DR MIGUEL RUBIO VALVULOPATIAS ELECCION DE LA PROTESIS IDEAL CLINICA BAZTERRICA HOSPITAL DE CLINICAS...
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Transcript of DR MIGUEL RUBIO VALVULOPATIAS ELECCION DE LA PROTESIS IDEAL CLINICA BAZTERRICA HOSPITAL DE CLINICAS...
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DR MIGUEL RUBIOVALVULOPATIAS
ELECCION DE LA PROTESIS IDEAL
CLINICA BAZTERRICA
HOSPITAL DE CLINICAS
UBA
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Corpus of the Anatomical Studies –The Aortic Valve Opening-ClosureLeonardo da Vinci. 1452-1519
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PROTESIS VALVULAR IDEAL
1- FACIL DE IMPLANTAR 2- PERFORMANCE HEMODINAMICA 3- ESTABILIDAD ESTRUCTURAL 4- NO TROMBOGENICA 5- NO INMUNOGENICA 6- SILENCIOSA
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PROTESIS IDEAL
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PROTESIS IDEAL
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PROTESIS IDEAL
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PROTESIS IDEAL
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PROTESIS IDEAL
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PROTESIS IDEAL
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CONSENSO DE VALVULOPATIAS SAC
ELECCION DE PROTESIS
MECANICAS
CLASE I * Menores de 70 A
( Sin problemas para anticoagular )
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CONSENSO DE VALVULOPATIAS SAC ELECCION DE
PROTESIS BIOLOGICAS
CLASE I
* Mayores de 70 A
* Menores de 70 A con dificultad en la anticoagulacion
* Expectativa de vida menor a 10 A
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CONSENSO DE VALVULOPATIAS SAC ELECCION DE PROTESIS
BIOLOGICAS HOMOINJERTOS
CLASE I
ENDOCARDITIS ACTIVA
CLASE II
ALTERNATIVA TECNICA
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CONSENSO DE VALVULOPATIAS SAC ELECCION DE PROTESIS
BIOLOGICAS OPERACIÓN DE ROSS
CLASE I
JOVENES
CLASE II
ENDOCARDITIS
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CONSENSO DE VALVULOPATIAS SAC ELECCION DE PROTESIS
BIOLOGICAS OPERACIÓN DE ROSS
CLASE III
SINDROME DE MARFAN
* Estrictamente contraindicadaJ Card Surg 2004;19:401-409 Hospital Reina Sofia Cordoba
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OPERACIÓN DE ROSS ANALISIS DE FACTIBILIDAD
M A Y O R E S D E 7 0 A
54 (51,9% )
M E N O R E S D E 4 5 A
3/105 (2,8% )
M E N O R E S D E 7 0 A
51 (48,1% )
TO TA L D E P A C IE N TE S (1 8 M E S E S )
458 AORTICOS 105 (22,9% )
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PROTESIS MECANICAS
O R IF IC IO E F E C TIV O A O R TIC O
E S C A S A M E D IA N A G R A N D E
S U P E R F IC IE C O R P O R A L
IN D E X0 .8 5 - 0 .7 5
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PROTESIS MECANICAS
O R IF IC IO E F E C TIV O A O R TIC O
2 8 .6 %
TA S A B R U TA
1 2 ,9 %
C O R R E C C IO N
S U P E R F IC IE C O R P O R A L A JU S TE E N B A S E A L P E S O ID E A L
IN D E X0 .8 5 - 0 .7 5 N :7 7
Rubio y col RAC/VOL 73 N2 90-95 2005 Rubio y col RAC/VOL 73 N2 90-95 2005
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ORIFICIO GEOMETRICO
MONODISCO
75 grados
#19 2.01
ORIFICIO INT 16
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ORIFICIO GEOMETRICO
BI VALVA 85 grados
# 19 = 1.63
ORIFICIO INT: 14.7
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MECANICAS SUPRANULARES
INCREMENTO DEL AREA ANATOMIA DE LOS OSTIUMS
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ORIFICIO EFECTIVO AORTICO
Concepto:
La superficie efectiva del orificio y los gradientes no solo mejoran luego del implante sino que son consistentemente mejores en forma alejada.....
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PROTESIS MECANICAS Y ANTIAGREGACION Clinical Trial Sudafrica N: 526 Protesis On-x 42% sin anticoagulacion Trombosis valvular: 0 % Tromboembolia 1.8 % p/y
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SITUACIONES ESPECIALES
FACTORES DE RIESGO TROMBOTICO PACIENTE/DEPENDIENTE
1- FA
2- AI GRANDE
3- DISFUNCION SEVERA VI
4-TROMBOEMBOLIA PREVIA
5-HIPERCOAGULABILIDAD
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SITUACIONES ESPECIALES
BIOPROTESIS CON FA VS MECANICAS
Mecanicas 886 TE: 5.3% P/Y HEM: 0.8
Bioprotesis 163 TE: 2.4% P/Y HEM: 3.2
45 % Bioprotesis con Coumadin
JTCS 2005 Jun;53(3):150-3 Jamiesson
Vancouver Canada
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MUCHAS GRACIAS