Colegio Argentino de Cardioangiólogos Intervencionistas Revista Argentina de Cardioangiología intervencionista 2250-7531 2313-9307 3 02 2012 2- 20 Percutaneous aortic interventions in patients with severe valvular aortic stenosis 0074 0088 EN Igor Palacios Cardiac Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA. ipalacios@ partners.org The treatment of choice for symptomatic severe aortic stenosis is aortic valve replacement (AVR). Percutaneous aortic valvuloplasty (PVA) is associated with improvement in symptoms and hemodynamic parameters but major complications and the high rate of restenosis at year are the main limitations. We present 310 patients with symptomatic severe aortic stenosis not surgical candidates who received 394 consecutive PVA between 1986 and 1993 at the Massachusetts General Hospital. A group of these patients underwent follow-up of aortic valve replacement (AVR). When these two groups was compared patients who received PVA as a bridge to AVR versus patients who received only PVA showed higher survival at follow-up. The subgroup of patients with severe aortic stenosis and cardiogenic shock have signifi cantly improved clinical and hemodynamic parameters after the PVA. Since Alan Cribier in 2002 implanted the fi rst percutaneous aortic valve (TAVI) in a patient inoperable this method has expanded exponentially. Currently being used two types of devices, the expandable balloon valve (Edwards Lifesciens, Irvine, California) and the self-expanding valve (Valve core, Irvine, California). The PARTNER Trial Cohort B was the fi rst randomized trial comparing patients with symptomatic severe aortic stenosis inoperable with TAVI versus standard therapy, where it was observed that the TAVI mortality was signifi cantly lower than with standard therapy. This diff erence persisted after two years. Based on this trial in 2011 the FDA approved the use of this device for inoperable patients. The PARTNER Trial Cohort A randomly compared in patients with symptomatic severe aortic stenosis at high surgical risk TAVI versus AVR, where it was observed that TAVI was not-inferior than AVR at year. However, the rate of stroke was higher the percutaneous group. Within the limitations of the TAVI are the stroke, perivalvular aortic insuffi ciency, complications in the access and the need for new pacemaker. The dream of percutaneous aortic valve implantation is a reality. Patient selection, using diff erent images for evaluating the valve and the role of vital multidisciplinary team to perform eff ective implant. The continuous development and improvement of these devices will be the key to success is increased, reduce complications and extend the indications to diff erent groups. aortic stenosis, aortic valve implantation, high-risk http://www.raci.com.ar/contenido/art.php?recordID=MjUx http://recursos.meducatium.com.ar/contenido/articulos/3500740088_251/pdf/3500740088.pdf