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DR MIGUEL RUBIO VALVULOPATIAS

DR MIGUEL RUBIO VALVULOPATIAS. ELECCION DE LA PROTESIS IDEAL CLINICA BAZTERRICA HOSPITAL DE CLINICAS UBA. Corpus of the Anatomical Studies – The Aortic Valve Opening-Closure Leonardo da Vinci. 1452-1519. PROTESIS VALVULAR IDEAL. 1- FACIL DE IMPLANTAR

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DR MIGUEL RUBIO VALVULOPATIAS

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  1. DR MIGUEL RUBIOVALVULOPATIAS ELECCION DE LA PROTESIS IDEAL CLINICA BAZTERRICA HOSPITAL DE CLINICAS UBA

  2. Corpus of the Anatomical Studies – The Aortic Valve Opening-Closure Leonardo da Vinci. 1452-1519

  3. PROTESIS VALVULAR IDEAL • 1- FACIL DE IMPLANTAR • 2- PERFORMANCE HEMODINAMICA • 3- ESTABILIDAD ESTRUCTURAL • 4- NO TROMBOGENICA • 5- NO INMUNOGENICA • 6- SILENCIOSA

  4. PROTESIS IDEAL

  5. PROTESIS IDEAL

  6. PROTESIS IDEAL

  7. PROTESIS IDEAL

  8. PROTESIS IDEAL

  9. PROTESIS IDEAL

  10. CONSENSO DE VALVULOPATIAS SAC • ELECCION DE PROTESIS • MECANICAS CLASE I * Menores de 70 A ( Sin problemas para anticoagular )

  11. CONSENSO DE VALVULOPATIAS SAC • ELECCION DE PROTESIS • BIOLOGICAS CLASE I * Mayores de 70 A * Menores de 70 A con dificultad en la anticoagulacion * Expectativa de vida menor a 10 A

  12. CONSENSO DE VALVULOPATIAS SAC • ELECCION DE PROTESIS BIOLOGICAS • HOMOINJERTOS CLASE I ENDOCARDITIS ACTIVA CLASE II ALTERNATIVA TECNICA

  13. CONSENSO DE VALVULOPATIAS SAC • ELECCION DE PROTESIS BIOLOGICAS • OPERACIÓN DE ROSS CLASE I JOVENES CLASE II ENDOCARDITIS

  14. CONSENSO DE VALVULOPATIAS SAC • ELECCION DE PROTESIS BIOLOGICAS • OPERACIÓN DE ROSS CLASE III SINDROME DE MARFAN * Estrictamente contraindicada J Card Surg 2004;19:401-409 Hospital Reina Sofia Cordoba

  15. OPERACIÓN DE ROSS ANALISIS DE FACTIBILIDAD

  16. PROTESIS MECANICAS

  17. PROTESIS MECANICAS Rubio y col RAC/VOL 73 N2 90-95 2005

  18. ORIFICIO GEOMETRICO • MONODISCO 75 grados #19 2.01 ORIFICIO INT 16

  19. ORIFICIO GEOMETRICO • BI VALVA 85 grados # 19 = 1.63 ORIFICIO INT: 14.7

  20. MECANICAS SUPRANULARES • INCREMENTO DEL AREA • ANATOMIA DE LOS OSTIUMS

  21. ORIFICIO EFECTIVO AORTICO • Concepto: La superficie efectiva del orificio y los gradientes no solo mejoran luego del implante sino que son consistentemente mejores en forma alejada.....

  22. PROTESIS MECANICAS Y ANTIAGREGACION • Clinical Trial Sudafrica • N: 526 • Protesis On-x • 42% sin anticoagulacion • Trombosis valvular: 0 % • Tromboembolia 1.8 % p/y

  23. SITUACIONES ESPECIALES FACTORES DE RIESGO TROMBOTICO PACIENTE/DEPENDIENTE 1- FA 2- AI GRANDE 3- DISFUNCION SEVERA VI 4-TROMBOEMBOLIA PREVIA 5-HIPERCOAGULABILIDAD

  24. SITUACIONES ESPECIALES BIOPROTESIS CON FA VS MECANICAS Mecanicas 886 TE: 5.3% P/Y HEM: 0.8 Bioprotesis 163 TE: 2.4% P/Y HEM: 3.2 45 % Bioprotesis con Coumadin JTCS 2005 Jun;53(3):150-3 Jamiesson Vancouver Canada

  25. MUCHAS GRACIAS

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