Implante de válvula aórtica transcateter, una década de experiencia en el primer centro cardiovascular en Colombia

Introducción: La estenosis aórtica (EA) severa es la principal patología estructural cardiaca. Hoy día, el reemplazo valvular aórtico transcateter (TAVR) se ha convertido en la intervención de elección en pacientes de riesgo quirúrgico alto y prohibitivo. Nuestro objetivo fue determinar la tasa de é...

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Autores:
Rojas Perdomo, Juan David
Fuentes Perez, Carlos Alberto
Tipo de recurso:
https://purl.org/coar/resource_type/c_7a1f
Fecha de publicación:
2024
Institución:
Universidad El Bosque
Repositorio:
Repositorio U. El Bosque
Idioma:
spa
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oai:repositorio.unbosque.edu.co:20.500.12495/12717
Acceso en línea:
https://hdl.handle.net/20.500.12495/12717
Palabra clave:
Estenosis valvular aórtica
Reemplazo transcateter de válvula aórtica
Desenlaces
Complicaciones
Mortalidad
Aortic Valve Stenosis,
Transcatheter Aortic Valve Replacement
Outcome
Complication
Mortality
WG 100
Rights
License
Attribution-NonCommercial-NoDerivatives 4.0 International
id UNBOSQUE2_208ea42bc0dcddb080fb4441b12cb4a4
oai_identifier_str oai:repositorio.unbosque.edu.co:20.500.12495/12717
network_acronym_str UNBOSQUE2
network_name_str Repositorio U. El Bosque
repository_id_str
dc.title.none.fl_str_mv Implante de válvula aórtica transcateter, una década de experiencia en el primer centro cardiovascular en Colombia
dc.title.translated.none.fl_str_mv Transcatheter aortic valve implantation. a decade of experience at the first cardiovascular center in Colombia
title Implante de válvula aórtica transcateter, una década de experiencia en el primer centro cardiovascular en Colombia
spellingShingle Implante de válvula aórtica transcateter, una década de experiencia en el primer centro cardiovascular en Colombia
Estenosis valvular aórtica
Reemplazo transcateter de válvula aórtica
Desenlaces
Complicaciones
Mortalidad
Aortic Valve Stenosis,
Transcatheter Aortic Valve Replacement
Outcome
Complication
Mortality
WG 100
title_short Implante de válvula aórtica transcateter, una década de experiencia en el primer centro cardiovascular en Colombia
title_full Implante de válvula aórtica transcateter, una década de experiencia en el primer centro cardiovascular en Colombia
title_fullStr Implante de válvula aórtica transcateter, una década de experiencia en el primer centro cardiovascular en Colombia
title_full_unstemmed Implante de válvula aórtica transcateter, una década de experiencia en el primer centro cardiovascular en Colombia
title_sort Implante de válvula aórtica transcateter, una década de experiencia en el primer centro cardiovascular en Colombia
dc.creator.fl_str_mv Rojas Perdomo, Juan David
Fuentes Perez, Carlos Alberto
dc.contributor.advisor.none.fl_str_mv Mendoza Beltrán, Fernán del Cristo
dc.contributor.author.none.fl_str_mv Rojas Perdomo, Juan David
Fuentes Perez, Carlos Alberto
dc.subject.none.fl_str_mv Estenosis valvular aórtica
Reemplazo transcateter de válvula aórtica
Desenlaces
Complicaciones
Mortalidad
topic Estenosis valvular aórtica
Reemplazo transcateter de válvula aórtica
Desenlaces
Complicaciones
Mortalidad
Aortic Valve Stenosis,
Transcatheter Aortic Valve Replacement
Outcome
Complication
Mortality
WG 100
dc.subject.keywords.none.fl_str_mv Aortic Valve Stenosis,
Transcatheter Aortic Valve Replacement
Outcome
Complication
Mortality
dc.subject.nlm.none.fl_str_mv WG 100
description Introducción: La estenosis aórtica (EA) severa es la principal patología estructural cardiaca. Hoy día, el reemplazo valvular aórtico transcateter (TAVR) se ha convertido en la intervención de elección en pacientes de riesgo quirúrgico alto y prohibitivo. Nuestro objetivo fue determinar la tasa de éxito de implante del dispositivo en pacientes sometidos a TAVR durante el periodo de enero de 2012 a diciembre de 2023. Métodos: Estudio observacional descriptivo tipo serie de casos de pacientes con EA severa que fueron llevados a TAVR entre 01 de enero del 2012 al 31 de diciembre de 2023. Se estratificaron los desenlaces compuestos de tasa de éxito técnico y tasa de éxito del dispositivo según la definición VARC-3. Asi mismo, se describieron las características clínicas, hemodinámicas y la frecuencia de complicaciones (ACV, marcapasos, lesiones vasculares, arritmias, sangrado, lesión renal aguda) en los pacientes de la cohorte. Resultados: 134 pacientes fueron incluidos. La mediana de edad fue 80 años. 70.16% eran pacientes con EA estadio D1, 8,9% D2 y 20.8% D3. Las principales comorbilidades fueron la hipertensión arterial (80.6%) y la enfermedad coronaria (46.3%). La mortalidad global fue 8.9%. La principal complicación fue la lesión renal aguda seguida por el requerimiento de marcapasos permanente y la presencia de parafugas valvulares evidenciadas en el 19.4%, 18.7% y 17.9% de los casos respectivamente. Se documentó en nuestra población, una tasa de éxito técnico del 96.2% y éxito del dispositivo del 80.5% según la definición VARC-3. Conclusión: La tasa de éxito del dispositivo fue observada en el 80.5% de los pacientes, datos similares a los reportados en la literatura, evidenciando la adecuada implementación y evolución del programa en nuestro centro.
publishDate 2024
dc.date.accessioned.none.fl_str_mv 2024-07-24T14:06:46Z
dc.date.available.none.fl_str_mv 2024-07-24T14:06:46Z
dc.date.issued.none.fl_str_mv 2024-07
dc.type.coar.fl_str_mv http://purl.org/coar/resource_type/c_7a1f
dc.type.local.spa.fl_str_mv Tesis/Trabajo de grado - Monografía - Especialización
dc.type.coar.none.fl_str_mv https://purl.org/coar/resource_type/c_7a1f
dc.type.driver.none.fl_str_mv info:eu-repo/semantics/bachelorThesis
dc.type.coarversion.none.fl_str_mv https://purl.org/coar/version/c_ab4af688f83e57aa
format https://purl.org/coar/resource_type/c_7a1f
dc.identifier.uri.none.fl_str_mv https://hdl.handle.net/20.500.12495/12717
dc.identifier.instname.spa.fl_str_mv instname:Universidad El Bosque
dc.identifier.reponame.spa.fl_str_mv reponame:Repositorio Institucional Universidad El Bosque
dc.identifier.repourl.none.fl_str_mv repourl:https://repositorio.unbosque.edu.co
url https://hdl.handle.net/20.500.12495/12717
identifier_str_mv instname:Universidad El Bosque
reponame:Repositorio Institucional Universidad El Bosque
repourl:https://repositorio.unbosque.edu.co
dc.language.iso.fl_str_mv spa
language spa
dc.relation.references.none.fl_str_mv Wal P, Rathore S, Aziz N, Singh YK, Gupta A. Aortic stenosis: a review on acquired pathogenesis and ominous combination with diabetes mellitus. Egyptian Heart Journal. 2023 Dec 1;75(1):1–17.
Baumgartner H, Hung J, Bermejo J, Chambers JB, BChir M, Edvardsen T, et al. EACVI/ASE CLINICAL RECOMMENDATIONS Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis: A Focused Update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. 2017;
Lee G, Chikwe J, Milojevic M, Wijeysundera HC, Biondi-Zoccai G, Flather M, et al. ESC/EACTS vs. ACC/AHA guidelines for the management of severe aortic stenosis. Eur Heart J. 2023 Mar 7;44(10):796–812.
Kumar V, Sandhu GS, Harper CM, Ting HH, Rihal CS. Transcatheter aortic valve replacement programs: Clinical outcomes and developments. J Am Heart Assoc. 2020 Apr 21;9(8).
Cribier A, Eltchaninoff H, Bash A, Borenstein N, Tron C, Bauer F, et al. Percutaneous Transcatheter Implantation of an Aortic Valve Prosthesis for Calcific Aortic Stenosis. Circulation. 2002 Dec 10;106(24):3006–8.
Bhogal S, Rogers T, Aladin A, Ben-Dor I, Cohen JE, Shults CC, et al. TAVR in 2023: Who Should Not Get It? Am J Cardiol. 2023 Apr 15;193:1–18.
Cormican D, Jayaraman A, Villablanca P, Ramakrishna H. TAVR Procedural Volumes and Patient Outcomes: Analysis of Recent Data. J Cardiothorac Vasc Anesth. 2020 Feb 1;34(2):545–50.
Writing Committee Members, Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2021 Feb 2;77(4):450–500.
Berger D. Evolution of a TAVR Program. Crit Care Nurs Q. 2018;41(4):360–8.
Mendoza F. Valvulopatías en insuficiencia cardiaca. ‘Lo que el internista debe saber’. ActA MédicA coloMbiAnA. 2016;41(3):8–17.
Goody PR, Hosen MR, Christmann D, Niepmann ST, Zietzer A, Adam M, et al. Aortic Valve Stenosis. Arterioscler Thromb Vasc Biol. 2020 Apr 1;40(4):885–900.
Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart diseaseDeveloped by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2022 Feb 12;43(7):561–632.
Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, et al. Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery. New England Journal of Medicine. 2010 Oct 21;363(17):1597–607.
Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, et al. Transcatheter versus Surgical Aortic-Valve Replacement in High-Risk Patients. New England Journal of Medicine. 2011 Jun 9;364(23):2187–98.
Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, et al. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014 Jun 10;63(22).
Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, et al. Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients. New England Journal of Medicine. 2016 Apr 28;374(17):1609–20.
Reardon MJ, Van Mieghem NM, Popma JJ, Kleiman NS, Søndergaard L, Mumtaz M, et al. Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients. New England Journal of Medicine. 2017 Apr 6;376(14):1321–31.
Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017 Jun 20;135(25):e1159–95.
Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, et al. Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients. New England Journal of Medicine. 2019 May 2;380(18):1695–705.
Popma JJ, Deeb GM, Yakubov SJ, Mumtaz M, Gada H, O’Hair D, et al. Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients. New England Journal of Medicine. 2019 May 2;380(18):1706–15.
Bana A. TAVR-present, future, and challenges in developing countries. Indian J Thorac Cardiovasc Surg. 2019 Jul 1;35(3):473–84.
Søndergaard L, Popma JJ, Reardon MJ, Van Mieghem NM, Deeb GM, Kodali S, et al. Comparison of a complete percutaneous versus surgical approach to aortic valve replacement and revascularization in patients at intermediate surgical risk results from the randomized SURTAVI trial. Circulation. 2019 Oct 15;140(16):1296–305.
Popma JJ, Deeb GM, Yakubov SJ, Mumtaz M, Gada H, O’Hair D, et al. Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients. New England Journal of Medicine. 2019 May 2;380(18):1706–15.
Claessen BE, Tang GHL, Kini AS, Sharma SK. Considerations for Optimal Device Selection in Transcatheter Aortic Valve Replacement: A Review. JAMA Cardiol. 2021 Jan 1;6(1):102–12.
Généreux P, Piazza N, Alu MC, Nazif T, Hahn RT, Pibarot P, et al. Valve Academic Research Consortium 3: Updated Endpoint Definitions for Aortic Valve Clinical Research. J Am Coll Cardiol. 2021 Jun 1;77(21):2717–46.
Rouleau SG, Brady WJ, Koyfman A, Long B. Transcatheter aortic valve replacement complications: A narrative review for emergency clinicians.
Arnold S V., Zhang Y, Baron SJ, McAndrew TC, Alu MC, Kodali SK, et al. Impact of Short-Term Complications on Mortality and Quality of Life After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv. 2019 Feb 25;12(4):362–9.
Adams DH, Popma JJ, Reardon MJ, Yakubov SJ, Coselli JS, Deeb GM, et al. Transcatheter Aortic-Valve Replacement with a Self-Expanding Prosthesis. New England Journal of Medicine. 2014 May 8;370(19):1790–8.
Pibarot P, Herrmann HC, Wu C, Hahn RT, Otto CM, Abbas AE, et al. Standardized Definitions for Bioprosthetic Valve Dysfunction Following Aortic or Mitral Valve Replacement: JACC State-of-the-Art Review. J Am Coll Cardiol. 2022 Aug 2;80(5):545–61.
Grube E, Sinning JM. The “Big Five” Complications After Transcatheter Aortic Valve Replacement: Do We Still Have to Be Afraid of Them?∗. JACC Cardiovasc Interv. 2019 Feb 25;12(4):370–2.
Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, et al. Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery. New England Journal of Medicine. 2010 Oct 21 ;363(17):1597–607.
Adams DH, Popma JJ, Reardon MJ, Yakubov SJ, Coselli JS, Deeb GM, et al. Transcatheter Aortic-Valve Replacement with a Self-Expanding Prosthesis. New England Journal of Medicine. 2014 May 8;370(19):1790–8.
Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, et al. Transcatheter versus Surgical Aortic-Valve Replacement in High-Risk Patients. New England Journal of Medicine. 2011 Jun 9;364(23):2187–98.
Rheude T, Costa G, Ribichini FL, Pilgrim T, Amat-Santos IJ, De Backer O, et al. Comparison of different percutaneous revascularisation timing strategies in patients undergoing transcatheter aortic valve implantation. EuroIntervention. 2023;19(7):589–99.
Majmundar M, Doshi R, Kumar A, Johnston D, Brockett J, Kanaa’n A, et al. Valve-in-valve transcatheter aortic valve implantation versus repeat surgical aortic valve replacement in patients with a failed aortic bioprosthesis. EuroIntervention. 2022 Feb 1;17(15):1227–37.
Benck KN, Nesbitt K, Dranow E, Glotzbach JP, Tandar A, Pereira SJ. Transcatheter Aortic Valve Replacement Improves Quality of Life and Ventricular Function With Low-Flow/Low-Gradient Aortic Stenosis. Journal of the Society for Cardiovascular Angiography and Interventions. 2024 Mar;3(3):101266.
Mosleh W, Amer MR, Ding Y, Megaly M, Mather JF, McMahon S, et al. Benefit of Transcatheter Aortic Valve Replacement in Patients With Paradoxical Low-Flow Low-Gradient Versus High-Gradient Aortic Stenosis and Preserved Left Ventricular Function. Circ Cardiovasc Interv. 2021 Mar 1;14(3):E010042.
Tomii D, Okuno T, Heg D, Lanz J, Praz F, Stortecky S, et al. Validation of the VARC-3 Technical Success Definition in Patients Undergoing TAVR. JACC Cardiovasc Interv. 2022 Feb 28 ;15(4):353–64.
Dai H, Fan J, He Y, Chen J, Zhou D, Yidilisi A, et al. Technical Success after Transcatheter Aortic Valve Replacement for Bicuspid versus Tricuspid Aortic Stenosis. J Clin Med. 2023 Jan 1;12(1).
Steul JH, Abdel-Wahab M, Stankowski T, Haussig S, Woitek FJ, Gasior T, et al. VARC-3 defined outcome of valve-in-valve transcatheter aortic valve implantation in stentless compared with stented aortic bioprostheses. Clinical Research in Cardiology. 2023 Dec 11;1(3):1–11.
Maznyczka A, Pilgrim T. Antithrombotic Treatment After Transcatheter Valve Interventions: Current Status and Future Directions. Clin Ther. 2024 Feb 1 ;46(2):122–33.
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spelling Mendoza Beltrán, Fernán del CristoRojas Perdomo, Juan DavidFuentes Perez, Carlos Alberto2024-07-24T14:06:46Z2024-07-24T14:06:46Z2024-07https://hdl.handle.net/20.500.12495/12717instname:Universidad El Bosquereponame:Repositorio Institucional Universidad El Bosquerepourl:https://repositorio.unbosque.edu.coIntroducción: La estenosis aórtica (EA) severa es la principal patología estructural cardiaca. Hoy día, el reemplazo valvular aórtico transcateter (TAVR) se ha convertido en la intervención de elección en pacientes de riesgo quirúrgico alto y prohibitivo. Nuestro objetivo fue determinar la tasa de éxito de implante del dispositivo en pacientes sometidos a TAVR durante el periodo de enero de 2012 a diciembre de 2023. Métodos: Estudio observacional descriptivo tipo serie de casos de pacientes con EA severa que fueron llevados a TAVR entre 01 de enero del 2012 al 31 de diciembre de 2023. Se estratificaron los desenlaces compuestos de tasa de éxito técnico y tasa de éxito del dispositivo según la definición VARC-3. Asi mismo, se describieron las características clínicas, hemodinámicas y la frecuencia de complicaciones (ACV, marcapasos, lesiones vasculares, arritmias, sangrado, lesión renal aguda) en los pacientes de la cohorte. Resultados: 134 pacientes fueron incluidos. La mediana de edad fue 80 años. 70.16% eran pacientes con EA estadio D1, 8,9% D2 y 20.8% D3. Las principales comorbilidades fueron la hipertensión arterial (80.6%) y la enfermedad coronaria (46.3%). La mortalidad global fue 8.9%. La principal complicación fue la lesión renal aguda seguida por el requerimiento de marcapasos permanente y la presencia de parafugas valvulares evidenciadas en el 19.4%, 18.7% y 17.9% de los casos respectivamente. Se documentó en nuestra población, una tasa de éxito técnico del 96.2% y éxito del dispositivo del 80.5% según la definición VARC-3. Conclusión: La tasa de éxito del dispositivo fue observada en el 80.5% de los pacientes, datos similares a los reportados en la literatura, evidenciando la adecuada implementación y evolución del programa en nuestro centro.Especialista en Cardiología de AdultosEspecializaciónIntroduction: Severe aortic stenosis (AS) is the main structural cardiac pathology. Nowadays, transcatheter aortic valve replacement (TAVR) has become the preferred intervention in patients with high and prohibitive surgical risk. Our objective was to determine the success rate of device implantation in patients undergoing TAVR during the period from January 2012 to December 2023. Methods: Descriptive observational case series study of patients with severe AS who underwent TAVR between January 1 and 2, 2012, and December 31, 2023. Composite outcomes of technical success rate and device success rate were stratified according to the VARC-3 definition. Likewise, the clinical and hemodynamic characteristics and the frequency of complications (stroke, pacemaker, vascular lesions, arrhythmias, bleeding, acute kidney injury) in the patients in the cohort were described. Results: 134 patients were included. The median age was 80 years. 70.16% were patients with AS stage D1, 8.9% D2 and 20.8% D3. The main comorbidities were arterial hypertension (80.6%) and coronary artery disease (46.3%). The global mortality was 8.9%. The main complication was acute kidney injury followed by the requirement for a permanent pacemaker and the presence of valvular leaks, which were seen in 19.4%, 18.7% and 17.9% of cases, respectively. A technical success rate of 96.2% and a device success rate of 80.5% according to the VARC-3 definition were documented in our population. Conclusion: The device success rate was observed in 80.5% of the patients, data similar to those previously reported, evidencing the adequate implementation and evolution of the program in our center.application/pdfAttribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/Acceso abiertohttps://purl.org/coar/access_right/c_abf2http://purl.org/coar/access_right/c_abf2Estenosis valvular aórticaReemplazo transcateter de válvula aórticaDesenlacesComplicacionesMortalidadAortic Valve Stenosis,Transcatheter Aortic Valve ReplacementOutcomeComplicationMortalityWG 100Implante de válvula aórtica transcateter, una década de experiencia en el primer centro cardiovascular en ColombiaTranscatheter aortic valve implantation. a decade of experience at the first cardiovascular center in ColombiaEspecialización en Cardiología AdultosUniversidad El BosqueFacultad de MedicinaTesis/Trabajo de grado - Monografía - Especializaciónhttps://purl.org/coar/resource_type/c_7a1fhttp://purl.org/coar/resource_type/c_7a1finfo:eu-repo/semantics/bachelorThesishttps://purl.org/coar/version/c_ab4af688f83e57aaWal P, Rathore S, Aziz N, Singh YK, Gupta A. Aortic stenosis: a review on acquired pathogenesis and ominous combination with diabetes mellitus. Egyptian Heart Journal. 2023 Dec 1;75(1):1–17.Baumgartner H, Hung J, Bermejo J, Chambers JB, BChir M, Edvardsen T, et al. EACVI/ASE CLINICAL RECOMMENDATIONS Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis: A Focused Update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. 2017;Lee G, Chikwe J, Milojevic M, Wijeysundera HC, Biondi-Zoccai G, Flather M, et al. ESC/EACTS vs. ACC/AHA guidelines for the management of severe aortic stenosis. Eur Heart J. 2023 Mar 7;44(10):796–812.Kumar V, Sandhu GS, Harper CM, Ting HH, Rihal CS. Transcatheter aortic valve replacement programs: Clinical outcomes and developments. J Am Heart Assoc. 2020 Apr 21;9(8).Cribier A, Eltchaninoff H, Bash A, Borenstein N, Tron C, Bauer F, et al. Percutaneous Transcatheter Implantation of an Aortic Valve Prosthesis for Calcific Aortic Stenosis. Circulation. 2002 Dec 10;106(24):3006–8.Bhogal S, Rogers T, Aladin A, Ben-Dor I, Cohen JE, Shults CC, et al. TAVR in 2023: Who Should Not Get It? Am J Cardiol. 2023 Apr 15;193:1–18.Cormican D, Jayaraman A, Villablanca P, Ramakrishna H. TAVR Procedural Volumes and Patient Outcomes: Analysis of Recent Data. J Cardiothorac Vasc Anesth. 2020 Feb 1;34(2):545–50.Writing Committee Members, Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2021 Feb 2;77(4):450–500.Berger D. Evolution of a TAVR Program. Crit Care Nurs Q. 2018;41(4):360–8.Mendoza F. Valvulopatías en insuficiencia cardiaca. ‘Lo que el internista debe saber’. 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Clin Ther. 2024 Feb 1 ;46(2):122–33.spaORIGINALTrabajo de grado.pdfTrabajo de grado.pdfapplication/pdf1058629https://repositorio.unbosque.edu.co/bitstreams/31d00607-3bc5-4628-a557-34313fd8aa7f/downloadba2e71bc4974fa88f8d3ad02b6a44c1fMD51CC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; charset=utf-8899https://repositorio.unbosque.edu.co/bitstreams/c1c6112a-5cea-4f0d-84cf-58aee62c08a3/download3b6ce8e9e36c89875e8cf39962fe8920MD53LICENSElicense.txtlicense.txttext/plain; charset=utf-82000https://repositorio.unbosque.edu.co/bitstreams/3cf09f30-0c9b-4041-ae59-dc38e87d0895/download17cc15b951e7cc6b3728a574117320f9MD54Carta de autorización.pdfapplication/pdf173226https://repositorio.unbosque.edu.co/bitstreams/ae26cf85-f69b-4c34-a1f0-ee8091471f58/download0cbb3f50b3240424965d710857a1b49dMD55Anexo 1 Probatus.pdfapplication/pdf183294https://repositorio.unbosque.edu.co/bitstreams/347d25d7-f3f2-4d6b-84fe-bee7644dc6a4/download84ec210d7b8abde5cf2310cc31597e31MD58TEXTTrabajo de grado.pdf.txtTrabajo de grado.pdf.txtExtracted texttext/plain99364https://repositorio.unbosque.edu.co/bitstreams/7c409335-4a97-47ce-ac57-f44be3d5b90a/download52358e803381f26466d51f91eee5767aMD56THUMBNAILTrabajo de grado.pdf.jpgTrabajo de grado.pdf.jpgGenerated Thumbnailimage/jpeg2391https://repositorio.unbosque.edu.co/bitstreams/a0c7eb72-164d-460d-8b68-4be85a7df1f3/downloaddc59512dd09bd221e884d1642d5d626aMD5720.500.12495/12717oai:repositorio.unbosque.edu.co:20.500.12495/127172024-08-02 15:48:04.924http://creativecommons.org/licenses/by-nc-nd/4.0/Attribution-NonCommercial-NoDerivatives 4.0 Internationalopen.accesshttps://repositorio.unbosque.edu.coRepositorio Institucional Universidad El Bosquebibliotecas@biteca.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