| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 2.51 MB | Adobe PDF |
Advisor(s)
Abstract(s)
Introdução: A raiz e válvula Aórticas são sistemas complexos e intimamente
relacionados que estão sujeitos a vários processos patológicos comuns, afetando,
individualmente ou simultaneamente, os seus componentes. Ao longo dos anos foram
surgindo cada vez mais opções terapêuticas para a patologias destas estruturas,
nomeadamente opções cirúrgicas com tendência para técnicas cada vez menos invasivas e
que tentam preservar uma anatomia e fisiologia o mais próximo da estrutura nativa
saudável.
Objetivo: Identificar as opções terapêuticas disponíveis e evidenciar as vantagens e
desvantagens de cada uma.
Método: Foi utilizado o motor de busca PubMed e foi pesquisada informação em livros
de Cirurgia Cardíaca. Foram também selecionados artigos encontrados como referências
de outros artigos quando considerados pertinentes. Na pesquisa foi imposto o limite
temporal de artigos posteriores a 2012, com algumas exceções no caso de haver pouca
informação nessas datas ou artigos dos criadores de alguns dos procedimentos abordados.
Foram priorizados os artigos mais recentes e mais abrangentes. A maioria dos artigos são
em inglês.
Resultados/Discussão: A patologia valvular aórtica pode surgir associada ou não a
patologia da raiz da Aorta.
No caso de patologia isolada podemos optar pela sua substituição, dispondo atualmente
de dispositivos mecânicos, biológicos ou percutâneos, auto ou homoenxertos e em casos
muito particulares é possível a sua reparação. A escolha deve ter em conta múltiplos
fatores, nomeadamente idade, risco de trombose e/ou hemorragia, degeneração,
comorbilidades e estilo de vida do doente.
Em caso de envolvimento da raiz da Aorta, é também necessária uma avaliação
abrangente para determinar a estratégia de tratamento mais adequada. As opções
cirúrgicas podem incluir o alargamento da raiz da Aorta, uso de enxertos vasculares
sintéticos, autoenxerto pulmonar ou até procedimentos que substituem a raiz da Aorta e
preservam a válvula nativa. Essas intervenções visam abordar a patologia subjacente da
raiz da Aorta e garantir uma função valvular ótima e bons resultados a longo prazo. Cada um dos procedimentos tem as suas vantagens e desvantagens, que estão
relacionadas com o tempo e complexidade cirúrgica, complicações pós-operatórias,
durabilidade, resultado hemodinâmico, sobrevida e qualidade de vida, entre outros.
Conclusão: Foram identificadas várias opções cirúrgicas, com maior foco nas menos
invasivas. Estas opções expandem o acesso aos doentes anteriormente considerados
inoperáveis. Essas técnicas têm demonstrado melhorias significativas na sobrevida e
qualidade de vida dos doentes. Os estudos futuros devem priorizar as opções menos
invasivas, de modo a aumentar a experiência técnica com estas novas abordagens,
enquanto também se aprimoram os procedimentos “clássicos”. A definição de critérios de
seleção de doentes apropriados e a elaboração de diretrizes serão fundamentais para
orientar a escolha do procedimento mais adequado.
Introduction: The Aortic root and valve are complex and closely related systems that are subject to various common pathological processes, individually or simultaneously affecting their components. Over the years, an increasing number of therapeutic options have emerged for the pathologies of these structures, particularly surgical options with a tendency towards less invasive techniques that aim to preserve anatomy and physiology as close to the healthy native structure as possible. Objective: To identify the available therapeutic options and highlight the advantages and disadvantages of each one. Method: Search was made with the “PubMed” engine, and information was also gathered from books on Cardiac Surgery. Additionally, some articles were selected from the references of other articles when deemed relevant. The search was limited to articles published after 2012, with some exceptions in cases where there was limited information available for those dates or articles authored by the creators of some of the procedures discussed. Priority was given to the most recent and comprehensive articles. Most of the articles are in English. Discussion/results: Aortic valve pathology can occur with or without pathology of the Aortic root. In cases of isolated pathology, replacement options are currently available, including mechanical, biological, or percutaneous devices, as well as autografts or homografts, and in very specific cases, repair may be possible. The choice should consider multiple factors, including age, risk of thrombosis and/or haemorrhage, degeneration, comorbidities, and the patient's lifestyle. In cases involving the Aortic root, a comprehensive evaluation is necessary to determine the most appropriate treatment strategy. Surgical options may include Aortic root enlargement, the use of synthetic vascular grafts, pulmonary autografts, or procedures that replace the Aortic root while preserving the native valve. These interventions aim to address the underlying pathology of the Aortic root and ensure optimal valve function and long-term outcomes. Each procedure has its advantages and disadvantages, which are related to surgical time and complexity, postoperative complications, durability, hemodynamic outcome, survival, and quality of life, among others. Conclusion: Several surgical options have been identified, with a greater focus on less invasive approaches. These options expand access to patients previously considered inoperable. These techniques have demonstrated significant improvements in patient survival and quality of life. Future studies should prioritize less invasive options to increase technical experience with these new approaches while also improving "classic" procedures. Defining appropriate patient selection criteria and developing guidelines will be essential in guiding the choice of the most suitable procedure for each patient.
Introduction: The Aortic root and valve are complex and closely related systems that are subject to various common pathological processes, individually or simultaneously affecting their components. Over the years, an increasing number of therapeutic options have emerged for the pathologies of these structures, particularly surgical options with a tendency towards less invasive techniques that aim to preserve anatomy and physiology as close to the healthy native structure as possible. Objective: To identify the available therapeutic options and highlight the advantages and disadvantages of each one. Method: Search was made with the “PubMed” engine, and information was also gathered from books on Cardiac Surgery. Additionally, some articles were selected from the references of other articles when deemed relevant. The search was limited to articles published after 2012, with some exceptions in cases where there was limited information available for those dates or articles authored by the creators of some of the procedures discussed. Priority was given to the most recent and comprehensive articles. Most of the articles are in English. Discussion/results: Aortic valve pathology can occur with or without pathology of the Aortic root. In cases of isolated pathology, replacement options are currently available, including mechanical, biological, or percutaneous devices, as well as autografts or homografts, and in very specific cases, repair may be possible. The choice should consider multiple factors, including age, risk of thrombosis and/or haemorrhage, degeneration, comorbidities, and the patient's lifestyle. In cases involving the Aortic root, a comprehensive evaluation is necessary to determine the most appropriate treatment strategy. Surgical options may include Aortic root enlargement, the use of synthetic vascular grafts, pulmonary autografts, or procedures that replace the Aortic root while preserving the native valve. These interventions aim to address the underlying pathology of the Aortic root and ensure optimal valve function and long-term outcomes. Each procedure has its advantages and disadvantages, which are related to surgical time and complexity, postoperative complications, durability, hemodynamic outcome, survival, and quality of life, among others. Conclusion: Several surgical options have been identified, with a greater focus on less invasive approaches. These options expand access to patients previously considered inoperable. These techniques have demonstrated significant improvements in patient survival and quality of life. Future studies should prioritize less invasive options to increase technical experience with these new approaches while also improving "classic" procedures. Defining appropriate patient selection criteria and developing guidelines will be essential in guiding the choice of the most suitable procedure for each patient.
Description
Keywords
Cirurgia da Raiz da Aorta Cirurgia Poupadora de Válvula Minimamente Invasiva Reparação da Válvula Aórtica