- Trattamento della valvulopatia aortica nei pazienti ad alto rischio: ruolo delle nuove tecnologie
- Surgical Treatment of Aortic Valve Stenosis: Role of new technologies
- Savini, Carlo <1969>
Subject
- MED/23 Chirurgia cardiaca
Description
- Nell’ultima decade, lo spettro terapeutico del trattamento chirurgico della stenosi aortica si e’ ampliato significativamente. Sono state sviluppate nuove protesi valvolai e nuovi approcci allo scopo di ridurre il rischio legato alla chirurgia. Oggi e’ possibile e giustificato trattare pazienti precedentemente giudicati inoperabili proponendogli efficaci trattamenti alternativi come le protesi transcatetere (TAVI) e le bioprotesi Sutureless. L’Heart Team e’ il gruppo multispecialistico che ha la responsabilita’ di decidere il percorso piu’ idoneo per questi pazienti. La TAVI (Transcathether Aortic Valve Inserction) e’ il campo di punta nelle alternative alla chirurgia convenzionale. Ma anche le nuove generazioni di protesi chirurgiche come le sutureless e l’estensione delle applicazioni degli approcci miniinvasivi nonche' dei circuiti miniaturizzati per la Circolazione ExtraCorporea consentono di rendere la chirurgia realmente competitiva nei pazienti ad alto rischio. Negli ultimi anni sono usciti diversi studi per meglio definire i confini delle indicazioni tra le varie procedure, ma servono ancora piu’ dati per validare l’estensione dell’applicazione della tecnologia transcatetere a categorie di pazienti a rischio intermedio/basso.
- In the last decade, the therapeutical spectrum of the surgical treatment of the aortic stenosis widened consistently. New valve prosthesis and new approaches have been developed in order to reduce the surgical risk. Not only now was it feasible and justifiable to treat formerly inoperable patients, this new treatment options also made it possible to shift patients with very high operative risk and expected poor outcome to alternative ways of aortic valve implantation as transcatheter (TAVI) and Sutureless prostheses. The previous decision of performing conventional surgery in a very high risk patient or leaving him with a very bad quality of life suddenly had a third option. TAVI (Transcathether Aortic Valve Inserction) is the leading field in the alternative options to conventional surgery, but the new generation of sutureless aortic valve prostheses, a better management and knowledge of miniinvasive surgical techniques and Minimized Extracorporeal Circulation Circuits (MECC) produced a further improvement of the results of conventional surgery. In the last years, many studies have been published in this field, but they could not definitively answer the question which option is better for high risk patients in the long run. In the European countries where TAVI is reimbursed on a rather lucrative scale, patients who were formerly left unoperated upon are now being aggressively treated, resulting in approximately one third of all aortic valve replacements being performed with this technique. With the broad acceptance of this therapy and recent advances in technology and techniques, there is now an increasing push to expand the indication to intermediate and low risk patients.
Date
- 2017-05-05
Type
- Doctoral Thesis
- PeerReviewed
Format
- application/pdf
Identifier
urn:nbn:it:unibo-20981
Savini, Carlo (2017) Trattamento della valvulopatia aortica nei pazienti ad alto rischio: ruolo delle nuove tecnologie, [Dissertation thesis], Alma Mater Studiorum Università di Bologna. Dottorato di ricerca in Scienze mediche specialistiche