Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 845
Filtrar
1.
Medicine (Baltimore) ; 100(22): e26123, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087862

RESUMO

ABSTRACT: Transcatheter aortic valve replacement (TAVR) is a standard treatment indicated for severe aortic stenosis in high-risk patients. The objective of this study was to evaluate the incidence of pacemaker dependency after permanent pacemaker implantation (PPI) following TAVR or surgical aortic valve replacement (SAVR) and the risk of mortality at a tertiary center in Korea.In this retrospective study conducted at a single tertiary center, clinical outcomes related to pacemaker dependency were evaluated for patients implanted with pacemakers after TAVR from January 2012 to November 2018 and post-SAVR from January 2005 to May 2015. Investigators reviewed patients' electrocardiograms and baseline rhythms as well as conduction abnormalities. Pacemaker dependency was defined as a ventricular pacing rate > 90% with an intrinsic rate of <40 bpm during interrogation.Of 511 patients who underwent TAVR for severe AS, 37(7.3%) underwent PPI after a median duration of 6 (3-7) days, whereas pacemakers were implanted after a median interval of 13 (8-28) days post-SAVR in 10 of 663 patients (P < .001). Pacemaker dependency was observed in 36 (97.3%) patients during 7 days immediately post-TAVR and in 25 (64.9%) patients between 8 and 180 days post-TAVR. Pacemaker dependency occurred after 180 days in 17 (50%) patients with TAVR and in 4 (44.4%) patients with SAVR. Twelve (41.4%) patients were pacemaker-dependent after 365 days post-TAVR.Pacemaker dependency did not differ at 6 months after TAVR vs SAVR. In patients undergoing post-TAVR PPI, 58.6% were not pacemaker-dependent at 1 year after the TAVR procedure.


Assuntos
Estenose da Valva Aórtica/cirurgia , Marca-Passo Artificial/estatística & dados numéricos , Substituição da Valva Aórtica Transcateter/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Estudos Retrospectivos , Centros de Atenção Terciária
2.
Int Heart J ; 62(1): 57-64, 2021 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-33455981

RESUMO

Tricuspid valve (TV) surgery is associated with a high risk of postoperative pacemaker requirement. We set out to identify the incidence of atrioventricular block (AVB) after TV surgery and determine whether atrioventricular conduction recovers within time.We investigated pre/intra- and postoperative predictors of AVB in patients who underwent tricuspid valve surgery (not only isolated TV surgery) at our institution between 2004 and 2017. Patients who had pacemakers prior to surgery were excluded.One year after surgery, 5.8% of the surviving cohort had received a pacemaker due to AVB. In the complete follow-up time, 33 out of 505 patients required pacemaker implantation because of AVB. Of the 37 patients who presented to the intensive care unit postoperatively with AVB III, 14 (38%) underwent pacemaker implantation for AVB, and 20 (54%) did not require a pacemaker. AVB III at ICU admission was identified as a predictor of pacemaker implantation (OR: 9.7, CI: 3.8-24.5, P < 0.001). TV endocarditis was also identified as a predictor (OR: 12.4, CI: 3.3-46.3, P < 0.001). Eleven out of 32 patients (34%) with tricuspid endocarditis required a pacemaker for AVB. The mean ventricular pacing burden within the first 5 years after pacemaker implantation was 79%.The issue of AVB after TV surgery is significant. Both the initial rhythm after surgery and etiology of the tricuspid disease can help predict pacemaker requirement. Within the first 5 years after surgery, the ventricular pacing burden remains high without relevant rhythm recovery.


Assuntos
Bloqueio Atrioventricular/etiologia , Endocardite/complicações , Marca-Passo Artificial/estatística & dados numéricos , Valva Tricúspide/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/cirurgia , Intervalo Livre de Doença , Endocardite/cirurgia , Feminino , Seguimentos , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/patologia , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Valva Tricúspide/patologia
3.
J Am Coll Cardiol ; 77(1): 1-14, 2021 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-33413929

RESUMO

BACKGROUND: Surgical aortic valve replacement and transcatheter aortic valve replacement (TAVR) are now both used to treat aortic stenosis in patients in whom life expectancy may exceed valve durability. The choice of initial bioprosthesis should therefore consider the relative safety and efficacy of potential subsequent interventions. OBJECTIVES: The aim of this study was to compare TAVR in failed transcatheter aortic valves (TAVs) versus surgical aortic valves (SAVs). METHODS: Data were collected on 434 TAV-in-TAV and 624 TAV-in-SAV consecutive procedures performed at centers participating in the Redo-TAVR international registry. Propensity score matching was applied, and 330 matched (165:165) patients were analyzed. Principal endpoints were procedural success, procedural safety, and mortality at 30 days and 1 year. RESULTS: For TAV-in-TAV versus TAV-in-SAV, procedural success was observed in 120 (72.7%) versus 103 (62.4%) patients (p = 0.045), driven by a numerically lower frequency of residual high valve gradient (p = 0.095), ectopic valve deployment (p = 0.081), coronary obstruction (p = 0.091), and conversion to open heart surgery (p = 0.082). Procedural safety was achieved in 116 (70.3%) versus 119 (72.1%) patients (p = 0.715). Mortality at 30 days was 5 (3%) after TAV-in-TAV and 7 (4.4%) after TAV-in-SAV (p = 0.570). At 1 year, mortality was 12 (11.9%) and 10 (10.2%), respectively (p = 0.633). Aortic valve area was larger (1.55 ± 0.5 cm2 vs. 1.37 ± 0.5 cm2; p = 0.040), and the mean residual gradient was lower (12.6 ± 5.2 mm Hg vs. 14.9 ± 5.2 mm Hg; p = 0.011) after TAV-in-TAV. The rate of moderate or greater residual aortic regurgitation was similar, but mild aortic regurgitation was more frequent after TAV-in-TAV (p = 0.003). CONCLUSIONS: In propensity score-matched cohorts of TAV-in-TAV versus TAV-in-SAV patients, TAV-in-TAV was associated with higher procedural success and similar procedural safety or mortality.


Assuntos
Estenose da Valva Aórtica/cirurgia , Bioprótese , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Injúria Renal Aguda/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Insuficiência da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/mortalidade , Conversão para Cirurgia Aberta/estatística & dados numéricos , Oclusão Coronária/epidemiologia , Feminino , Hemorragia/epidemiologia , Humanos , Masculino , Marca-Passo Artificial/estatística & dados numéricos , Segurança do Paciente , Pontuação de Propensão , Sistema de Registros
4.
Am J Cardiol ; 144: 83-90, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33383014

RESUMO

Kidney transplant recipients (KTRs) are considered high-risk patients for surgical interventions. Transcatheter aortic valve implantation (TAVI) has been introduced as an alternative to surgical aortic valve replacement (SAVR) in patients with aortic stenosis (AS) at high operative risk. However, the outcomes of TAVI compared with SAVR KTRs have not been well-studied in nationally representative data. Patients with prior history of functioning kidney transplant who were hospitalized for TAVI and SAVR between January 2012 and December 2017 were identified retrospectively in the Nationwide Readmissions Database. Our study included 762 TAVI and 1,278 SAVR KTRs. Compared with SAVR, TAVI patients generally had higher rates of co-morbidities with lower risk of in-hospital mortality (3.1% vs 6.3, p = 0.002), blood transfusion (11.5% vs 38.6%, p <0.001), acute myocardial infarction (3.9% vs 6.5%, p = 0.16), acute kidney injury (24.5% vs 42.1%, p <0.001), sepsis (3.9% vs 9.5%, p <0.001) and discharge with disability (42.6% vs 68.4%, p <0.001). However, the rate of permanent pacemaker implantation was significantly higher in TAVI group (11.4% vs 3.9%, p <0.001). Of note, in-hospital stroke and 30-day readmission were comparable between both groups. These findings were confirmed after adjusting for other co-morbidities. TAVI is growing as a valid and safe alternative for KTRs with severe AS.


Assuntos
Estenose da Valva Aórtica/cirurgia , Mortalidade Hospitalar , Transplante de Rim , Complicações Pós-Operatórias/epidemiologia , Substituição da Valva Aórtica Transcateter/métodos , Injúria Renal Aguda/epidemiologia , Idoso , Transfusão de Sangue/estatística & dados numéricos , Comorbidade , Endocardite/epidemiologia , Feminino , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Instituições para Cuidados Intermediários/estatística & dados numéricos , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Marca-Passo Artificial/estatística & dados numéricos , Alta do Paciente , Diálise Renal , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Sepse/epidemiologia , Instituições de Cuidados Especializados de Enfermagem/estatística & dados numéricos , Acidente Vascular Cerebral/epidemiologia , Resultado do Tratamento , Estados Unidos/epidemiologia
6.
Rev. esp. cardiol. (Ed. impr.) ; 73(7): 554-560, jul. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-197835

RESUMO

INTRODUCCIÓN Y OBJETIVOS: El bloqueo auriculoventricular (BAV) en presencia de fármacos bradicardizantes (FBZ) puede ser reversible, y está en controversia el implante de marcapasos. El objetivo es analizar la necesidad de tratamiento con marcapasos a medio plazo, tras la suspensión de los FBZ, e identificar factores predictores. MÉTODOS: Se estudió a una cohorte de pacientes que acudieron a urgencias con BAV de alto grado mientras tomaban FBZ. Se estudió la persistencia de BAV tras la interrupción del fármaco, la recurrencia en los pacientes con resolución del BAV y las variables predictoras asociadas con la necesidad de marcapasos a los 3 años de seguimiento. RESULTADOS: De 127 pacientes (edad, 79 [71-83] años), en 60 (47,2%) se resolvió el BAV; de estos, en 40 (66,6%) el BAV recurrió en los 24 meses de seguimiento medio; 107 pacientes (84,3%) tuvieron indicación de implante de marcapasos pese a suspenderse los FBZ. Las variables asociadas con la necesidad de marcapasos a los 3 años en el multivariable fueron: frecuencia cardiaca<35 lpm (OR=8,12; IC95%, 1,82-36,17); síntomas diferentes del síncope (OR=4,09; IC95%, 1,18-14,13) y QRS ancho (OR=5,65; IC95%, 1,77-18,04). El tratamiento con antiarrítmicos no se asoció con necesidad de marcapasos (OR=0,12; IC95%, 0,02-0,66). CONCLUSIONES: Más del 80% de los pacientes con BAV secundario a FBZ precisan implante de marcapasos a pesar de suspenderlos; los predictores son el QRS ancho, la frecuencia cardiaca <35 lpm y la presentación clínica distinta del síncope


INTRODUCTION AND OBJECTIVES: Atrioventricular block (AVB) in the presence of bradycardic drugs (BD) can be reversible, and pacemaker implantation is controversial. Our objective was to analyze the pacemaker implantation rate in the mid-term, after BD suspension, and to identify predictive factors. METHODS: We performed a cohort study that included patients attending the emergency department with high-grade AVB in the context of BD. We studied the persistence of AVB after BD discontinuation, recurrence in patients with AVB resolution, and the predictive variables associated with pacemaker requirement at 3 years. RESULTS: Of 127 patients included (age, 79 [71-83] years), BAV resolved in 60 (47.2%); among these patients, recurrence occurred during the 24-month median follow-up in 40 (66.6%). Pacemaker implantation was required in 107 patients (84.3%), despite BD discontinuation. On multivariable analysis, the variables associated with pacemaker need at 3 years were heart rate <35 bpm (OR, 8.12; 95%CI, 1.82-36.17), symptoms other than syncope (OR, 4.09; 95%CI, 1.18-14.13), and wide QRS (OR, 5.65; 95%CI, 1.77-18.04). Concomitant antiarrhythmic treatment was associated with AVB resolution (OR, 0.12; 95%CI, 0.02-0.66). CONCLUSIONS: More than 80% of patients with AVB secondary to BD require pacemaker implantation despite drug discontinuation. Predictive variables were wide QRS, heart rate <35 bpm, and clinical presentation other than syncope


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Bloqueio Atrioventricular/terapia , Marca-Passo Artificial/estatística & dados numéricos , Antiarrítmicos/efeitos adversos , Conduta Expectante/tendências , Bloqueio Atrioventricular/induzido quimicamente , Síncope/epidemiologia , Estudos Retrospectivos
7.
Am J Cardiol ; 128: 202-209, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32534734

RESUMO

There are two commercially available transcatheter heart valve systems: balloon expandable valves (BEV) and self-expanding valves (SEV). However, there is a paucity of randomized trials comparing both systems. Electronic databases (Medline, the Cochrane Library, Web of Science, and clinicaltrials.gov) and major conference proceedings were searched for randomized trials of patients with symptomatic severe aortic stenosis and received transcatheter aortic valve implantation (TAVI) with a SEV or BEV or surgical aortic valve replacement. The main efficacy outcomes were all-cause mortality and stroke at the longest available follow-up. The main analysis was performed using a random-effects network meta-analysis complemented by several subgroup and sensitivity analyses. Ten trials with 9,439 patients (mostly undergoing transfemoral TAVI) were included. At a median of 27 months, there was no difference between BEV and SEV valves in terms of all-cause mortality (odds ratio [OR] 1.05, 95% confidence interval [CI] 0.79 to 1.42). The incidence of any stroke was higher with BEV (OR 1.51, 95% CI 1.01 to 2.26), but there was no difference in the incidence of disabling stroke. At 30-days, BEV valves were associated with lower incidence of new permanent pacemaker placement (OR 0.50, 95% CI 0.32 to 0.79) and moderate/severe paravalvular regurgitation (OR 0.39, 95% CI 0.22 to 0.68). In conclusion, in patients with severe symptomatic aortic stenosis undergoing transfemoral TAVI, SEV and BEV were associated with similar all-cause mortality. BEV were associated with a higher incidence of any stroke driven by nondisabling strokes, but lower incidence of new permanent pacemaker placement and moderate/severe paravalvular regurgitation compared with SEV.


Assuntos
Insuficiência da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/cirurgia , Arritmias Cardíacas/epidemiologia , Estimulação Cardíaca Artificial/estatística & dados numéricos , Próteses Valvulares Cardíacas , Complicações Pós-Operatórias/epidemiologia , Desenho de Prótese , Acidente Vascular Cerebral/epidemiologia , Substituição da Valva Aórtica Transcateter/instrumentação , Arritmias Cardíacas/terapia , Causas de Morte , Humanos , Incidência , Mortalidade , Marca-Passo Artificial/estatística & dados numéricos
8.
PLoS One ; 15(6): e0233894, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32479546

RESUMO

BACKGROUND: Transcatheter aortic valve-in-valve (VIV) procedure is a safe alternative to conventional reoperation for bioprosthetic dysfunction. Balloon-expandable valve (BEV) and self-expanding valve (SEV) are the 2 major types of devices used. Evidence regarding the comparison of the 2 valves remains scarce. METHODS: A systematic review and meta-analysis was conducted to compare the outcomes of BEV and SEV in transcatheter VIV for aortic bioprostheses dysfunction. A computerized search of Medline, PubMed, Embase, and Cochrane databases was performed. English-language journal articles reporting SEV or BEV outcomes of at least 10 patients were included. RESULTS: In total, 27 studies were included, with 2,269 and 1,671 patients in the BEV and SEV groups, respectively. Rates of 30-day mortality and stroke did not differ significantly between the 2 groups. However, BEV was associated with significantly lower rates of postprocedural permanent pacemaker implantation (3.8% vs. 12%; P < 0.001). Regarding echocardiographic parameters, SEV was associated with larger postprocedural effective orifice area at 30 days (1.53 cm2 vs. 1.23 cm2; P < 0.001) and 1 year (1.55 cm2 vs. 1.22 cm2; P < 0.001). CONCLUSIONS: For patients who underwent transcatheter aortic VIV, SEV was associated with larger postprocedural effective orifice area but higher rates of permanent pacemaker implantation. These findings provide valuable information for optimizing device selection for transcatheter aortic VIV.


Assuntos
Valva Aórtica/cirurgia , Bioprótese/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Falha de Prótese , Substituição da Valva Aórtica Transcateter/instrumentação , Tomada de Decisão Clínica , Humanos , Marca-Passo Artificial/estatística & dados numéricos , Reoperação/instrumentação , Reoperação/métodos , Substituição da Valva Aórtica Transcateter/métodos , Resultado do Tratamento
10.
Am J Cardiol ; 126: 73-81, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32336533

RESUMO

Recent positive results of transcatheter aortic valve replacement (TAVI) in clinical trials have sparked debate on whether TAVI should be first line for all patients with aortic stenosis. However, limited evidence exists on the clinical impact of TAVI on a national level. Using the national inpatient sample (NIS) of hospital discharges in the United States from 2001 to 2016, we evaluated the rate of AVR and associated in-hospital outcomes in pre-TAVI and TAVI era. Hierarchical mixed effect modeling was used to assess for trend and calculate risk adjusted estimates. Annual volume of AVR increased from 49,357 in 2001 to 100,050 in 2016 (103% increase). Compared with the pre-TAVI era, mean annual change in volume of AVR was higher in the TAVI era (+2.9% vs +9.4%, respectively, p <0.001). In contrast, rate of in-hospital mortality decreased from 5.4% in 2001 to 2.7% in 2016 (50% decrease). Compared with the pre-TAVI era, magnitude of mean annual change in mortality was higher in TAVI era (-4.0% vs -6.7%, respectively, p = 0.04). Unlike SAVR for which risk-adjusted rate for most outcomes seems to have plateaued, TAVI demonstrated significant improvement from 2012 to 2016 for mortality (4.6% to 1.8%), acute kidney injury (15.1% to 2.6%) and nonroutine home discharge (63.6% to 44.6%). However, no significant change in the rate of stroke (2.4% to 2.1%) and pacemaker implantation remained high (8.1% to 9.4%). Lastly, median length of stay was shorter for TAVI compared with isolated SAVR (3 vs 8 days, respectively). In conclusion, the adoption of TAVI has led to increase in volume of AVR for severe aortic stenosis in the United States with favorable short-term outcome.


Assuntos
Estenose da Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/tendências , Substituição da Valva Aórtica Transcateter/tendências , Injúria Renal Aguda/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/mortalidade , Bases de Dados Factuais , Feminino , Implante de Prótese de Valva Cardíaca/mortalidade , Mortalidade Hospitalar/tendências , Humanos , Tempo de Internação/tendências , Masculino , Marca-Passo Artificial/estatística & dados numéricos , Acidente Vascular Cerebral/epidemiologia , Substituição da Valva Aórtica Transcateter/mortalidade , Estados Unidos/epidemiologia
11.
G Ital Cardiol (Rome) ; 21(2): 157-169, 2020 Feb.
Artigo em Italiano | MEDLINE | ID: mdl-32051640

RESUMO

BACKGROUND: The pacemaker (PM) and implantable cardioverter-defibrillator (ICD) Registry of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC) monitors the main epidemiological data in real-world practice. The survey for the 2018 activity collects information about demographics, clinical characteristics, main indications for PM/ICD therapy and device types from the Italian collaborating centers. METHODS: The Registry collects prospectively national PM and ICD implantation activity on the basis of European cards. RESULTS: PM Registry: data about 23 912 PM implantations were collected (20 084 first implants and 3828 replacements). The number of collaborating centers was 180. Median age of treated patients was 81 years (75 quartile I; 86 quartile III). ECG indications included atrioventricular conduction disorders in 34.5% of first PM implants, sick sinus syndrome in 18.3%, atrial fibrillation plus bradycardia in 13.0%, other in 34.2%. Among atrioventricular conduction defects, third-degree atrioventricular block was the most common type (19.2% of first implants). Use of single-chamber PMs was reported in 24.9% of first implants, of dual-chamber PMs in 67.6%, of PMs with cardiac resynchronization therapy (CRT) in 1.6%, and of single lead atrial-synchronized ventricular stimulation (VDD/R PMs) in 5.9%. ICD Registry: data about 18 353 ICD implantations were collected (13 944 first implants and 4359 replacements). The number of collaborating centers was 433. Median age of treated patients was 71 years (63 quartile I; 78 quartile III). Primary prevention indication was reported in 84.3% of first implants, secondary prevention in 15.7% (cardiac arrest in 5.3%). A single-chamber ICD was used in 27.9% of first implants, dual-chamber ICD in 31.9% and biventricular ICD in 40.2%. CONCLUSIONS: The PM and ICD Registry appears fundamental for monitoring PM and ICD utilization on a large national scale with rigorous examination of demographics and clinical indications. The PM Registry showed stable electrocardiographic and symptom indications, with an important prevalence of dual-chamber pacing. The use of CRT-PM regards a very limited number of patients. The ICD Registry documented a large use of prophylactic and biventricular ICD, reflecting a favorable adherence to trials and guidelines in clinical practice. In order to increase and optimize the cooperation of Italian implanting centers, online data entry (http://www.aiac.it/riprid) should be adopted at large scale.


Assuntos
Arritmias Cardíacas/terapia , Terapia de Ressincronização Cardíaca/estatística & dados numéricos , Desfibriladores Implantáveis/estatística & dados numéricos , Marca-Passo Artificial/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/fisiopatologia , Criança , Eletrocardiografia , Feminino , Fidelidade a Diretrizes , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Prevenção Primária/estatística & dados numéricos , Sistema de Registros , Prevenção Secundária/estatística & dados numéricos , Adulto Jovem
12.
PLoS One ; 15(1): e0226188, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31995558

RESUMO

INTRODUCTION: The aim of our study was to perform an economic assessment in order to check whether or not telemonitoring of users with pacemakers offers a cost-effective alternative to traditional follow-up in outpatient clinics. METHODS: We used effectiveness and cost data from the NORDLAND trial, which is a controlled, randomized, non-masked clinical trial. Fifty patients were assigned to receive either telemonitoring (TM; n = 25) or conventional monitoring (CM; n = 25) and were followed up for 12 months after the implantation. A cost-utility analysis was performed in terms of additional costs per additional Quality-Adjusted Life Year (QALY) attained from the perspectives of the Norwegian National Healthcare System and patients and their caregivers. RESULTS: Effectiveness was similar between alternatives (TM: 0.7804 [CI: 0.6864 to 0.8745] vs. CM: 0.7465 [CI: 0.6543 to 0.8387]), while cost per patient was higher in the RM group, both from the Norwegian NHS perspective (TM: €2,079.84 [CI: 0.00 to 4,610.58] vs. €271.97 [CI: 158.18 to 385.76]; p = 0.147) and including the patient/family perspective (TM: €2,295.91 [CI: 0.00 to 4,843.28] vs. CM: €430.39 [CI: 0.00 to 4,841.48]), although these large differences-mainly due to a few patients being hospitalized in the TM group, as opposed to none in the CM group-did not reach statistical significance. The Incremental Cost-Effectiveness Ratio (ICER) from the Norwegian NHS perspective (€53,345.27/QALY) and including the patient/caregiver perspective (€55,046.40/QALY), as well as the Incremental Net Benefit (INB), favors the CM alternative, albeit with very broad 95%CIs. The probabilistic analysis confirmed inconclusive results due to the wide CIs even suggesting that TM was not cost-effective in this study. Supplemental analysis excluding the hospitalization costs shows positive INBs, whereby suggesting a discrete superiority of the RM alternative if hospitalization costs were not considered, albeit also with broad CIs. CONCLUSIONS: Cost-utility analysis of TM vs. CM shows inconclusive results because of broad confidence intervals with ICER and INB figures ranging from potential savings to high costs for an additional QALY, with the majority of ICERs being above the usual NHS thresholds for coverage decisions. TRIAL REGISTRATION: ClinicalTrials.gov NCT02237404.


Assuntos
Análise Custo-Benefício , Hospitais/estatística & dados numéricos , Marca-Passo Artificial/economia , Marca-Passo Artificial/estatística & dados numéricos , Qualidade de Vida , Telemedicina/economia , Telemedicina/estatística & dados numéricos , Idoso , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida
13.
Cardiology ; 145(1): 27-34, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31722361

RESUMO

AIMS: Permanent pacemaker (PPM) implantation is one of the most common complications after transcatheter aortic valve replacement (TAVR). We studied the incidence of PPM implantation and identified the predictors in patients who underwent TAVR in a Chinese population. METHODS AND RESULTS: A total of 256 patients who underwent TAVR with self-expandable valves were included. The incidence of PPM implantation in our study population was 14.8%. In patients who received PPM implantation, the proportion of bicuspid aortic valve (BAV) patients was much lower compared to tricuspid aortic valve (TAV) patients (18.4 vs. 81.6%, p < 0.05). Patients with BAV were associated with a significantly lower PPM implantation rate and shallower implantation depth compared to patients with TAV (6.4 vs. 21.7% and 4.2 ± 4.4 vs. 6.2 ± 5.0 mm, respectively, p < 0.05 for both). In the multivariable logistic regression analysis, prior right bundle branch block (RBBB; OR 8.3, 95% CI 2.2-32.1, p < 0.05), implantation depth (OR 1.3, 95% CI 1.1-1.5, p = 0.01), and TAV (OR 4.7, 95% CI 1.5-14.4, p < 0.05) were independent predictors of PPM implantation after TAVR. There was no difference in 30-day and 1-year all-cause mortality between the 2 groups. CONCLUSIONS: The incidence of PPM implantation in patients with self-expandable valves after TAVR was 14.8% in our cohort study. Independent predictors of PPM implantation included prior RBBB, TAV, and implantation depth at the noncoronary sinus side. TAVR in BAV with a supra-annular structure-based sizing strategy might decrease the risk of PPM implantation.


Assuntos
Estenose da Valva Aórtica/terapia , Arritmias Cardíacas/terapia , Estimulação Cardíaca Artificial/efeitos adversos , Marca-Passo Artificial/estatística & dados numéricos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/fisiopatologia , Arritmias Cardíacas/mortalidade , Arritmias Cardíacas/fisiopatologia , Estimulação Cardíaca Artificial/mortalidade , China/epidemiologia , Eletrocardiografia , Feminino , Próteses Valvulares Cardíacas , Humanos , Incidência , Modelos Logísticos , Masculino , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco , Substituição da Valva Aórtica Transcateter/instrumentação , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do Tratamento
14.
Geriatr Gerontol Int ; 20(2): 106-111, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31820544

RESUMO

AIM: With increasing lifespans, patients requiring a pacemaker are older than they were in the past. Data regarding all-cause mortality in older patients implanted with a pacemaker are scarce. As physical activity is associated with a decrease in all-cause mortality, we investigated whether daily physical activity time, expressed as the activity rate determined by pacemakers, can predict all-cause mortality in older patients (aged ≥75 years) with a pacemaker. METHODS: We retrospectively investigated the baseline characteristics, echocardiographic indices, laboratory data and pacemaker parameters of 107 consecutive older patients with a newly implanted pacemaker at our hospital (age 83.8 ± 5.0 years; 54.2% men). The study end-point was all-cause mortality. RESULTS: During the follow-up period (mean 3.0 years), 21 cases of all-cause death were reported. The area under the receiver operating characteristic curve for activity rate to predict all-cause mortality was 0.82 (95% confidence interval 0.72-0.92, P < 0.001). An activity rate of 3.4% (50 min/day) had a sensitivity of 86.0% and a specificity of 66.7% for predicting all-cause mortality. The survival rate was significantly higher among patients with an activity rate ≥3.4% than among those with an activity rate <3.4% (log-rank, P < 0.001). A multivariate Cox regression analysis identified low activity rates as a predictor of all-cause mortality (hazard ratio 15.0, 95% confidence interval 4.29-52.6; P < 0.001). CONCLUSIONS: Low activity rates appear to be a strong predictor of all-cause mortality in older patients with a pacemaker. Geriatr Gerontol Int 2020; 20: 106-111.


Assuntos
Exercício Físico , Marca-Passo Artificial/estatística & dados numéricos , Acelerometria , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Ecocardiografia , Feminino , Humanos , Japão , Masculino , Análise Multivariada , Modelos de Riscos Proporcionais , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida
15.
Radiol Med ; 125(3): 329-335, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31832987

RESUMO

INTRODUCTION: The management of patients bearing a cardiac implantable electronic device and needing a radiotherapy treatment is an important clinical scenario. The aim of this survey was to evaluate the level of awareness within the Italian Radiation Oncologist community on this topic. MATERIALS AND METHODS: A survey was promoted by the Young Group of Italian Association of Radiotherapy and Clinical Oncology (AIRO) with a questionnaire made up of 22 questions allowing for multiple answers, which was administered, both online and on paper version. It was addressed to Radiation Oncologists, AIRO members, participating in the National Congress held in 2015. RESULTS: A total of 113 questionnaires were collected back and analyzed (survey online: 50 respondents; paper version: 63). The answers showed a good level of awareness on the issue, but with a nonhomogeneous adherence to the different published guidelines (GL). There is a general low rate of referral for a preliminary cardiological evaluation in patients bearing PM/ICDs, in line with some published surveys; nevertheless, a focused attention to certain specific treatment factors and patient-centered point of view emerged. CONCLUSIONS: A generally good awareness of this topic was shown but homogeneous application of GL was not observed, possibly due to the multiplicity of available GL. A prospective data collection could help to better clarify the shadows on this topics.


Assuntos
Desfibriladores Implantáveis , Fidelidade a Diretrizes , Marca-Passo Artificial , Radioterapia (Especialidade) , Radioterapia , Adulto , Desfibriladores Implantáveis/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Itália , Marca-Passo Artificial/estatística & dados numéricos , Doses de Radiação , Radioterapia (Especialidade)/estatística & dados numéricos , Sociedades Médicas
17.
Am Heart J ; 218: 128-132, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31806088

RESUMO

New-onset left bundle branch block (N-LBBB) after transcatheter aortic valve replacement (TAVR) is a challenging clinical dilemma. In our single-center study, 60 out of 172 patients who underwent permanent pacemaker implantation (PPM) after TAVR had N-LBBB (34.9%). At a median follow-up duration of 357 days (IQR, 178; 560 days), two patients (3.5%) were completely pacemaker-dependent, and four others (7%) were partially dependent. Twelve patients (24%) recovered conduction in their left bundle at a median follow-up duration of 5 weeks (IQR, 4; 14 weeks). Due to the lack of clinical predictors of pacemaker dependency, active surveillance is warranted and may be an alternative to permanent pacemaker implantation.


Assuntos
Bloqueio de Ramo/terapia , Marca-Passo Artificial , Complicações Pós-Operatórias/terapia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Bloqueio de Ramo/etiologia , Bloqueio de Ramo/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Marca-Passo Artificial/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Implantação de Prótese/estatística & dados numéricos , Recuperação de Função Fisiológica , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/estatística & dados numéricos , Resultado do Tratamento
18.
J Interv Cardiol ; 2019: 1906814, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31772515

RESUMO

Objectives: The purpose of this study was to compare the efficacy and safety of the Evolut PRO to the Evolut R valve in a real-world setting. Background: The next-generation self-expanding transcatheter aortic valve replacement (TAVR) system, the CoreValve Evolut PRO was designed with an outer pericardial skirt to improve valve-sealing performance. Safety and efficacy of this valve have not previously been compared to its predecessor, the Evolut R valve. Methods: We retrospectively studied 134 patients who underwent TAVR with the Evolut PRO or Evolut R valve over one year at a tertiary center. Endpoints, defined by the Valve Academic Research Consortium-2 criteria, included device success, paravalvular leak (PVL), and a composite safety endpoint including mortality, stroke, major vascular complications, life-threatening bleeding, acute kidney injury, coronary artery obstruction, and repeat procedure for valve-related dysfunction. Results: 60 Evolut PRO and 56 Evolut R patients met the study criteria. Both groups had similar device success rates (90 vs. 89%, p=0.44). Incidence of moderate PVL was similar on discharge (5 vs. 11%, p=0.68) and at 30 days (11 vs. 13%, p=0.79), with nil incidence of severe PVL. There were no mortalities, and the VARC-2 safety endpoint at 30 days was comparable. Conclusion: Despite the additional pericardial skirt and larger sheath size of Evolut PRO, outcomes were comparable between the two Evolut systems, supporting adoption of the newest generation valve in the management of severe aortic stenosis as well as continued use of the Evolut R in patients with smaller vasculature warranting a lower profile device.


Assuntos
Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter/instrumentação , Injúria Renal Aguda/epidemiologia , Idoso de 80 Anos ou mais , Valvuloplastia com Balão/estatística & dados numéricos , Feminino , Hemorragia/epidemiologia , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Marca-Passo Artificial/estatística & dados numéricos , Complicações Pós-Operatórias , Desenho de Prótese , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia , Substituição da Valva Aórtica Transcateter/métodos
19.
J Am Coll Cardiol ; 74(21): 2607-2620, 2019 11 26.
Artigo em Inglês | MEDLINE | ID: mdl-31753204

RESUMO

BACKGROUND: Risk factors for post-operative conduction disturbances after cardiac valve surgery requiring a permanent pacemaker (PPM) are poorly characterized. OBJECTIVES: The aim of this study was to investigate the timing and risk factors for PPM implantation after mitral or aortic valve surgery. METHODS: All patients who underwent open aortic or mitral valve surgery between January 1996 and December 2014 were reviewed using New York State's mandatory hospital discharge database. Patients with prior cardiac surgery or pre-existing PPM were excluded. The primary endpoint was PPM implantation within 1 year. RESULTS: Among 77,882 patients, 63.8% (n = 49,706) underwent aortic valve replacement (AVR), 18.9% (n = 14,686) underwent mitral valve replacement (MVR), 10.5% (n = 8,219) underwent mitral valve repair (MVr), 5.4% (n = 4,202) underwent AVR plus MVR, and 1.4% (n = 1,069) underwent AVR plus MVr. The 1-year PPM implantation rate was 4.5% after MVr, 6.6% after AVR, 9.3% after AVR plus MVr, 10.5% after MVR, and 13.3% after AVR plus MVR (p < 0.001). Across all groups, the majority of PPMs were implanted during the index hospitalization (79.9%). MVr was associated with the lowest risk for PPM and AVR plus MVR with the highest risk. Older age, history of arrhythmias, pre-operative conduction disturbances, and concomitant index procedures were associated with increased risk for PPM during the index hospitalization. Conversely, beyond 30 days, chronic comorbidities were associated with increased risk for PPM. CONCLUSIONS: Conduction disturbances requiring PPM remain a common adverse event after valve surgery. Identifying patients at risk for PPM will help facilitate perioperative planning and inform clinical decision making regarding post-operative rhythm surveillance.


Assuntos
Valva Aórtica/cirurgia , Procedimentos Cirúrgicos Cardíacos/mortalidade , Valva Mitral/cirurgia , Marca-Passo Artificial/estatística & dados numéricos , Complicações Pós-Operatórias/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Estudos Retrospectivos , Fatores de Risco
20.
Pacing Clin Electrophysiol ; 42(12): 1534-1540, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31677175

RESUMO

BACKGROUND: Aortic stenosis is currently the most frequently occurring valve pathology. Developments, such as transcatheter prostheses and rapid deployment prostheses, allow for the offer of a valve replacement to higher risk patients, but these techniques are linked with a higher need for a permanent pacemaker during the immediate postoperative period. METHODS: We studied the incidence and the factors associated with permanent pacemaker implantation after aortic valve replacement with Edwards Intuity rapid deployment prosthesis. RESULTS: Between October 2012 and December 2016, the Edwards Intuity prosthesis was implanted in 71 patients (68% male, 75.3 ± 5 years old). Six patients (8%) required a permanent pacemaker during immediate postoperative period. Univariate analysis showed that a history of acute myocardial infarction (AMI) (P = .046, B = 7.5, 95% CI [1.039-54.1]) and preoperative amiodarone (P = .009, B = 31.5; 95% CI [2.32-426]) were associated with a higher need for a pacemaker during the postoperative period. CONCLUSIONS: The incidence of permanent pacemaker implantation during the immediate postoperative period of aortic valve replacement with Edwards Intuity prosthesis was 8%, a value which is within the limits reported for conventional aortic prostheses. Preoperative amiodarone treatment and previous AMI may increase the need for a pacemaker during the postoperative period of these aortic prostheses.


Assuntos
Estenose da Valva Aórtica/cirurgia , Marca-Passo Artificial/estatística & dados numéricos , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Masculino , Período Pós-Operatório , Estudos Prospectivos , Esternotomia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...