Transcatheter aortic valve implantation for aortic stenosis. Initial experience
Tratamiento de la estenosis valvular aórtica con implante de prótesis valvular transcatéter. Experiencia inicial
Guillermo Careaga-Reynaa,
, José Luis Lázaro-Castillob, Carlos Alberto Lezama-Urtechoc, Enriqueta Macías-Mirandad, Juan José Dosta-Herrerad, José Galván Díazc
Corresponding author
gcareaga3@gmail.com
Corresponding author at: Dirección General UMAE, Hospital General Dr. Gaudencio González Garza, CMN La Raza, IMSS, Calz. Vallejo y Jacarandas s/n, Col. La Raza, Delegación Azcapotalco, C.P. 02990 Mexico City, Mexico. Tel.: +52 0155 57245900ext.23300.
Corresponding author at: Dirección General UMAE, Hospital General Dr. Gaudencio González Garza, CMN La Raza, IMSS, Calz. Vallejo y Jacarandas s/n, Col. La Raza, Delegación Azcapotalco, C.P. 02990 Mexico City, Mexico. Tel.: +52 0155 57245900ext.23300.
a Dirección General, Unidad Médica de Alta Especialidad, Hospital General Dr. Gaudencio González Garza, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
b Unidad Médica de Alta Especialidad, Departamento de Hemodinamia y Terapia Endovascular, Hospital General Dr. Gaudencio González Garza, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
c Unidad Médica de Alta Especialidad, Departamento de Cirugía Cardiotorácica, Hospital General Dr. Gaudencio González Garza, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
d Unidad Médica de Alta Especialidad, Departamento de Anestesiología, Hospital General Dr. Gaudencio González Garza, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
Read
1926
Timeswas read the article
545
Total PDF
1381
Total HTML
Share statistics
array:24 [ "pii" => "S2444050717300815" "issn" => "24440507" "doi" => "10.1016/j.circen.2017.11.014" "estado" => "S300" "fechaPublicacion" => "2017-09-01" "aid" => "270" "copyright" => "Academia Mexicana de Cirugía A.C." "copyrightAnyo" => "2016" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Cir Cir. 2017;85:375-80" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 583 "formatos" => array:3 [ "EPUB" => 58 "HTML" => 401 "PDF" => 124 ] ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S0009741116300871" "issn" => "00097411" "doi" => "10.1016/j.circir.2016.10.006" "estado" => "S300" "fechaPublicacion" => "2017-09-01" "aid" => "270" "copyright" => "Academia Mexicana de Cirugía A.C." "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Cir Cir. 2017;85:375-80" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1898 "formatos" => array:3 [ "EPUB" => 54 "HTML" => 1524 "PDF" => 320 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">ARTÍCULO ORIGINAL</span>" "titulo" => "Tratamiento de la estenosis valvular aórtica con implante de prótesis valvular transcatéter. Experiencia inicial" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "375" "paginaFinal" => "380" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Transcatheter aortic valve implantation for aortic stenosis. Initial experience" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1227 "Ancho" => 950 "Tamanyo" => 169296 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se observa el momento en que se infla el globo para fijar la prótesis valvular aórtica percutánea a la aorta.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Guillermo Careaga-Reyna, José Luis Lázaro-Castillo, Carlos Alberto Lezama-Urtecho, Enriqueta Macías-Miranda, Juan José Dosta-Herrera, José Galván Díaz" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Guillermo" "apellidos" => "Careaga-Reyna" ] 1 => array:2 [ "nombre" => "José Luis" "apellidos" => "Lázaro-Castillo" ] 2 => array:2 [ "nombre" => "Carlos Alberto" "apellidos" => "Lezama-Urtecho" ] 3 => array:2 [ "nombre" => "Enriqueta" "apellidos" => "Macías-Miranda" ] 4 => array:2 [ "nombre" => "Juan José" "apellidos" => "Dosta-Herrera" ] 5 => array:2 [ "nombre" => "José" "apellidos" => "Galván Díaz" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2444050717300815" "doi" => "10.1016/j.circen.2017.11.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444050717300815?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0009741116300871?idApp=UINPBA00004N" "url" => "/00097411/0000008500000005/v1_201711040032/S0009741116300871/v1_201711040032/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2444050717300748" "issn" => "24440507" "doi" => "10.1016/j.circen.2017.11.007" "estado" => "S300" "fechaPublicacion" => "2017-09-01" "aid" => "275" "copyright" => "Academia Mexicana de Cirugía A.C." "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Cir Cir. 2017;85:381-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 959 "formatos" => array:3 [ "EPUB" => 40 "HTML" => 808 "PDF" => 111 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Results to 4-year follow-up of the treatment of the cervical stenosis by corpectomy, titanium mesh cage and anterior plate fixation" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "381" "paginaFinal" => "386" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Resultados a 4 años de seguimiento del tratamiento del conducto cervical estrecho mediante corpectomía, malla de titanio y fijación anterior con placa" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 837 "Ancho" => 1505 "Tamanyo" => 123618 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">(A) Immediate postoperative X-ray. (B) X-ray at 4 years postoperatively.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Alejandro Antonio Reyes Sánchez, Luis Alberto Gameros Castañeda, Claudia Obil Chavarría, Armando Alpizar Aguirre, Barón Zárate Kalfópulos, Luis Miguel Rosales-Olivares" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Alejandro Antonio" "apellidos" => "Reyes Sánchez" ] 1 => array:2 [ "nombre" => "Luis Alberto" "apellidos" => "Gameros Castañeda" ] 2 => array:2 [ "nombre" => "Claudia" "apellidos" => "Obil Chavarría" ] 3 => array:2 [ "nombre" => "Armando" "apellidos" => "Alpizar Aguirre" ] 4 => array:2 [ "nombre" => "Barón" "apellidos" => "Zárate Kalfópulos" ] 5 => array:2 [ "nombre" => "Luis Miguel" "apellidos" => "Rosales-Olivares" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0009741116300925" "doi" => "10.1016/j.circir.2016.10.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0009741116300925?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444050717300748?idApp=UINPBA00004N" "url" => "/24440507/0000008500000005/v2_201802210427/S2444050717300748/v2_201802210427/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Transcatheter aortic valve implantation for aortic stenosis. Initial experience" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "375" "paginaFinal" => "380" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Guillermo Careaga-Reyna, José Luis Lázaro-Castillo, Carlos Alberto Lezama-Urtecho, Enriqueta Macías-Miranda, Juan José Dosta-Herrera, José Galván Díaz" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Guillermo" "apellidos" => "Careaga-Reyna" "email" => array:1 [ 0 => "gcareaga3@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "José Luis" "apellidos" => "Lázaro-Castillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Carlos Alberto" "apellidos" => "Lezama-Urtecho" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Enriqueta" "apellidos" => "Macías-Miranda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "Juan José" "apellidos" => "Dosta-Herrera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 5 => array:3 [ "nombre" => "José Galván" "apellidos" => "Díaz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Dirección General, Unidad Médica de Alta Especialidad, Hospital General Dr. Gaudencio González Garza, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad Médica de Alta Especialidad, Departamento de Hemodinamia y Terapia Endovascular, Hospital General Dr. Gaudencio González Garza, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Unidad Médica de Alta Especialidad, Departamento de Cirugía Cardiotorácica, Hospital General Dr. Gaudencio González Garza, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Unidad Médica de Alta Especialidad, Departamento de Anestesiología, Hospital General Dr. Gaudencio González Garza, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: Dirección General UMAE, Hospital General Dr. Gaudencio González Garza, CMN La Raza, IMSS, Calz. Vallejo y Jacarandas s/n, Col. La Raza, Delegación Azcapotalco, C.P. 02990 Mexico City, Mexico. Tel.: +52 0155 57245900ext.23300." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento de la estenosis valvular aórtica con implante de prótesis valvular transcatéter. Experiencia inicial" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1238 "Ancho" => 950 "Tamanyo" => 123608 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Angiographic control to confirm the correct positioning of the implant and determine the presence or absence of paravalvular leakage. This is also reviewed by echocardiogram.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">When the correct clinical conditions apply, the standard treatment for aortic valve disease has been the replacement of the valve with a prosthesis that is either mechanical or biological through heart surgery with cardiopulmonary bypass.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Expected mortality for this type of procedure is approximately 3%, although it depends on the patient's concomitant disease which may contraindicate the surgical procedure despite the need to treat the impaired valve. It has thus been the case that high risk patients or those with complications have never been offered surgery by the attending physician and in these conditions up to 33% of patients miss the opportunity to be assessed for surgical treatment.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Less invasive procedures have been developed for this type of patient, aimed at offering them a more favourable recovery, with replacement of the aortic valve through mini sternotomy instead of standard total sternotomy. This approach allows patients to have an earlier recovery.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">4</span></a> There is, however, a group of patients for whom this approach is still risky and they cannot be given any other option except medical treatment to improve the quality of their lives but not survival. Under these circumstances and with the technological advances of recent years, a valvular prosthesis system was designed which could be implanted through the femoral or iliac artery and with fluoroscopic control. The first aortic valve prosthesis implanted with this type of approach was performed by Cribier et al. In 2002.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">5</span></a> A good number of patients have now been implanted with this type of prosthesis worldwide, which has led to a considerable improvement in their survival and quality of life.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">6–8</span></a> It is important to mention that at present aortic valve stenosis is the most frequent valve disorder, especially in elderly patients, who in the majority of cases also present with associated systemic diseases.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a> In our environment this therapy modality for treating native aortic valve stenosis is recent. We present our initial experience with this type of prosthesis and the results obtained in a group of patients.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">Between 1st November 2014 and 31st May 2015 were selected with the already established inclusion criteria accepted in international medical literature, and were offered the option of treatment with an endovascular device for aortic valve replacement to be implanted with peripheral venous access.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Criteria for referral to this procedure were: patients with a diagnosis of critical aortic valve stenosis (area of aortic valve <1<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span> measured by echocardiography), with a mean gradient of aortic pressure of >40<span class="elsevierStyleHsp" style=""></span>mmHg, elevated surgical risk (EuroSCORE<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>20%) and/or rating >10%<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a> from the Society of Thoracic Surgeons. In the case of coronary arterial disease, this was to be previously treated using coronary angioplasty.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Preparation for the procedure included measuring the aortic valve ring using computed tomography with slices gated at aortic valve level and using transthoracic and transesophageal echocardiography.</p><p id="par0035" class="elsevierStylePara elsevierViewall">An echocardiogram, computed angiography and cardiac catheterisation with aortogram and coronariography in addition to pressure measurement was performed on all patients.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The procedure was performed under general anaesthesia, intubation of the airway and with prior monitoring through radial arterial catheter, central venous catheter, vesical catheter and electrocardiogram. Transfemoral access was used with surgical exposure of the femoral artery in all cases and transesophageal echocardiographic and fluoroscopic control of images. A temporary electrode for an endocardial pacemaker in the right ventricle was implanted. After this balloon aortic valvuloplasty was performed and angiographic control with cardiac stimulation to 180<span class="elsevierStyleHsp" style=""></span>lpm. Later, once the patient had been haemodynamically stabilised, the valve was implanted, through the femoral artery and the aorta and with angiographic control, at aortic ring level, where again with pacemaker stimulation at 180<span class="elsevierStyleHsp" style=""></span>lpm, it was attached to the wall by dilating the valve (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Pacemaker stimulation was suspended, and once cardiac frequency and mean blood pressure had been stabilised, valve function was assessed by transophageal echocardiogram. Once correct valve function had been confirmed and the presence or non presence of periprosthetic leakage had been confirmed, angiographic images and pressure strokes were taken in the left ventricle and the aortic root (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>) and the endovascular catheters were subsequently removed so as to proceed with closure of vascular accesses and surgical site.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Echocardiogram with trans-esophageal transducer and fluoroscopy were used for procedure control.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The valve used was Sapien XT<span class="elsevierStyleSup">®</span> (Edwards Lifesciences Inc., Irvine, CA, U.S.A.), with diameters of 23<span class="elsevierStyleHsp" style=""></span>mm and 26<span class="elsevierStyleHsp" style=""></span>mm in accordance with anatomical measurements of the patient's valve ring and the distance between the ring and the coronary ostia.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">Between 1st November 2014 and 31st May 2015 6 aortic valves were implanted using this technique. Four were implanted in men and 2 in women (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), with an average age of 78.83±5.66 years (range between 72 and 89). The average transvalve gradient prior to the procedure was 90.16±28.53<span class="elsevierStyleHsp" style=""></span>mmHg (range between 51 and 129), and after the implant, was 3.33±2.92<span class="elsevierStyleHsp" style=""></span>mmHg (range between 0 and 8) (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Two patients also had coronary artery disease which was treated prior to surgery for valve implantation with drug-eluting coronary stents. One patient had also been implanted with a two-chamber endocardial pacemaker due to a conduction system disease. One patent with a diagnosis of bivalve aorta disease mild aortic impairment with no haemodynamic or clinical repercussions.</p><p id="par0065" class="elsevierStylePara elsevierViewall">One patient (the second case) presented with acute occlusion of the right coronary artery during valve implantation, which was satisfactorily and immediately resolved with a drug-eluting stent. There were no signs of myocardial infarction during the patient's evolution. However, due to the background of kidney failure and postoperative aortic failure, the patient presented with exacerbation of kidney failure, heart failure and stroke with neurological recovery. The patient died one month after the procedure from sepsis and respiratory failure.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The other cases progressed satisfactorily with an average hospital discharge of 7 days, with no complications in follow-up, the mean of which was 4.5 months, and with a range of between 3 and 8 months.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">The treatment of aortic valve disease, as has already been commented upon, basically involves replacing the valve.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">1,3</span></a> However, a person over 80 or with a EuroSCORE<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>20% was considered to have contraindications for surgery.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">1,8,9</span></a> until the appearance of the valve implant option through peripheral venous access.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">5</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">This type of procedure has been under analysis because it was a new alternative which involved a series of considerations such as risk-benefit, cost of resource, appropriate patient selection and associated complications, among other variables.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">10,11</span></a> It has been demonstrated that with the use of a peripheral venous approach hospital stay time is lower than with conventional surgery.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">9</span></a> However, paravalvular leakage, adverse vascular events and the need for a definitive postoperative pacemaker is higher with the vascular approach.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">9,10</span></a> These situations should be taken into consideration due to clinical repercussions. In the majority of cases the paravalvular leakage is mild and has no significant repercussions, especially in the cases where there is a previous double aortic lesion (stenosis and valve failure) confirmed by medical assessment and additional studies such as echocardiogram or cardiac catheterisation.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">12</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">In one review Cao et al.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">9</span></a> reported that approximately 40,000 transcatheter aortic valve implants were not able to be medically justified or based on cost-benefit, because in the medium term mortality in cases treated with surgery and with transcatheter approaches were similar. In contrast, patients who had not been referred to surgery and who benefited from a peripheral venous access valve implant had better survival than with standard medical treatment, although a greater complication rate of cerebral vascular events was observed.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">9</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Based on these findings, it is important to consider that patients referred to transcatheter aortic valve surgery only when there is very solid clinical evidence and not due to personal preference of the patient who rejects open heart surgery or the attending physician who is keen to market it, nor in cases where the patient has a short life expectancy due to another disease.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a> Furthermore, the iliac vessels should be between 6 and 9<span class="elsevierStyleHsp" style=""></span>mm in diameter, the patient should have no history</p><p id="par0095" class="elsevierStylePara elsevierViewall">aorto femoral surgery and there should be no torsion in the aorta, abdominal aneurism or severe atheroma in the aortic arch.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">In the majority of cases surgery is performed under general anaesthesia although in patient groups with greater experience it may be sufficient to apply sedation and analgesia for a transfemoral approach.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a> Intensive therapy postoperative care is required for at least 24<span class="elsevierStyleHsp" style=""></span>h after surgery for the follow-up of kidney function and monitoring of blood and venous accesses.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Transcatheter aortic valve implantation is considered to be successful when an aortic valve area of between 1.5 and 1.8<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span> is obtained; observed survival at 2 years is between 70% and 80%, and mortality at 30 days is between 5% and 18%.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a> In contrast, a frequency of vascular complications of between 10% and 15% has been identified, vascular cerebral events of between 3% and peri procedural coronary occlusion <1%.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a> Due to this type of data it is important to insist on a very careful selection of patients to be treated in this way.</p><p id="par0110" class="elsevierStylePara elsevierViewall">In approximately 50% of cases, coronary lesions coexist with the aortic valve lesion. In our experience conservative criteria have been chosen in the treatment of previous lesions, although reports are now in existence of simultaneous treatment of coronary obstructions and valve implantations with the use of greater contrast agents, vascular accesses and other variables that should be taken into consideration.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">13</span></a> Here it is important to remember that coronary occlusion may present in acute form during the procedure of calcium displacement of the valve to the coronary orifices or inappropriate implantation. This is a serious and possibly even lethal complication and requires immediate treatment with mechanical circulatory support at times.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a> In our experience a complication of acute right coronary closure was resolved by the implantation of a drug-eluting stent in a patient who was classified as high risk due to pre-existing kidney failure and who died the following month due to kidney failure complications and sepsis, following a prolonged hospital stay.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The findings in our patient group were those expected based on the comparison with those published in the literature we were able to consult and are promising in that they confirm that the well indicated procedure offers a different therapeutic option in our centre for aortic valve stenosis with observed clinical improvement in treated patients.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusion</span><p id="par0120" class="elsevierStylePara elsevierViewall">This initial experience shows several satisfactory outcomes in the implantation of a percutaneous aortic valve, in keeping with results reported in the international medical literature, with the required safety and it shows the viability of the procedure for our centre in well selected cases.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflict of interests</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres986525" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec954122" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres986524" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec954123" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-08-20" "fechaAceptado" => "2016-10-17" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec954122" "palabras" => array:4 [ 0 => "Valvular prosthesis" 1 => "Aortic stenosis" 2 => "Transcatheter valve" 3 => "Percutaneous aortic valve" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec954123" "palabras" => array:4 [ 0 => "Prótesis valvular" 1 => "Estenosis aórtica" 2 => "Válvula transcatéter" 3 => "Válvula aórtica percutánea" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Aortic stenosis is a frequent disease in the elderly, and is associated with other systemic pathologies that may contraindicate the surgical procedure. Another option for these patients is percutaneous aortic valve implantation, which is less invasive. We present our initial experience with this procedure.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Patients with aortic stenosis were included once selection criteria were accomplished. Under general anaesthesia and echocardiographic and fluosocopic control, a transcatheter aortic valve was implanted following valvuloplasty. Once concluded the procedure, angiographic and pressure control was realised in order to confirm the valve function.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Between November 2014 and May 2015, 6 patients were treated (4 males and 2 females), with a mean age of 78.83±5.66 years-old. The preoperative transvalvular gradient was 90.16±28.53<span class="elsevierStyleHsp" style=""></span>mmHg and posterior to valve implant was 3.33±2.92<span class="elsevierStyleHsp" style=""></span>mmHg (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05). Two patients had concomitant coronary artery disease which had been treated previously. One patient presented with acute right coronary artery occlusion which was immediately treated. However due to previous renal failure, postoperative sepsis and respiratory failure, the patient died one month later.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">It was concluded that our preliminary results showed that in selected patients percutaneous aortic valve implantation is a safe procedure with clinical improvement for treated patients.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La estenosis valvular aórtica es frecuente en adultos mayores, y asociada a otras enfermedades puede contraindicar el procedimiento quirúrgico. Otra opción para estos pacientes es un sistema de prótesis valvular aórtica implantado por vía transcateterismo con menor riesgo. Presentamos nuestra experiencia inicial con esta modalidad de tratamiento.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se seleccionaron pacientes con estenosis aórtica que reunían los criterios de selección. El procedimiento se realizó bajo anestesia general, con apoyo de fluoroscopia y ecocardiografía transesofágica, por acceso femoral. Previa vavuloplastia aórtica, se implantó la prótesis valvular en posición aórtica, se realizó control angiográfico y se midieron presiones para verificar la posición y la funcionalidad.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Entre noviembre de 2014 y mayo de 2015 se trataron 6 pacientes (4 varones y 2 mujeres), con una edad promedio de 78.83<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.66 años. El gradiente transvalvular promedio previo al procedimiento fue de 90.16<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>28.53<span class="elsevierStyleHsp" style=""></span>mmHg, y el posterior al implante, de 3.33<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.92<span class="elsevierStyleHsp" style=""></span>mmHg (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05). Dos pacientes tuvieron además enfermedad arterial coronaria, la cual se trató en un tiempo quirúrgico previo. Un paciente presentó oclusión aguda de la coronaria derecha durante el implante protésico, la cual se resolvió de manera satisfactoria, y debido al antecedente de insuficiencia renal e insuficiencia aórtica posprocedimiento falleció al mes del procedimiento por sepsis y falla respiratoria.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Esta experiencia inicial muestra resultados satisfactorios en la colocación de una prótesis valvular aórtica percutánea y se demuestra la factibilidad del procedimiento para nuestro medio en casos bien seleccionados.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Careaga-Reyna G, Lázaro-Castillo JL, Lezama-Urtecho CA, Macías-Miranda E, Dosta-Herrera JJ, Díaz JG. Tratamiento de la estenosis valvular aórtica con implante de prótesis valvular transcatéter. Experiencia inicial. Cir Cir. 2017;85:375–380.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1227 "Ancho" => 950 "Tamanyo" => 162685 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The moment of balloon inflation is observed for attaching the percutaneous aortic valve to the aorta.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1238 "Ancho" => 950 "Tamanyo" => 123608 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Angiographic control to confirm the correct positioning of the implant and determine the presence or absence of paravalvular leakage. This is also reviewed by echocardiogram.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 950 "Ancho" => 1267 "Tamanyo" => 223051 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Pressure measurement after valve implantation to confirm correct functioning.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">PTCA: percutaneous transluminal coronary angioplasty; AVB: AV block; RC: right coronary; FC: functional class; AD: anterior descending; F: female; M: male; post: post procedure; pre: prior to procedure.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age (years) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Gender \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Risk factors \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Gradient pre (mmHg) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Gradient post (mmHg) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Prosthesis (mm) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Previous or additional procedures \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Evolution \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Coronary diseases and AVB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">AD Stent</span><br>Two-chamber pacemaker \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Satisfactory \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Kidney failure<br>Impairment<br>FC III-IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">127 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">PTCA RC from acute occlusion<br>Ultrafiltration<br>Peritoneal dialysis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Died one month later from sepsis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Satisfactory \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bivalve aorta \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">129 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Satisfactory \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Arthritis<br>Trivascular coronary disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">RC stents</span>, circumflex and AD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Satisfactory \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Satisfactory \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1675302.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Patient characteristics.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0075" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transcetheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC) in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Vahanian" 1 => "O. Alfieri" 2 => "N. Al-Attar" 3 => "M. Antunes" 4 => "J. Bax" 5 => "B. Cormier" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehn183" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2008" "volumen" => "29" "paginaInicial" => "1463" "paginaFinal" => "1470" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18474941" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0080" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnóstico y tratamiento de la patología valvular aórtica: estado actual" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.A. Hernández" 1 => "G. Careaga" 2 => "R. Argüero" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Mex Cardiol" "fecha" => "2006" "volumen" => "17" "paginaInicial" => "92" "paginaFinal" => "100" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0085" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Jung" 1 => "A. Cachier" 2 => "G. Baron" 3 => "D. Messika-Zeitoun" 4 => "F. Delahaye" 5 => "P. Tornos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehi471" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2005" "volumen" => "26" "paginaInicial" => "2714" "paginaFinal" => "2720" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16141261" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0090" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Miniesternotomía para el implante de prótesis aórtica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Esparza" 1 => "G. Careaga" 2 => "R. Argüero" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Cir Cir" "fecha" => "2000" "volumen" => "68" "paginaInicial" => "229" "paginaFinal" => "233" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0095" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Cribier" 1 => "H. Eltchaninoff" 2 => "A. Bash" 3 => "N. Borenstein" 4 => "C. Tron" 5 => "F. Bauer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2002" "volumen" => "106" "paginaInicial" => "3006" "paginaFinal" => "3008" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12473543" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0100" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systematic review and meta-analysis of transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Cao" 1 => "S.C. Ang" 2 => "P. Indraratna" 3 => "C. Manganas" 4 => "P. Bannon" 5 => "D. Black" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3978/j.issn.2225-319X.2012.11.09" "Revista" => array:6 [ "tituloSerie" => "Ann Cardiothorac Surg" "fecha" => "2013" "volumen" => "2" "paginaInicial" => "10" "paginaFinal" => "23" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23977554" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0105" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Quality-of-life in elderly patients one year after transcatheter aortic valve implantation for severe aortic stenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.P. Ussia" 1 => "M. Barbanti" 2 => "V. Cammalleri" 3 => "M. Scarabelli" 4 => "M. Mulè" 5 => "P. Aruta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4244/EIJV7I5A93" "Revista" => array:6 [ "tituloSerie" => "EuroIntervention" "fecha" => "2011" "volumen" => "7" "paginaInicial" => "573" "paginaFinal" => "579" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21930461" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0110" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Worldwide TAVI registries: what have we learned?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Haussig" 1 => "G. Schuler" 2 => "A. Linke" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00392-014-0698-y" "Revista" => array:6 [ "tituloSerie" => "Clin Res Cardiol" "fecha" => "2014" "volumen" => "103" "paginaInicial" => "603" "paginaFinal" => "612" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24648061" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0115" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transcatheter aortic valve implantation: clinical outcomes and costs" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Cao" 1 => "P. Indraratna" 2 => "S.C. Ang" 3 => "J. Park" 4 => "J. Allan" 5 => "T. Yan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2013.09.095" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2014" "volumen" => "97" "paginaInicial" => "1481" "paginaFinal" => "1482" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24694445" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0120" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transcatheter aortic valve implantation (TAVI): risky and costly" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H. Van Brabandt" 1 => "M. Neyt" 2 => "F. Hulstaert" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "BMJ" "fecha" => "2012" "volumen" => "345" "paginaInicial" => "e4710" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22849955" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0125" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Preinterventional screening of the TAVI patient: how to choose the suitable patient and the best procedure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.J. O'Sullivan" 1 => "S. Stortecky" 2 => "L. Buellesfeld" 3 => "P. Wenaweser" 4 => "S. Windecker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00392-014-0676-4" "Revista" => array:6 [ "tituloSerie" => "Clin Res Cardiol" "fecha" => "2014" "volumen" => "103" "paginaInicial" => "259" "paginaFinal" => "274" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24515650" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0130" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Does residual aortic regurgitation after transcatheter aortic valve implantation increase mortality in all patients? The importance of baseline natriuretic peptides" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Borz" 1 => "E. Durand" 2 => "M. Godin" 3 => "C. Tron" 4 => "A. Canville" 5 => "C. Hauville" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2014.03.011" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2014" "volumen" => "173" "paginaInicial" => "436" "paginaFinal" => "440" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24679693" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0135" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systematic review of percutaneous coronary intervention and transcatheter aortic valve implantation for concomitant aortic stenosis and coronary artery disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.A. Virk" 1 => "D.H. Tian" 2 => "K. Liou" 3 => "F. Pathan" 4 => "C. Villanueva" 5 => "Z. Akhunji" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2015.03.391" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2015" "volumen" => "187" "paginaInicial" => "453" "paginaFinal" => "455" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25841148" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0140" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Emergent use of retrograde left ventricular support in patients after transcatheter aortic valve replacement" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.A. Martinez" 1 => "V. Singh" 2 => "A.W. Heldman" 3 => "W.W. O’Neill" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ccd.24583" "Revista" => array:6 [ "tituloSerie" => "Catheter Cardiovasc Interv" "fecha" => "2013" "volumen" => "82" "paginaInicial" => "E128" "paginaFinal" => "E132" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22888042" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/24440507/0000008500000005/v2_201802210427/S2444050717300815/v2_201802210427/en/main.assets" "Apartado" => array:4 [ "identificador" => "44603" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24440507/0000008500000005/v2_201802210427/S2444050717300815/v2_201802210427/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444050717300815?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 10 | 1 | 11 |
| 2024 September | 16 | 2 | 18 |
| 2024 August | 17 | 3 | 20 |
| 2024 July | 8 | 5 | 13 |
| 2024 June | 9 | 3 | 12 |
| 2024 May | 16 | 7 | 23 |
| 2024 April | 20 | 4 | 24 |
| 2024 March | 41 | 7 | 48 |
| 2024 February | 29 | 2 | 31 |
| 2024 January | 25 | 4 | 29 |
| 2023 December | 10 | 2 | 12 |
| 2023 November | 25 | 11 | 36 |
| 2023 October | 12 | 10 | 22 |
| 2023 September | 17 | 2 | 19 |
| 2023 August | 15 | 5 | 20 |
| 2023 July | 7 | 5 | 12 |
| 2023 June | 19 | 6 | 25 |
| 2023 May | 31 | 11 | 42 |
| 2023 April | 35 | 4 | 39 |
| 2023 March | 21 | 2 | 23 |
| 2023 February | 19 | 5 | 24 |
| 2023 January | 23 | 5 | 28 |
| 2022 December | 21 | 10 | 31 |
| 2022 November | 23 | 15 | 38 |
| 2022 October | 12 | 9 | 21 |
| 2022 September | 14 | 19 | 33 |
| 2022 August | 15 | 15 | 30 |
| 2022 July | 12 | 7 | 19 |
| 2022 June | 16 | 9 | 25 |
| 2022 May | 23 | 6 | 29 |
| 2022 April | 20 | 10 | 30 |
| 2022 March | 24 | 4 | 28 |
| 2022 February | 22 | 5 | 27 |
| 2022 January | 26 | 9 | 35 |
| 2021 December | 12 | 8 | 20 |
| 2021 November | 10 | 9 | 19 |
| 2021 October | 17 | 12 | 29 |
| 2021 September | 19 | 7 | 26 |
| 2021 August | 13 | 6 | 19 |
| 2021 July | 17 | 12 | 29 |
| 2021 June | 16 | 8 | 24 |
| 2021 May | 19 | 8 | 27 |
| 2021 April | 20 | 21 | 41 |
| 2021 March | 15 | 9 | 24 |
| 2021 February | 8 | 2 | 10 |
| 2021 January | 15 | 9 | 24 |
| 2020 December | 12 | 13 | 25 |
| 2020 November | 15 | 14 | 29 |
| 2020 October | 14 | 8 | 22 |
| 2020 September | 13 | 8 | 21 |
| 2020 August | 29 | 10 | 39 |
| 2020 July | 14 | 8 | 22 |
| 2020 June | 8 | 10 | 18 |
| 2020 May | 16 | 8 | 24 |
| 2020 April | 7 | 3 | 10 |
| 2020 March | 14 | 4 | 18 |
| 2020 February | 12 | 6 | 18 |
| 2020 January | 12 | 5 | 17 |
| 2019 December | 26 | 6 | 32 |
| 2019 November | 6 | 7 | 13 |
| 2019 October | 16 | 3 | 19 |
| 2019 September | 17 | 5 | 22 |
| 2019 August | 7 | 3 | 10 |
| 2019 July | 6 | 1 | 7 |
| 2019 June | 18 | 5 | 23 |
| 2019 May | 56 | 11 | 67 |
| 2019 April | 27 | 19 | 46 |
| 2019 March | 6 | 3 | 9 |
| 2019 February | 12 | 4 | 16 |
| 2019 January | 8 | 0 | 8 |
| 2018 December | 8 | 3 | 11 |
| 2018 November | 14 | 4 | 18 |
| 2018 October | 10 | 10 | 20 |
| 2018 September | 38 | 3 | 41 |
| 2018 August | 4 | 9 | 13 |
| 2018 July | 13 | 0 | 13 |
| 2018 June | 12 | 0 | 12 |
| 2018 May | 4 | 2 | 6 |
| 2018 April | 8 | 0 | 8 |
| 2018 March | 10 | 1 | 11 |
| 2018 February | 25 | 5 | 30 |
| 2018 January | 23 | 3 | 26 |
| 2017 December | 7 | 6 | 13 |
Show all