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1.
Rev. esp. cardiol. (Ed. impr.) ; 72(1): 21-29, ene. 2019. tab, graf
Artigo em Espanhol | LILACS-Express | ID: ibc-ET1-2075

RESUMO

Introducción y objetivos: El daño renal agudo (DRA) ocurre con frecuencia tras el implante percutáneo de válvula aórtica (TAVI) y se asocia con una mayor mortalidad. Sin embargo, el impacto del DRA en la evolución a largo plazo continúa siendo controvertida. Por dicho motivo se evalúa el impacto del DRA el resultado a corto y largo plazo tras el TAVI usando los criterios Valve Academic Research Consortium 2. Métodos: Se incluyeron 794 pacientes consecutivos con estenosis aórtica grave en un registro multicéntrico brasileño. Para la identificación de los predictores de DRA se utilizó el análisis de regresión logística. La supervivencia a 4 años se determinó mediante las curvas de Kaplan-Meier y para determinar el impacto del DRA en la mortalidad entre los supervivientes a 12 meses se usó un análisis de punto de referencia ajustado. Resultados: La incidencia de DRA tras el TAVI fue del 18%. Los predictores independientes de DRA fueron: edad, diabetes mellitus, hemorragia mayor o amenazante para la vida y la malaposición valvular. El DRA se asoció independientemente con un riesgo mayor de muerte total (HR ajustada = 2,8; IC95%, 2,0-3,9; p < 0,001) y cardiovascular (HR ajustada = 2,9; IC95%, 1,9-4,4; p < 0,001) durante el periodo de seguimiento completo. Sin embargo, cuando se consideró solo los supervivientes a 12 meses, no hubo diferencias en ambos objetivos clínicos (HR ajustada = 1,2; IC95%, 0,5-2,4; p = 0,71, y HR = 0,7; IC95%, 0,2-2,1; p = 0,57, respectivamente). Conclusiones: El DRA es una complicación frecuente tras el TAVI. La edad avanzada, la diabetes, la hemorragia mayor o amenazante para la vida y la malaposición valvular eran factores predictivos de DRA. El DRA se asoció con el pronóstico a corto y largo plazo, sin embargo, el impacto del DRA sobre la mortalidad se limitó al primer año tras el TAVI


Introduction and objectives: Acute kidney injury (AKI) is frequently observed after transcatheter aortic valve implantation (TAVI) and is associated with higher mortality. However, the impact of AKI on long-term outcomes remains controversial. Therefore, we sought to evaluate the impact of AKI on short- and long-term outcomes following TAVI using the Valve Academic Research Consortium 2 criteria. Methods: Consecutive patients (n = 794) with severe aortic stenosis who underwent TAVI were included in a multicenter Brazilian registry. Logistic regression analysis was used to identify predictors of AKI. Four-year outcomes were determined as Kaplan-Meier survival curves, and an adjusted landmark analysis was used to test the impact of AKI on mortality among survivors at 12 months. Results: The incidence of AKI after TAVI was 18%. Independent predictors of AKI were age, diabetes mellitus, major or life-threatening bleeding and valve malpositioning. Acute kidney injury was independently associated with higher risk of all-cause death (adjusted HR, 2.8; 95%CI, 2.0-3.9; P < .001) and cardiovascular mortality (adjusted HR, 2.9; 95%CI, 1.9-4.4; P < .001) over the entire follow-up period. However, when considering only survivors at 12 months, there was no difference in both clinical endpoints (adjusted HR, 1.2; 95%CI, 0.5-2.4; P = .71, and HR, 0.7; 95%CI, 0.2-2.1; P = .57, respectively). Conclusions: Acute kidney injury is a frequent complication after TAVI. Older age, diabetes, major or life-threatening bleeding, and valve malpositioning were independent predictors of AKI. Acute kidney injury is associated with worse short- and long-term outcomes. However, the major impact of AKI on mortality is limited to the first year after TAVI

2.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29358043

RESUMO

INTRODUCTION AND OBJECTIVES: Acute kidney injury (AKI) is frequently observed after transcatheter aortic valve implantation (TAVI) and is associated with higher mortality. However, the impact of AKI on long-term outcomes remains controversial. Therefore, we sought to evaluate the impact of AKI on short- and long-term outcomes following TAVI using the Valve Academic Research Consortium 2 criteria. METHODS: Consecutive patients (n = 794) with severe aortic stenosis who underwent TAVI were included in a multicenter Brazilian registry. Logistic regression analysis was used to identify predictors of AKI. Four-year outcomes were determined as Kaplan-Meier survival curves, and an adjusted landmark analysis was used to test the impact of AKI on mortality among survivors at 12 months. RESULTS: The incidence of AKI after TAVI was 18%. Independent predictors of AKI were age, diabetes mellitus, major or life-threatening bleeding and valve malpositioning. Acute kidney injury was independently associated with higher risk of all-cause death (adjusted HR, 2.8; 95%CI, 2.0-3.9; P < .001) and cardiovascular mortality (adjusted HR, 2.9; 95%CI, 1.9-4.4; P < .001) over the entire follow-up period. However, when considering only survivors at 12 months, there was no difference in both clinical endpoints (adjusted HR, 1.2; 95%CI, 0.5-2.4; P = .71, and HR, 0.7; 95%CI, 0.2-2.1; P = .57, respectively). CONCLUSIONS: Acute kidney injury is a frequent complication after TAVI. Older age, diabetes, major or life-threatening bleeding, and valve malpositioning were independent predictors of AKI. Acute kidney injury is associated with worse short- and long-term outcomes. However, the major impact of AKI on mortality is limited to the first year after TAVI.

3.
JAMA ; 316(10): 1083-92, 2016 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-27623462

RESUMO

IMPORTANCE: Limited data exist on clinical characteristics and outcomes of patients who had infective endocarditis after undergoing transcatheter aortic valve replacement (TAVR). OBJECTIVE: To determine the associated factors, clinical characteristics, and outcomes of patients who had infective endocarditis after TAVR. DESIGN, SETTING, AND PARTICIPANTS: The Infectious Endocarditis after TAVR International Registry included patients with definite infective endocarditis after TAVR from 47 centers from Europe, North America, and South America between June 2005 and October 2015. EXPOSURE: Transcatheter aortic valve replacement for incidence of infective endocarditis and infective endocarditis for in-hospital mortality. MAIN OUTCOMES AND MEASURES: Infective endocarditis and in-hospital mortality after infective endocarditis. RESULTS: A total of 250 cases of infective endocarditis occurred in 20 006 patients after TAVR (incidence, 1.1% per person-year; 95% CI, 1.1%-1.4%; median age, 80 years; 64% men). Median time from TAVR to infective endocarditis was 5.3 months (interquartile range [IQR], 1.5-13.4 months). The characteristics associated with higher risk of progressing to infective endocarditis after TAVR was younger age (78.9 years vs 81.8 years; hazard ratio [HR], 0.97 per year; 95% CI, 0.94-0.99), male sex (62.0% vs 49.7%; HR, 1.69; 95% CI, 1.13-2.52), diabetes mellitus (41.7% vs 30.0%; HR, 1.52; 95% CI, 1.02-2.29), and moderate to severe aortic regurgitation (22.4% vs 14.7%; HR, 2.05; 95% CI, 1.28-3.28). Health care-associated infective endocarditis was present in 52.8% (95% CI, 46.6%-59.0%) of patients. Enterococci species and Staphylococcus aureus were the most frequently isolated microorganisms (24.6%; 95% CI, 19.1%-30.1% and 23.3%; 95% CI, 17.9%-28.7%, respectively). The in-hospital mortality rate was 36% (95% CI, 30.0%-41.9%; 90 deaths; 160 survivors), and surgery was performed in 14.8% (95% CI, 10.4%-19.2%) of patients during the infective endocarditis episode. In-hospital mortality was associated with a higher logistic EuroSCORE (23.1% vs 18.6%; odds ratio [OR], 1.03 per 1% increase; 95% CI, 1.00-1.05), heart failure (59.3% vs 23.7%; OR, 3.36; 95% CI, 1.74-6.45), and acute kidney injury (67.4% vs 31.6%; OR, 2.70; 95% CI, 1.42-5.11). The 2-year mortality rate was 66.7% (95% CI, 59.0%-74.2%; 132 deaths; 115 survivors). CONCLUSIONS AND RELEVANCE: Among patients undergoing TAVR, younger age, male sex, history of diabetes mellitus, and moderate to severe residual aortic regurgitation were significantly associated with an increased risk of infective endocarditis. Patients who developed endocarditis had high rates of in-hospital mortality and 2-year mortality.


Assuntos
Endocardite Bacteriana/epidemiologia , Endocardite/etiologia , Mortalidade Hospitalar/tendências , Substituição da Valva Aórtica Transcateter/efeitos adversos , Fatores Etários , Idoso , Endocardite Bacteriana/etiologia , Feminino , Seguimentos , Insuficiência Cardíaca , Humanos , Masculino , Razão de Chances , Sistema de Registros , Fatores de Risco , Fatores Sexuais , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/etiologia , Staphylococcus aureus , Resultado do Tratamento
4.
Artigo em Inglês | MEDLINE | ID: mdl-27496637

RESUMO

BACKGROUND: Direct transcatheter aortic valve replacement (TAVR) is regarded as having potential advantages over TAVR with balloon aortic valve predilatation (BAVP) in reducing procedural complications, but there are few data to support this approach. METHODS AND RESULTS: Patients included in the Brazilian TAVR registry with CoreValve and Sapien-XT prosthesis were compared according to the implantation technique, with or without BAVP. Clinical and echocardiographic data were analyzed in overall population and after propensity score matching. A total of 761 consecutive patients (BAVP=372; direct-TAVR=389) were included. Direct-TAVR was possible in 99% of patients, whereas device success was similar between groups (BAVP=81.2% versus direct-TAVR=78.1%; P=0.3). No differences in clinical outcomes at 30 days and 1 year were observed, including all-cause mortality (7.6% versus 10%; P=0.25 and 18.1% versus 24.5%; P=0.07, respectively) and stroke (2.8% versus 3.8%; P=0.85 and 5.5% versus 6.8%; P=0.56, respectively). Nonetheless, TAVR with BAVP was associated with a higher rate of new onset persistent left bundle branch block with the CoreValve (47.7% versus 35.1%; P=0.01 at 1 year). Mean gradient and incidence of moderate/severe aortic regurgitation were similar in both groups at 1 year (11% versus 13.3%; P=0.57 and 9.8±5.5 versus 8.7±4.3; P=0.09, respectively). After propensity score matching analysis, all-cause mortality and stroke remained similar. By multivariable analysis, BAVP and the use of CoreValve were independent predictors of new onset persistent left bundle branch block. CONCLUSIONS: The 2 TAVR strategies, with or without BAVP, provided similar clinical and echocardiographic outcomes over a midterm follow-up although BAVP was associated with a higher rate of new onset persistent left bundle branch block, particularly in patients receiving a CoreValve.


Assuntos
Angioplastia Coronária com Balão/métodos , Substituição da Valva Aórtica Transcateter/métodos , Idoso , Idoso de 80 Anos ou mais , Bloqueio de Ramo/etiologia , Causas de Morte , Feminino , Humanos , Masculino , Pontuação de Propensão , Sistema de Registros , Substituição da Valva Aórtica Transcateter/mortalidade
5.
Circ Cardiovasc Interv ; 9(8): e003605-e003605, 2016.
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: ses-34619

RESUMO

Background—Direct transcatheter aortic valve replacement (TAVR) is regarded as having potential advantages over TAVRwith balloon aortic valve predilatation (BAVP) in reducing procedural complications, but there are few data to supportthis approach. Methods and Results—Patients included in the Brazilian TAVR registry with CoreValve and Sapien-XT prosthesis were compared according to the implantation technique, with or without BAVP. Clinical and echocardiographic data were analyzed in overall population and after propensity score matching. A total of 761 consecutive patients (BAVP=372;direct-TAVR=389) were included. Direct-TAVR was possible in 99% of patients, whereas device success was similarbetween groups (BAVP=81.2% versus direct-TAVR=78.1%; P=0.3). No differences in clinical outcomes at 30 daysand 1 year were observed, including all-cause mortality (7.6% versus 10%; P=0.25 and 18.1% versus 24.5%; P=0.07,respectively) and stroke (2.8% versus 3.8%; P=0.85 and 5.5% versus 6.8%; P=0.56, respectively). Nonetheless, TAVRwith BAVP was associated with a higher rate of new onset persistent left bundle branch block with the CoreValve (47.7%versus 35.1%; P=0.01 at 1 year). Mean gradient and incidence of moderate/severe aortic regurgitation were similar inboth groups at 1 year (11% versus 13.3%; P=0.57 and 9.8±5.5 versus 8.7±4.3; P=0.09, respectively). After propensityscore matching analysis, all-cause mortality and stroke remained similar. By multivariable analysis, BAVP and the use ofCoreValve were independent predictors of new onset persistent left bundle branch block...(AU)


Assuntos
Estenose da Valva Aórtica , Valvuloplastia com Balão , Pontuação de Propensão
6.
JAMA ; 316(10): 1083-1092, 2016.
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: ses-34665

RESUMO

IMPORTANCE: Limited data exist on clinical characteristics and outcomes of patients who had infective endocarditis after undergoing transcatheter aortic valve replacement (TAVR). OBJECTIVE: To determine the associated factors, clinical characteristics, and outcomes of patients who had infective endocarditis after TAVR. DESIGN, SETTING, AND PARTICIPANTS: The Infectious Endocarditis after TAVR International Registry included patients with definite infective endocarditis after TAVR from 47 centers from Europe, North America, and South America between June 2005 and October 2015. EXPOSURE: Transcatheter aortic valve replacement for incidence of infective endocarditis and infective endocarditis for in-hospital mortality. MAIN OUTCOMES AND MEASURES: Infective endocarditis and in-hospital mortality after infective endocarditis. RESULTS: A total of 250 cases of infective endocarditis occurred in 20 006 patients after TAVR (incidence, 1.1% per person-year; 95% CI, 1.1%-1.4%; median age, 80 years; 64% men). Median time from TAVR to infective endocarditis was 5.3 months (interquartile range [IQR], 1.5-13.4 months). The characteristics associated with higher risk of progressing to infective endocarditis after TAVR was younger age (78.9 years vs 81.8 years; hazard ratio [HR], 0.97 per year; 95% CI, 0.94-0.99), male sex (62.0% vs 49.7%; HR, 1.69; 95% CI, 1.13-2.52), diabetes mellitus (41.7% vs 30.0%; HR, 1.52; 95% CI, 1.02-2.29), and moderate to severe aortic regurgitation (22.4% vs 14.7%; HR, 2.05; 95% CI, 1.28-3.28). Health care-associated infective endocarditis was present in 52.8% (95% CI, 46.6%-59.0%) of patients...(AU)


Assuntos
Endocardite , Substituição da Valva Aórtica Transcateter , Endocardite Bacteriana
7.
Catheter Cardiovasc Interv ; 86(3): 501-5, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25586633

RESUMO

OBJECTIVE: To compare the 1-year outcomes of complete percutaneous approach versus surgical vascular approach for transfemoral transcatheter aortic valve implantation (TAVI), among "real-world" patients from the multi-center Brazilian TAVI registry. BACKGROUND: Vascular access still remains a major challenge for TAVI via transfemoral approach. Vascular access through complete percutaneous approaches or through open surgical vascular techniques seems to be acutely similar. However, the long-term outcomes of both techniques remain poorly described. METHODS: The study population comprised all patients treated via transfemoral route in the Brazilian TAVI registry, a "real-world", nation-based, multi-center study. Patients were divided according to the initial vascular access approach (percutaneous vs. surgical) and clinically followed-up for 1 year. The primary endpoint was the incidence of combined adverse events all-cause mortality, life-threatening bleeding, and/or major vascular complication at 1 year. RESULTS: A total of 402 patients from 18 centers comprised the study population (percutaneous approach in 182 patients; surgical cutdown approach 220 patients). The incidence of combined adverse events was not different in the percutaneous and the surgical groups at 30 days (17.6% vs. 16.3%; P = 0.8) and at 1 year (primary endpoint) (30.9% vs. 28.8%; P = 0.8). Also, the study groups overall were comparable regarding the incidence of each individual safety adverse events at 30 days and at 1 year. CONCLUSION: Total percutaneous techniques or surgical cutdown and closure may provide similar safety and effectiveness during the first year of follow-up in patients undergoing transfemoral TAVI.


Assuntos
Estenose da Valva Aórtica/terapia , Artéria Femoral/cirurgia , Substituição da Valva Aórtica Transcateter/métodos , Idoso de 80 Anos ou mais , Brasil , Comorbidade , Feminino , Humanos , Masculino , Sistema de Registros , Fatores de Risco , Resultado do Tratamento
8.
Catheter Cardiovasc Interv ; 85(5): E153-62, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25510532

RESUMO

OBJECTIVE: The study sought to evaluate outcomes and predictors of mortality after transcatheter aortic valve implantation (TAVI). BACKGROUND: TAVI registries can reliably address outcomes and issues that adversely affect results in real-life. METHODS: All endpoints and complications were analyzed according to Valve Academic Research Consortium-2 criteria. RESULTS: Between January 2008 and January 2013, 418 patients underwent TAVI in 18 centers and were included in the Brazilian registry. The transfemoral approach was used in 96.2% of the procedures. The CoreValve and Sapien XT prosthesis were used in 360 (86.1%) and 58 (13.9%) cases, respectively. All-cause mortality at 30 days and 1 year were 9.1 and 21.5%. Chronic obstructive pulmonary disease (COPD) (HR: 3.50), acute kidney injury (AKI) (HR: 3.07), stroke (HR: 2.71) and moderate/severe paravalvular regurgitation (PVR) (HR: 2.76) emerged as independent predictors of overall mortality. COPD (OR: 3.00), major vascular complications (OR: 7.99) and device malpositioning (OR: 6.97) were predictors of early (≤30 days) mortality, while COPD (HR: 2.68), NYHA class III/IV (HR: 3.04), stroke (HR: 4.15), AKI (HR: 2.44) and moderate/severe PVR (HR: 3.20) impacted late (>30 days) mortality. The use of transesophageal echocardiogram (TEE) to monitor the procedure was found to be a protective factor against overall (HR: 0.57) and late (HR: 0.47) mortality. CONCLUSION: This multicenter registry reflected a real-life national TAVI experience. Comorbidities, periprocedural complications and moderate/severe PVR were associated with increased mortality and the use of TEE to monitor the procedure acted as a protective factor.


Assuntos
Estenose da Valva Aórtica/cirurgia , Complicações Pós-Operatórias/mortalidade , Sistema de Registros , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/mortalidade , Brasil/epidemiologia , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Fatores de Tempo
9.
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: ses-31720

RESUMO

The study sought to evaluate outcomes and predictors of mortality after transcatheteraortic valve implantation (TAVI). Background: TAVI registries can reliablyaddress outcomes and issues that adversely affect results in real-life. Methods: Allendpoints and complications were analyzed according to Valve Academic ResearchConsortium-2 criteria. Results: Between January 2008 and January 2013, 418 patientsunderwent TAVI in 18 centers and were included in the Brazilian registry. The transfemoralapproach was used in 96.2% of the procedures. The CoreValve and Sapien XTprosthesis were used in 360 (86.1%) and 58 (13.9%) cases, respectively. All-cause mortalityat 30 days and 1 year were 9.1 and 21.5%. Chronic obstructive pulmonary disease(COPD) (HR: 3.50), acute kidney injury (AKI) (HR: 3.07), stroke (HR: 2.71) and moderate/severe paravalvular regurgitation (PVR) (HR: 2.76) emerged as independent predictors ofoverall mortality. COPD (OR: 3.00), major vascular complications (OR: 7.99) and devicemalpositioning (OR: 6.97) were predictors of early ( 30 days) mortality, while COPD (HR:2.68), NYHA class III/IV (HR: 3.04), stroke (HR: 4.15), AKI (HR: 2.44) and moderate/severePVR (HR: 3.20) impacted late (>30 days) mortality. The use of transesophageal echocardiogram(TEE) to monitor the procedure was found to be a protective factor againstoverall (HR: 0.57) and late (HR: 0.47) mortality. Conclusion: This multicenter registryreflected a real-life national TAVI experience. Comorbidities, periprocedural complicationsand moderate/severe PVR were associated with increased mortality and the useof TEE to monitor the procedure acted as a protective factor. (AU)


Assuntos
Implante de Prótese de Valva Cardíaca , Ecocardiografia , Lesão Renal Aguda
10.
Int J Cardiol ; 175(2): 248-52, 2014 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-24880480

RESUMO

BACKGROUND: The aim of this study is to evaluate the predictors of permanent pacemaker (PPM) implantation after TAVI. METHODS: Between January 2008 and February 2012, 418 patients with severe aortic stenosis underwent TAVI and were enrolled in a Brazilian multicenter registry. After excluding patients who died during the procedure and those with a previous PPM, 353 patients were included in the analysis. RESULTS: At 30 days, the overall incidence of PPM implantation was 25.2%. Patients requiring PPM were more likely to be older (82.73 vs. 81.10 years, p=0.07), have pre-dilation (68.42% vs. 60.07%, p=0.15), receive CoreValve (93.68% vs. 82.55%, p=0.008), and have baseline right bundle branch block (RBBB, 25.26% vs. 6.58%, p<0.001). On multivariable analysis, CoreValve vs. Sapien XT (OR, 4.24; 95% CI, 1.56-11.49; p=0.005), baseline RBBB (OR, 4.41; 95% CI, 2.20-8.82; p<0.001), and balloon pre-dilatation (OR, 1.75; 95% CI, 1.02-3.02; p=0.04) were independent predictors of PPM implantation. CONCLUSION: PPM implantation occurred in approximately one-fourth of cases. Pre-existing RBBB, balloon pre-dilatation, and CoreValve use were independent predictors of PPM after TAVI. The type of prosthesis used and pre-balloon dilatation should be considered in TAVI candidates with baseline RBBB.


Assuntos
Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Estimulação Cardíaca Artificial/tendências , Marca-Passo Artificial/tendências , Sistema de Registros , Substituição da Valva Aórtica Transcateter/tendências , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/epidemiologia , Brasil/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Valor Preditivo dos Testes
11.
International Journal of Cardiology ; 175(2): 248-252, 2014. ilus
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: ses-29595

RESUMO

Background: The aimof this study is to evaluate the predictors of permanent pacemaker (PPM) implantation afterTAVI.Methods: Between January 2008 and February 2012, 418 patientswith severe aortic stenosis underwent TAVI andwere enrolled in a Brazilian multicenter registry. After excluding patients who died during the procedure andthose with a previous PPM, 353 patients were included in the analysis.Results: At 30 days, the overall incidence of PPM implantation was 25.2%. Patients requiring PPM weremore likelyto be older (82.73 vs. 81.10 years, p = 0.07), have pre-dilation (68.42% vs. 60.07%, p = 0.15), receive CoreValve(93.68% vs. 82.55%, p = 0.008), and have baseline right bundle branch block (RBBB, 25.26% vs. 6.58%, p b 0.001).On multivariable analysis, CoreValve vs. Sapien XT (OR, 4.24; 95% CI, 1.56–11.49; p = 0.005), baseline RBBB (OR,4.41; 95% CI, 2.20–8.82; p b 0.001), and balloon pre-dilatation (OR, 1.75; 95% CI, 1.02–3.02; p = 0.04) were independentpredictors of PPM implantation.Conclusion: PPM implantation occurred in approximately one-fourth of cases. Pre-existing RBBB, balloon predilatation,and CoreValve use were independent predictors of PPM after TAVI. The type of prosthesis used andpre-balloon dilatation should be considered in TAVI candidates with baseline RBBB. (AU)


Assuntos
Estenose da Valva Aórtica , Ecocardiografia Transesofagiana , Volume Sistólico
12.
Rev. bras. ortop ; 31(10): 838-42, out. 1996. ilus, tab
Artigo em Português | LILACS | ID: lil-212934

RESUMO

Entre abril de 1988 e janeiro de 1996 foram operados, pelo Grupo de Ombro do Departamento de Ortopedia e Traumatologia da Santa Casa de Säo Paulo - "Pavilhäo Fernandinho Simonsen", 26 pacientes com fratura da clavícula distal. Destes, 15 foram acompanahdos por período médio de 12,7 meses, sendo que seis fraturas foram classificadas como tipo II, uma como tipo III e oito como tipo V (classificaçäo de Craig). A técnica cirúrgica utilizada foi a dupla cerclagem coracoclavicular com fio inabsorvível n§ 5, como descrita por Neer, em 11 pacientes, fio de Kirschner cruzados em dois e técnica de Weaver-Dunn em dois. Os resultados obtidos foram avaliados pelo método UCLA, sendo dez pacientes classificados como excelentes e cinco como bons. A restauraçäo do "mecanismo suspensor" do ombro, através da reduçäo e fixaçäo indireta do foco de fratura com dupla cerclagem coracoclavicular, mostrou-se ser método simples, eficaz e com baixo índice de complicaçoes.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Clavícula/cirurgia , Clavícula/lesões , Seguimentos , Estudos Retrospectivos , Resultado do Tratamento
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