19 research outputs found
Prediction of paravalvular leakage after transcatheter aortic valve implantation
Significant paravalvular leakage (PVL) after transcatheter aortic valve implantation (TAVI) is related to patient mortality. Predicting the development of PVL has focused on computed tomography (CT) derived variables but literature targeting CoreValve devices is limited, controversial, and did not make use of standardized echocardiographic methods. The study included 164 consecutive patients with severe aortic stenosis that underwent TAVI with a Medtronic CoreValve system©, with available pre-TAVI CT and pre-discharge transthoracic echocardiography. The predictive value for significant PVL of the CT-derived Agatston score, aortic annulus size and eccentricity, and “cover index” was assessed, according to both echocardiographic Valve Academic Research Consortium (VARC) criteria and angiographic Sellers criteria. Univariate predictors for more than mild PVL were the maximal diameter of the aortic annulus size (for both angiographic and echocardiographic assessment of PVL), cover index (for echocardiographic assessment of PVL only), and Agatston score (for both angiographic and echocardiographic assessment of PVL). The aortic annulus eccentricity index was not predicting PVL. At multivariate analysis, Agatston score was the only independent predictor for both angiographic and echocardiographic assessment of PVL. Agatston score is the only independent predictor of PVL regardless of the used imaging technique for the definition of PVL
Incidence of hypo- and hyper-capnia in a cross-sectional European cohort of ventilated newborn infants.
peer reviewedOBJECTIVE: To determine the incidence of hypo- and hyper-capnia in a European
cohort of ventilated newborn infants. DESIGN AND SETTING: Two-point
cross-sectional prospective study in 173 European neonatal intensive care units.
PATIENTS AND METHODS: Patient characteristics, ventilator settings and
measurements, and blood gas analyses were collected for endotracheally ventilated
newborn infants on two separate dates. RESULTS: A total of 1569 blood gas
analyses were performed in 508 included patients with a mean+/-SD Pco2 of 48+/-12
mm Hg or 6.4+/-1.6 kPa (range 17-104 mm Hg or 2.3-13.9 kPa). Hypocapnia (Pco2<30
mm Hg or 4 kPa) and hypercapnia (Pco2>52 mm Hg or 7 kPa) was present in,
respectively, 69 (4%) and 492 (31%) of the blood gases. Hypocapnia was most
common in the first 3 days of life (7.3%) and hypercapnia after the first week of
life (42.6%). Pco2 was significantly higher in preterm infants (49 mm Hg or 6.5
kPa) than term infants (43 mm Hg or 5.7 kPa) and significantly lower during
pressure-limited ventilation (47 mm Hg or 6.3+/-1.6 kPa) compared with
volume-targeted ventilation (51 mm Hg or 6.8+/-1.7 kPa) and high-frequency
ventilation (50 mm Hg or 6.7+/-1.7 kPa). CONCLUSIONS: This study shows that
hypocapnia is a relatively uncommon finding during neonatal ventilation. The
higher incidence of hypercapnia may suggest that permissive hypercapnia has found
its way into daily clinical practice