RESUMEN
BACKGROUND: Cardiac conduction abnormalities requiring permanent pacemaker (PPM) implantation are major complications of transcatheter aortic valve replacement (TAVR). We aimed to investigate whether the relationship between prosthetic valve size and cardiac-gated computed tomography (CT)-based aortic root complex measurements can aid in recognizing patients at risk for PPM implantation post-TAVR. METHODS: We included 83 of 114 consecutive patients who underwent TAVR with the Edwards Sapien valve (Edwards Lifesciences, Irving, CA, USA) at our institution. We excluded patients with preexisting PPM, patients who required conversion to an open surgical procedure, and patients without CT data. We assessed the significance of various potential predictors of PPM placement post-TAVR. RESULTS: Following TAVR, eight patients (9.6%) required PPM. Prosthetic valve to sinus of Valsalva (SOV) index was significantly higher in those patients requiring a PPM post-TAVR (84.1 ± 9.3 vs 76.8 ± 7.1, P = 0.009). CONCLUSIONS: The prosthetic valve size to diameter of SOV index was identified as a novel predictor of PPM implantation after TAVR.
Asunto(s)
Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/cirugía , Técnicas de Imagen Sincronizada Cardíacas , Prótesis Valvulares Cardíacas , Marcapaso Artificial , Tomografía Computarizada por Rayos X , Reemplazo de la Válvula Aórtica Transcatéter , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: The Centers for Disease Control and Prevention has recommended teaching patients to remind health care workers to disinfect their hands. However, cognitive impairment among patients may hamper such efforts. METHODS: The St. Louis University Mental Status (SLUMS) Examination was administered to randomly selected inpatients at the Omaha VA Medical Center in Omaha, Nebraska. We asked patients and their families about attitudes toward reminding health care workers to disinfect their hands: willingness, feeling comfortable, and feeling responsible. RESULTS: Of 143 patients, 94 completed SLUMS; 9 had normal mental status and appropriate attitudes. Overall, 16 encounters involved patients or family who were well-suited for giving reminders. CONCLUSION: Programs to encourage hospitalized adults to remind staff to perform hand hygiene may encounter barriers related to cognitive impairment and attitudes.