DISCUSION
Symptomatic severe aortic stenosis is associated with high mortality
rates, ~ 50% at 1 year, and the prevalence will likely
increase as the population ages. In this pathology, interventional
procedures (surgery is still the gold standard, especially in younger
patients) have been shown to drastically reduce mortality and improve
quality of life. 15,16 Nevertheless, in many cases
when we replace the diseased AV with a prosthesis we are changing one
problem for another. Many complications have been described in heart
valve prosthesis, but of particular interest to us are the complications
derived from poor OAC therapy control (mechanical prosthesis) and those
due to the rapid degeneration of biological
prosthesis.2-4,17 Most of the patients in the Peruvian
public health system are poor and do not have timely access to health
services, which is why it is difficult to provide adequate OAC therapy
in these patients, many of whom are from the interior of the country and
they come to the capital just for the surgery. Early degeneration of
biological prosthesis generates more public spending (mainly because
trans-catheter therapy is now preferred) and a higher risk of mortality
due to reoperation. AVRec surgery offers many advantages, mainly avoid
OAC therapy and promises to be a technique with excellent long-term
results, so it is a relatively economical technique compared to AV
replacement, we believe it is an ideal choice for developing countries.
This idea is supported by other authors.18,19