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reparacion mitral
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Resumen
Hemos realmente perdido ideas y conceptos valiosos en un intento de deshacernos de lo que no se quiere. Nuestro entendimiento de la reparación “borde-a- borde” transcateter (TEER, por sus siglas en inglés) para la válvula mitral (VM), de la cual el MitraClip es el dispositivo más utilizado en la práctica diaria (MitraClip therapy MitraClipTM TMVr Transcatheter Mitral Valve Repair; Abbott, 3200 Lakeside Dr, Santa Clara, 95054, EUA) deriva de sistemas de predicción poco confiables, los cuales en muchas ocasiones no son compatibles con la realidad. El conflicto de intereses entre los participantes de la Mitral Valve Academy Research (MVARC) y algunos de los ensayos dirigidos a analizar los resultados de TEER en la insuficiencia mitral (IM) también se agrega a la lista de potenciales irregularidades que han salido a la luz a medida que avanzamos en las pesquisas derivadas de la disparidad en los datos disponibles provenientes de los grandes estudios randomizados a la fecha actual. Más específicamente, el conflicto de intereses entre MVARC, COAPT, y MitraClip (Abbott) es un tema inquietante que debe ser esclarecido en forma urgente.
Reparación valvular mitral quirúrgica como marco de referencia para terapias transcatéter enfocadas en la insuficiencia mitral El punto comparativo para las tecnologías de vanguardia utilizadas para la reparación de la de la VM lo constituye la reparación quirúrgica como tratamiento de elección para su insuficiencia. Al aplicar parámetros específicos sobre la reparación de la VM en la enfermedad degenerativa, McCarthy et al. han demostrado que la libertad de reoperación a 10 años es de 99,7%, la ausencia de IM recurrente ≥3+ de 98,4%, y 84,4% para IM grado 2+(1).
Utilizando resección cuadrangular, plicatura del anillo nativo, y el uso de un anillo de anuloplastía en pacientes con enfermedad degenerativa de la VM, Lapenna et al. reportaron una tasa de reoperación de 4,3% ± 1,7% [intervalo de confianza (IC) del 95%, 1,7% a 8,8%], una incidencia de IM 3+ de 8,8% ± 2,8% (IC 95%, 4,3% a 15,5%). Para el grado 2+ de IM, esta fue solamente de 10%, a 18 años de seguimiento(2). De Bonis et al. reportaron a lo largo de un seguimento máximo de hasta 17,6 años en pacientes con enfermedad degenerativa de la VM, tras una reparación de la VM por insuficiencia utilizando la técnica “borde-a-borde” de Alfieri y anillo de anuloplastía, una libertad de reoperación de 89,6 ± 2,51%, con IM ≥3+ en 13,6%(3).
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