Click Valvar #725 - Sobrevida e a abordagem precoce da estenose aórtica
·4 min
The episode begins by referencing Professor Eudine Braunaldi's seminal 1960s publication that established symptoms as the cornerstone for valve disease intervention. It then introduces the hypothesis that intervention might be beneficial before symptoms appear, leading to trials designed to explore this. The Recovery Trial, published 10 years ago, is highlighted as a key study comparing early surgical intervention in asymptomatic individuals with significant aortic stenosis. Criteria for severe aortic stenosis are detailed, including flow velocity above 4.5 meters per second, mean systolic gradient over 50 mmHg, and valve area less than 0.75. The 10-year clinical follow-up of this trial is discussed, showing that early intervention maintained benefits over the long term, with lower composite outcomes of surgical and cardiovascular mortality in the intervention group. The episode notes that all trials supporting early intervention report surgical mortality below 1.5%, even with conventional surgery. It emphasizes that this low mortality rate is not universal across all structural heart disease services, affecting decisions for early intervention in asymptomatic patients. Another point evaluated is the quality of prosthetic devices, with high-performance devices offering greater durability and lower complication rates like thrombosis and deterioration. The host reflects on lessons learned, stating that the composite outcome study involves a 1.5% rate in a group of 12 people, but the publication helps approach the best timing for intervention. The episode concludes by cautioning against extrapolating results to the real world, especially in different clinical services, to reproduce positive outcomes. It ends with promotional content for the Devolve Club website and a free course on aortic stenosis and valvular prosthesis, available via an app. The host, Thiago Bignotto, is introduced as reading scientific publications and debating ideas for application in patient daily life, based in São Paulo.
