Infection-related complications in patients with end stage renal failure dialyzed through a permanent catheter

Objectives Progression of renal failure leads to an increase in the number of patients who require forming dialysis access. Old age and a rising morbidity make it impossible to form a native arteriovenous fistula and a permanent catheter becomes the first choice. The presence of a catheter frequently generates complications, including infections, which may result in a higher mortality rate. Patients and methods A retrospective analysis data has been conducted, involving 398 patients who had permanent catheters implanted from 2010 to 2016. Out of this group, 65 patients who suffered infection-related complications have been identified. Risk factors for infection and a survival rate of the population have been estimated. Results Between 2010 and 2016, 495 catheters were implanted for 398 patients aged 68.73(13.26) years on average. 92 catheter-related infections (23.1%) were recorded in 65 patients. A higher risk of infection has been noted among younger patients, with coronary disease and heart failure. Patients affected by infection had 35.38% survivability as against 38.14% for those with no infection: p= 0.312. A higher mortality risk was identified among patients suffering catheter-related infections with cardiac implants and vascular prostheses. Unfavourable prognosis was for infections occurring together with hypotension, high leucocytosis, a low number of platelets and a high leukocyte/platelet ratio. Conclusion Dialysis patients who use permanent catheters run a high risk of infection-related complications, especially younger patients suffering from coronary conditions and heart failure. Severe catheter-related infections lead to a high mortality rate, therefore it is necessary to limit this form of access

Tako-tsubo cardiomyopathy as a recurrent disease with doubtful prognosis of recovery and heterogenic symptoms

Tako-tsubo cardiomyopathy, known since 1990, is described as hypo/akinesis of apical heart segments with the hyperkinesis of the basis of the heart which mimics the shape of a traditional Japanese octopus trap. (Cardiol J 2012; 19, 5: 521-523

To grade or not to grade the application of safety requirements for transvenous lead extraction: Experience with 2216 procedures

Background: Transvenous lead extraction (TLE) procedures are now increasingly safe, but there is still a risk of major complications (MC). Aims: Assessment of the impact of the organization of TLE on the safety of procedures. Methods: We analyzed 2216 TLE preformed in two centers in years 2006‒2021 and compared three organizational models of  procedure: (1) TLE in electrophysiology laboratory (EP-LAB) with intravenous analgesia/sedation;  (2) TLE with the grading of safety requirements (high-risk patients in the cardiac surgery operating theatre, the remained in EP-LAB); (3) TLE in the hybrid room in all patients under general anaesthesia with transoesophageal echocardiographic (TEE) monitoring. The safety of procedures and mortality after TLE in three-year follow-up were assessed. Results: The rate of MC in EP-lab was 1.55% and the rate of procedure-related deaths (PRD) was 0.33%. Using the graded approach to safety requirements, the percentage of MC was 2.61% and PRD 0.29%. When performing TLE procedures in the hybrid room, the MC percentage was 1.33% and PRD 0.00%. Long-term survival after TLE was comparable in all study groups. Conclusions: A key factor in preventing TLE-related deaths is an organization of procedure that enables emergency cardiac surgery. TLE performed in a hybrid room with cardiac surgeon in collaboration and vital signs monitoring appears to be the safest possible option for the patient.  A graded safety approach is associated with the risk of unexpected MC and PRD. Any newly established TLE center can achieve satisfactory results if optimal organizational model of the procedure is used

Discontinuation of cardiac implantable electronic device therapy after transvenous lead extraction

Background: Patients with cardiac implantable electronic devices (CIEDs) may no longer be eligible for continued therapy.Aims: The study aimed to assess the circumstances under which CIED reimplantation may not be necessary after transvenous lead extraction (TLE).Methods: A retrospective analysis of 3646 TLE procedures was performed with assessment of indications for device reimplantation.Results: Reimplantation was not performed immediately after TLE in 169 (4.6%) and, in long-term follow-up, in 146 (4.0%) of patients. No further need for CIED reimplantation was mostly associated with establishment of stable sinus rhythm (2.4%), conversion of sinus node dysfunction to chronic atrial fibrillation (AF; 1.4%), or improvement in left ventricular ejection fraction (LVEF) (0.9%). Independent prognostic factors were in the pacing groups: LVEF (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01–1.05; P <0.001), AF (OR, 3.8; 95% CI, 2.4–15.7; P <0.001), patients’ age during first CIED implantation (OR, 0.97; 95% C, 0.96–0.98; P <0.001), and New York Heart Association (NYHA) class (OR, 0.616; 95% CI, 0.43–0.86; P <0.01); in the cardioverter-defibrillator group: LVEF (OR, 1.06; 95% CI, 1.04–1.09; P <001). Non-reimplanted patients had more complex procedures and more frequent complications, but survival after TLE was better in this group of patients.Conclusions: Reassessment of the need for continuation of CIED therapy should be considered in all patients following lead extraction and also before planned device replacement as TLE delay increases implant duration, complexity, and procedural risk. The predictors of non-reimplantation are a younger age during the first CIED implantation, lower NYHA class, presence of AF, and higher LVEF in pacemaker carriers, and, in the defibrillator group, only higher LVEF. A decision not to reimplant does not negatively affect the long-term prognosis

Characterization of patients with pulmonary arterial hypertension : data from the polish registry of pulmonary hypertension (BNP-PL)

Current knowledge of pulmonary arterial hypertension (PAH) epidemiology is based mainly on data from Western populations, and therefore we aimed to characterize a large group of Caucasian PAH adults of Central-Eastern European origin. We analyzed data of incident and prevalent PAH adults enrolled in a prospective national registry involving all Polish PAH centers. The estimated prevalence and annual incidence of PAH were 30.8/mln adults and 5.2/mln adults, respectively and they were the highest in females ≥65 years old. The most frequent type of PAH was idiopathic (n = 444; 46%) followed by PAH associated with congenital heart diseases (CHD-PAH, n = 356; 36.7%), and PAH associated with connective tissue disease (CTD-PAH, n = 132; 13.6%). At enrollment, most incident cases (71.9%) were at intermediate mortality risk and the prevalent cases had most of their risk factors in the intermediate or high risk range. The use of triple combination therapy was rare (4.7%). A high prevalence of PAH among older population confirms the changing demographics of PAH found in the Western countries. In contrast, we found: a female predominance across all age groups, a high proportion of patients with CHD-PAH as compared to patients with CTD-PAH and a low use of triple combination therapy