Guia terapêutico para implante de próteses valvares cardíacas transcateter Braile Inovare em biopróteses convencionais Braile, em valvas transcateter Braile inovare previamente implantadas em biopróteses convencionais Braile, e em anéis de anuloplastia valvar mitral Braile
Data
2024-09-30
Autores
Cardoso, Caio Cesar 
Orientadores
Santos, Diego Felipe Gaia dos
Tipo
Tese de doutorado
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ISSN da Revista
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Resumo
Objetivos: Construção de guia terapêutico para implante de valva transcateter (VT) Braile Inovare em biopróteses (BP) Braile (valve-in-valve - VIV), em conjuntos valve-in-valve (valve-in-valve-in-valve - V-I-V-I-V) e em anéis de anuloplastia mitral Braile (valve-in-ring – V-I-R). Material e Métodos: Em cada conjunto proposto, com o Duplicador de Pulsos e padronizações do FDA e ISO, calculou-se EOA (área orificial efetiva) e ΔP (gradiente transvalvar), além de incremento porcentual do volume regurgitante (R%). Nos testes V-I-V, em cada BP implantou-se uma VT 1mm maior e 1mm menor. Para os testes V-I-V-I-V, em cada conjunto V-I-V mais adequado, alocou-se VT de imediato tamanho menor à VT já implantada. Nos testes V-I-R, em cada anel implantou-se VT de mesmo diâmetro nominal, 2mm maior e 2mm menor. Resultados: Nos testes V-I-V, houve melhores resultados hidrodinâmicos com VT de tamanho 1mm menor em relação à BP, e resultados limítrofes para aplicação clínica em BP aórtica 21mm e BP mitral 27mm. Os testes V-I-V-I-V propostos mostraram boa performance, com resultados limítrofes com VT 20mm para a posição aórtica, e 24mm para posição mitral. Os melhores resultados nos testes V-I-R se deram com VT de mesmo tamanho em relação ao anel, com restrições no anel 24mm. Conclusão: Foi possível a criação de guia terapêutico para emprego de VT Braile Inovare nas modalidades: V-I-V em BP Braile; V-I-V-I-V em conjuntos de BP Braile com VT Braile Inovare previamente implantada; e V-I-R em anéis de anuloplastia mitral Braile.
Objectives: Construction of a therapeutic guide for transcatheter valve implantation (TV) Braile Inovare in bioprostheses (BP) Braille (valveinvalve VIV), in valveinvalve sets (valveinvalveinvalve VIVIV) and Braille mitral annuloplasty rings (valveinring– VIR). Material and Methods: In each proposed set, with the Pulse Duplicator and FDA and ISO standards, EOA (effective orificial area) and ΔP (transvalvular gradient) were calculated, in addition to the percentage increase in regurgitant volume (R%). In the VIV tests, a TV 1mm larger and 1mm smaller was implanted in each BP. For the VIVIV tests, in each most appropriate VIV set, a smaller TV was immediately allocated to the already implemented TV. In the VIR tests, a TV with the same nominal diameter, 2mm larger and 2mm smaller, was implanted in each ring. Results: In the VIV tests, there were better hydrodynamic results with TV 1mm smaller in relation to BP, and borderline results for clinical application in aortic BP 21mm and mitral BP 27mm. The proposed VIVIV tests showed good performance, with borderline results with TV 20mm for the aortic position, and 24mm for the mitral position. The best results in the VIR tests occurred with a TV of the same size in relation to the ring, with restrictions on the 24mm ring. Conclusion: Was possible the construction of a therapeutic guide for the implantation of Braile Inovare TV in the following modalities: VIV in Braile BP; VIVIV in Braile Inovare TV previously implanted in Braile BP; and VIR in Braile mitral annuloplasty rings.
Objectives: Construction of a therapeutic guide for transcatheter valve implantation (TV) Braile Inovare in bioprostheses (BP) Braille (valveinvalve VIV), in valveinvalve sets (valveinvalveinvalve VIVIV) and Braille mitral annuloplasty rings (valveinring– VIR). Material and Methods: In each proposed set, with the Pulse Duplicator and FDA and ISO standards, EOA (effective orificial area) and ΔP (transvalvular gradient) were calculated, in addition to the percentage increase in regurgitant volume (R%). In the VIV tests, a TV 1mm larger and 1mm smaller was implanted in each BP. For the VIVIV tests, in each most appropriate VIV set, a smaller TV was immediately allocated to the already implemented TV. In the VIR tests, a TV with the same nominal diameter, 2mm larger and 2mm smaller, was implanted in each ring. Results: In the VIV tests, there were better hydrodynamic results with TV 1mm smaller in relation to BP, and borderline results for clinical application in aortic BP 21mm and mitral BP 27mm. The proposed VIVIV tests showed good performance, with borderline results with TV 20mm for the aortic position, and 24mm for the mitral position. The best results in the VIR tests occurred with a TV of the same size in relation to the ring, with restrictions on the 24mm ring. Conclusion: Was possible the construction of a therapeutic guide for the implantation of Braile Inovare TV in the following modalities: VIV in Braile BP; VIVIV in Braile Inovare TV previously implanted in Braile BP; and VIR in Braile mitral annuloplasty rings.
Descrição
Citação
CARDOSO, Caio Cesar. Guia terapêutico para implante de próteses valvares cardíacas transcateter Braile Inovare em biopróteses convencionais Braile, em valvas transcateter Braile Inovare previamente implantadas em biopróteses convencionais Braile, e em anéis de anuloplastia valvar mitral Braile. 2024. 123 f. Tese (Doutorado em Cardiologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2024.