Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Anomalía de Ebstein , Insuficiencia de la Válvula Tricúspide , Humanos , Anomalía de Ebstein/complicaciones , Anomalía de Ebstein/diagnóstico , Anomalía de Ebstein/cirugía , Válvula Tricúspide/diagnóstico por imagen , Válvula Tricúspide/cirugía , Válvula Tricúspide/anomalías , Insuficiencia de la Válvula Tricúspide/diagnóstico , Insuficiencia de la Válvula Tricúspide/etiología , Insuficiencia de la Válvula Tricúspide/cirugíaRESUMEN
BACKGROUND: The aim of this meta-analysis was to compare the efficacy and adverse events of percutaneous occlusion among patients with sufficient and deficient rims. METHODS: A systematic review of all articles published in the Pubmed, MEDLINE and Google Scholar databases was performed. Odds ratio (OR) and 95% CI were used as a measure of effect of the combination of studies. I2 with 95% CI was estimated to assess study heterogeneity. For the meta-analysis, a random effects model was used. RESULTS: The systematic search identified ten studies which included 4355 patients; 2661 of those had sufficient rim and the remaining 1694 patients showed some rim deficiency. Implant failure rate was 4.13% CI 95% 3.53-4.72%. Compared to frequency of failures in the group with a deficient rim (5.43% CI 95% 4.35-6.50%), implant failure in patients with a sufficient rim was significantly lower (3.30% CI 95% 2.62-3.97%), OR 2.27 CI 1.34-3.83 (p 0.002). The combined adverse events were 5.19% CI 95% 4.22-6.35% vs 2.7% CI 95% 2.08-3.31% in the deficient vs sufficient rim groups respectively (OR 2.21 CI 0.93-5.29; p 0.07). Implant failures and adverse events were more frequent in patients with posterior inferior rim deficiency. CONCLUSION: Patients presenting a posteroinferior rim deficiency are associated to both, an increased incidence of closure failure and a combined adverse events occurrence. More studies on posterior rim deficiency are necessary to ensure the feasibility and safety of the percutaneous approach.
Asunto(s)
Defectos del Tabique Interatrial , Dispositivo Oclusor Septal , Humanos , Cateterismo Cardíaco/efectos adversos , Defectos del Tabique Interatrial/diagnóstico , Defectos del Tabique Interatrial/cirugía , Incidencia , Oportunidad Relativa , Resultado del Tratamiento , Ecocardiografía TransesofágicaAsunto(s)
Taponamiento Cardíaco , Derrame Pericárdico , Humanos , Derrame Pericárdico/etiología , CorazónAsunto(s)
Humanos , Masculino , Femenino , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Cateterismo Cardíaco/métodos , Ecocardiografía Transesofágica/métodos , Ecocardiografía Doppler en Color/métodos , Defectos del Tabique Interatrial/cirugía , Estudios Retrospectivos , Ecocardiografía Tridimensional/métodos , Defectos del Tabique Interatrial/diagnóstico por imagenAsunto(s)
Cateterismo Cardíaco/métodos , Ecocardiografía Doppler en Color/métodos , Ecocardiografía Transesofágica/métodos , Defectos del Tabique Interatrial/cirugía , Adolescente , Adulto , Anciano , Niño , Preescolar , Ecocardiografía Tridimensional/métodos , Femenino , Defectos del Tabique Interatrial/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenAsunto(s)
Humanos , Femenino , Adulto , Trastornos Puerperales/cirugía , Trastornos Puerperales/diagnóstico por imagen , Enfermedades Vasculares/congénito , Anomalías de los Vasos Coronarios/cirugía , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Enfermedades Vasculares/cirugía , Enfermedades Vasculares/diagnóstico por imagenAsunto(s)
Anomalías de los Vasos Coronarios , Trastornos Puerperales , Enfermedades Vasculares/congénito , Adulto , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Anomalías de los Vasos Coronarios/cirugía , Femenino , Humanos , Trastornos Puerperales/diagnóstico por imagen , Trastornos Puerperales/cirugía , Enfermedades Vasculares/diagnóstico por imagen , Enfermedades Vasculares/cirugíaRESUMEN
Anti-coagulated patients who undergo elective surgery require temporary interruption of vitamin K antagonists. The aim of this study was to evaluate the incidence of thromboembolic events and bleeding complications in anti-coagulated patients undergoing elective invasive procedures by using an institutional management protocol. This was a descriptive study with prospective follow-up that included patients over 18 year old anti-coagulated with vitamin K antagonists, undergoing elective surgery. Those with atrial fibrillation (AF) at moderate and high risk of thromboembolic events, with mechanical heart valve (MCV) at moderate and high risk of thromboembolic events, and patients' venous thromboembolism (VTE) at high risk of thromboembolic events received bridging therapy with enoxaparin. Embolic and bleeding events in the pre-operative period were recorded. Seventy-eight received bridging, mean age 69.4 ± 11.9 years. Twenty-eight had AF (36.4 %), 12 had VTE (15.6 %) and 37 had MCV (48.1 %). Postoperatively, 1 embolic event (1.6 %) and 12 bleeding events (15.4 %) were documented, of which 10 were minor (12.8 %) and 2 major (2.6 %). The safety of bridging therapy is still under debate, and we should await the result of randomized studies comparing different strategies of bridging vs. interruption of anticoagulant therapy in the pre-operative period prior to reaching a definitive conclusion.
Asunto(s)
Procedimientos Quirúrgicos Electivos/métodos , Hemorragia/epidemiología , Atención Perioperativa/métodos , Tromboembolia/epidemiología , Vitamina K/antagonistas & inhibidores , Anciano , Anciano de 80 o más Años , Anticoagulantes/uso terapéutico , Fibrilación Atrial/cirugía , Enoxaparina/uso terapéutico , Femenino , Estudios de Seguimiento , Hemorragia/tratamiento farmacológico , Hemorragia/prevención & control , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Tromboembolia/tratamiento farmacológico , Tromboembolia/prevención & controlRESUMEN
Los pacientes anticoagulados crónicamente que son sometidos a cirugías electivas requieren la suspensión temporaria de los antagonistas de vitamina K. El objetivo del presente trabajo fue evaluar la incidencia de eventos tromboembólicos y hemorrágicos en pacientes anticoagulados sometidos a un procedimiento invasivo, aplicando un protocolo de manejo de anticoagulación en el perioperatorio. Se realizó un estudio descriptivo, con datos obtenidos de manera prospectiva, donde se incluyeron mayores de 18 años que ingresaron para la realización de una cirugía electiva. Recibieron sustitución con enoxaparina aquellos con fibrilación auricular(FA) de moderado y alto riesgo de evento tromboembólico, pacientes con reemplazo con válvula cardíaca mecánica(VCM) de moderado y alto riesgo de evento tromboembólico y con tromboembolismo venoso(TEV) de alto riesgo de evento tromboembólico. Se evaluaron los eventos embólicos y hemorrágicos en el perioperatorio. Setenta y ocho recibieron sustitución con enoxaparina en el perioperatorio, edad promedio de 69.4 ± 11.9 años. Veintiocho tenían FA (36.4%), 12 TEV (15.6%) y 37 VCM (48.1%). En el postoperatorio hubo un evento embólico (1.6%) y 12 eventos hemorrágicos (15.4%) de los cuales 10 fueron menores (12.8%) y 2mayores (2.6%). La seguridad de la sustitución con enoxaparina aún es cuestionable, y se deberán esperar estudios aleatorizados, comparando diferentes estrategias de sustitución con heparinas versus la suspensión del tratamiento anticoagulante en el período perioperatorio para una conclusión definitiva.(AU)
Anti-coagulated patients who undergo elective surgery require temporary interruption of vitamin K antagonists. The aim of this study was to evaluate the incidence of thromboembolic events and bleeding complications in anti-coagulated patients undergoing elective invasive procedures by using an institutional management protocol. This was a descriptive study with prospective follow-up that included patients over 18 year old anti-coagulated with vitamin K antagonists, undergoing elective surgery. Those with atrial fibrillation (AF) at moderate and high risk of thromboembolic events, with mechanical heart valve (MCV) at moderate and high risk of thromboembolic events, and patients venous thromboembolism (VTE) at high risk of thromboembolic events received bridging therapy with enoxaparin. Embolic and bleeding events in the pre-operative period were recorded. Seventy- eight received bridging, mean age 69.4 ± 11.9 years. Twenty-eight had AF (36.4 %), 12 had VTE (15.6 %) and 37 had MCV (48.1 %). Postoperatively, 1 embolic event (1.6 %) and 12 bleeding events (15.4 %) were documented, of which 10 were minor (12.8 %) and 2 major (2.6 %). The safety of bridging therapy is still under debate, and we should await the result of randomized studies comparing different strategies of bridging vs. interruption of anticoagulant therapy in the pre-operative period prior to reaching a definitive conclusion.(AU)