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Vol. 58. Issue 1.
Pages 32-42 (January - March 2023)
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Vol. 58. Issue 1.
Pages 32-42 (January - March 2023)
Artículo original
Estenosis aórtica grave. Evolución y resultados del tratamiento según la función renal
Severe aortic stenosis. Evolution and outcomes of treatment according to renal function
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Vicente Mora Llabata
Corresponding author
vmoral@comv.es

Autor para correspondencia.
, Celia Gil Llopis, M. Belén Contreras Tornero, Ildefonso Roldán Torres, Ester Galiana Talavera, Juan Geraldo Martínez, Pablo Aguar Carrascosa, Claudia Cabadés Rumbeu, José Ferrando Cervelló, Amparo Valls Serral
Servicio de Cardiología, Hospital Universitario Doctor Peset, Valencia, España
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Resumen
Introducción y objetivos

La coexistencia de estenosis aórtica (EA) y enfermedad renal crónica (ERC) se asocia a mayor mortalidad. Nuestro objetivo fue evaluar la evolución de la EA grave después del recambio valvular aórtico (RVA) frente al tratamiento conservador (TtC) según el estadio de la función renal.

Métodos

Se incluyeron 452 pacientes consecutivos ≥18 años de edad diagnosticados de EA grave (área valvular aórtica <1cm2 (indexada <0,6 cm2/m2) o gradiente medio transvalvular ≥40mmHg) desde abril de 2009 a septiembre de 2019, con valores de creatinina sérica en situación hemodinámica estable disponibles 2 meses antes o después del ecocardiograma. El objetivo principal fue la mortalidad global y el secundario la mortalidad cardiovascular.

Resultados

La mediana de supervivencia fue de 52,7 (IC95%, 40,7-64,7) meses (78,7; IC95%, 60,2-97,3) en los pacientes con función renal normal; 28,7 (IC95%, 15,1-42,2) con ERC ligera; 19,2 (IC95%, 5,8-32,5) con ERC moderada y 16,0 (IC95%, 9,0-23,0) con ERC grave (log-rank, p<0,0001). La supervivencia tras el RVA fue mayor que con TtC en pacientes con función renal normal, ERC ligera y ERC moderada (todos log rank, p<0,0001). No hubo diferencia en aquellos con ERC grave (log-rank, p=0,12).

Conclusiones

En pacientes con EA grave el deterioro de la función renal se asoció con un aumento de la mortalidad global y cardiovascular. Aunque los pacientes con ERC tienen mayor mortalidad después del RVA, este se asoció con mayor supervivencia respecto al TtC en la ERC leve y moderada.

Palabras clave:
Estenosis aórtica
Función renal
Recambio valvular aórtico
Enfermedad renal crónica
Abstract
Introduction and objectives

The coexistence of aortic stenosis (AS) and chronic kidney disease (CKD) has been associated with increased mortality. Our objective was to compare the evolution of severe AS after aortic valve replacement (AVR) or conservative management according to stage of renal function.

Methods

Between April 2009 and September 2019, we consecutively recruited 452 patients aged ≥18 years and diagnosed with severe AS [aortic valve area < 1cm2 and/or mean transvalvular gradient ≥40 mmHg)], and for whom serum creatinine values were available for the 2 months before or after an echocardiogram. The main endpoint was overall mortality, and the secondary endpoint was cardiovascular mortality.

Results

Median survival was 52.7 (95%CI, 40.7-64.7) months (78.7; 95%CI, 60.2-97.3) months in patients with normal renal function; 28.7 (95%CI, 15.1-42.2) months in patients with mild CKD; 19.2 (95%CI, 5.8-32.5) months in patients with moderate CKD, and 16.0 (95%CI, 9.0-23.0) months in those with severe CKD (log-rank test, P < .0001)]. Survival after AVR was higher than that achieved with conservative treatment in patients without renal failure and mild or moderate CKD (all log-rank tests, P < .0001), while no difference was detected in those with severe CKD (log-rank test, P = .12).

Conclusions

In patients with severe AS the deterioration of renal function is associated with an increase in global and cardiovascular mortality. Although patients with CKD experience higher mortality after AVR, they also experience higher survival rates than those receiving conservative treatment for mild and moderate CKD.

Keywords:
Aortic valve stenosis
Renal function
Aortic valve replacement
Chronic kidney disease

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