Implante transcateter de valva aórtica e marca-passo em feixe de His na vigência de disfunção ventricular esquerda grave e bloqueio de ramo esquerdo

Abstract

Aortic stenosis is the most prevalent valve disease in developed countries and has high morbidity and mortality after the onset of symptoms. The prevalence of severe aortic stenosis in elderly patients (>75 years) is approximately 3.4%. The transcatheter aortic valve replacement has been employed for approximately 20 years and had robust outcomes published. However, it is a challenging procedure when performed on a patient in cardiogenic shock, caused by severe deterioration of left ventricular function, a condition aggravated in cases of electromechanical dyssynchrony due to left bundle branch block. There is evidence that reestablishing the electrical conduction with a pacemaker implanted directly in the conduction system, in patients with left ventricular dysfunction and dyssynchrony, can significantly improve the systolic function. In this context, the objective of the present study was to present and discuss the particularities and evidence available for treating this complex subgroup of patients.