12 research outputs found
Valvotomia mitral com cateter balĂŁo
Orientadores : Eduardo A. Nogueira, Siguemituzo ArieTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: 1. Objetivo: o objetivo deste estudo foi mostrar as caracterĂsticas
clĂnicas, radiolĂłgicas, eletrocardiográficas, ecocardiográficas e hemodinâmicas dos pacientes que obtiveram sucesso (G-A) ou
insucesso (G-B) atravĂ©s da valvotomia mitral com cateter balĂŁo (VMCB), avaliar os dados evolutivos, comentar as complicações ocorridas e tambĂ©m a ultilização do procedimento em pacientes grávidas. 2. CasuĂstica e mĂ©todos: De janeiro de, 1988 a julho de 1990, 50 pacientes foram
submetidos à VMCB. A idade variou de 16 a 73 anos, média de
36,3 ! 13,3 anos. Quarenta e cinco (88%) eram do sexo feminino,
sendo 7 (14%) gestantes com idade gestacional média de 24,6 +-
9,5 semanas. Foram selecionados para o procedimento pacientes com
área valvar menor que 1,5cm2, sem história pregressa de
tromboembolismo, sem evidências de trombo em átrio esquerdo e
sem outras lesões valvares cirĂşrgicas associadas. Os pacientes foram submetidos Ă avaliação clĂnica, radiolĂłgica, eletrocardiográfica, ecocardiográfica e hemodinâmica antes, imediatamente apĂłs a VMCB e no controle evolutivo que variou de 3 a 33 meses. A VMCB foi realizada pela tĂ©cnica anterĂłgrada por punção do septo interatrial ÂżObservação: O resumo, na Ăntegra poderá ser visualizado no texto completo da tese digital.Abstract: 1. Purpose: The purpose of this investigation was to analyse
clinical, radiologic, eletrocardiographic, echocardiographic
and hemodynamic caracteristics of the patients that underwent mitral balloon valvotomy,assess the follow-up data,comment the complications and its usefullness in pregnant women. 2. patients and Methods: We studied the data from 50 patients that underwent mitral balloon valvotomy from January 1988 to July 1990. The mean age was 36.3f13.3 years, ranging from 16 to 73 years. Forty-five (88%) were women, seven (14%) were pregnant with mean gestational age of 24.6 +- 9.5 weeks. The selected patients had mitral valve area less than 1.5cm2 and no previous stroke, no evidence of left atrial thrombus or other significant cardiac valve disease. Clinical examination, eletrocardiographic, radiologic, echocardiographic and hemodynamic evaluation were performed before and immediately after valvotomy and in the follow-up period that ranged from 3 to 33 months. Mitral balloon valvotomy was performed by transeptal technique ...Note: The complete abstract is available with the full electronic digital thesis or dissertations.DoutoradoDoutor em CiĂŞncias MĂ©dica
Obstrucao Coronaria apos Implante por Cateter de Protese Valvar Aortica
Fundamentos: O implante por cateter de bioprĂłtese valvar aĂłrtica (TAVI) consolidou-se como alternativa para o tratamento de pacientes com estenose aĂłrtica importante de alto risco cirĂşrgico. Contudo, há poucos dados na literatura com respeito Ă obstrução coronária que, apesar de rara, trata-se de grave complicação do TAVI. Objetivo: Avaliar, no contexto brasileiro, a presença dessa importante complicação. MĂ©todos: Foram avaliados todos os casos de obstrução coronária incluĂdos no Registro Brasileiro de TAVI. Foram coletados dados clĂnicos, do procedimento, do manejo e de evolução intra-hospitalar. Resultados: Entre 418 pacientes consecutivos do registro, ocorreram trĂŞs casos de obstrução coronária (incidĂŞncia de 0,72%). Em sua totalidade, os pacientes eram do sexo feminino, sem cirurgia de revascularização miocárdica (CRM) prĂ©via, com idade mĂ©dia de 85 ± 3 anos, EuroSCORE logĂstico de 15 ± 6% e STS de 9 ± 4%. Todos os casos foram realizados com a válvula balĂŁo-expansĂvel Sapien XT. Em um dos pacientes, com dados de tomografia computadorizada prĂ©-procedimento, verificaram-se origem das artĂ©rias coronárias baixa e seio de Valsalva estreito. Todos os pacientes apresentaram-se clinicamente com hipotensĂŁo importante e mantida, imediatamente apĂłs o implante da válvula, e, apesar de angioplastia com implante de stent, todos os pacientes foram a Ăłbito, sendo dois periprocedimento e um durante hospitalização. ConclusĂŁo: A obstrução coronária como complicação do TAVI, apesar de rara, Ă© potencialmente fatal, podendo ocorrer mais frequentemente em mulheres e com as prĂłteses expansĂveis por balĂŁo. Fatores anatĂ´micos podem estar relacionados com sua ocorrĂŞncia, ressaltando-se a importância de boa avaliação prĂ©-procedimento no sentido de evitar essa grave complicação
Temporal Trends, Characteristics, and Outcomes of Infective Endocarditis After Transcatheter Aortic Valve Replacement.
Procedural improvements combined with the contemporary clinical profile of patients undergoing transcatheter aortic valve replacement (TAVR) may have influenced the incidence and outcomes of infective endocarditis (IE) following TAVR. We aimed to determine the temporal trends, characteristics, and outcomes of IE post-TAVR. Observational study including 552 patients presenting definite IE post-TAVR. Patients were divided in 2 groups according to the timing of TAVR (historical cohort [HC]: before 2014; contemporary cohort [CC]: after 2014). Overall incidence rates of IE were similar in both cohorts (CC vs HC: 5.45 vs 6.52 per 1000 person-years; P = .12), but the rate of early IE was lower in the CC (2.29‰ vs 4.89‰, P < .001). Enterococci were the most frequent microorganism. Most patients presented complicated IE ( CC: 67.7%; HC: 69.6%; P = .66), but the rate of surgical treatment remained low (CC: 20.7%; HC: 17.3%; P = .32). The CC exhibited lower rates of in-hospital acute kidney injury (35.1% vs 44.6%; P = .036) and in-hospital (26.6% vs 36.4%; P = .016) and 1-year (37.8% vs 53.5%; P < .001) mortality. Higher logistic EuroScore, Staphylococcus aureus etiology, and complications (stroke, heart failure, and acute renal failure) were associated with in-hospital mortality in multivariable analyses (P < .05 for all). Although overall IE incidence has remained stable, the incidence of early IE has declined in recent years. The microorganism, high rate of complications, and very low rate of surgical treatment remained similar. In-hospital and 1-year mortality rates were high but progressively decreased over time
Temporal Trends, Characteristics, and Outcomes of Infective Endocarditis After Transcatheter Aortic Valve Replacement
BACKGROUND
Procedural improvements combined with the contemporary clinical profile of patients undergoing transcatheter aortic valve replacement (TAVR) may have influenced the incidence and outcomes of infective endocarditis (IE) following TAVR. We aimed to determine the temporal trends, characteristics, and outcomes of IE post-TAVR.
METHODS
Observational study including 552 patients presenting definite IE post-TAVR. Patients were divided in 2 groups according to the timing of TAVR (historical cohort [HC]: before 2014; contemporary cohort [CC]: after 2014).
RESULTS
Overall incidence rates of IE were similar in both cohorts (CC vs HC: 5.45 vs 6.52 per 1000 person-years; P = .12), but the rate of early IE was lower in the CC (2.29‰ vs 4.89‰, P < .001). Enterococci were the most frequent microorganism. Most patients presented complicated IE ( CC: 67.7%; HC: 69.6%; P = .66), but the rate of surgical treatment remained low (CC: 20.7%; HC: 17.3%; P = .32). The CC exhibited lower rates of in-hospital acute kidney injury (35.1% vs 44.6%; P = .036) and in-hospital (26.6% vs 36.4%; P = .016) and 1-year (37.8% vs 53.5%; P < .001) mortality. Higher logistic EuroScore, Staphylococcus aureus etiology, and complications (stroke, heart failure, and acute renal failure) were associated with in-hospital mortality in multivariable analyses (P < .05 for all).
CONCLUSIONS
Although overall IE incidence has remained stable, the incidence of early IE has declined in recent years. The microorganism, high rate of complications, and very low rate of surgical treatment remained similar. In-hospital and 1-year mortality rates were high but progressively decreased over time
Perivalvular Extension of Infective Endocarditis after Transcatheter Aortic Valve Replacement.
BACKGROUND
Infective endocarditis (IE) following transcatheter aortic valve replacement (TAVR) has been associated with a dismal prognosis. However, scarce data exist on IE perivalvular extension (PEE) in such patients.
METHODS
This multicenter study included a total of 579 patients who had the diagnosis of definite IE at a median of 171 (53-421) days following TAVR. PEE was defined as the presence of an intracardiac abscess, pseudoaneurysm or fistula confirmed by transthoracic/transophageal echocardiography, computed tomography or peri-operative findings.
RESULTS
A total of 105 patients (18.1%) were diagnosed with PEE (perivalvular abscess, pseudoaneurysm, fistula, or a combination in 87, 7, 7, and 4 patients, respectively). A history of chronic kidney disease (ORadj: 2.08; 95% CI: [1.27-3.41], p=0.003) and IE secondary to coagulase-negative staphylococci (ORadj: 2.71; 95% CI: [1.57-4.69], p<0.001) was associated with an increased risk of PEE. Surgery was performed at index IE episode in 34 patients (32.4%) with PEE (vs. 15.2% in patients without PEE, p<0.001). In-hospital and 2-year mortality rates among PEE-IE patients were 36.5% and 69.4%, respectively. Factors independently associated with an increased mortality risk were the occurrence of other complications (stroke post-TAVR, acute renal failure, septic shock) and the lack of surgery at index IE hospitalization (padj<0.05 for all).
CONCLUSION
PEE occurred in about one fifth of IE post-TAVR patients, with the presence of coagulase-negative staphylococci and chronic kidney disease determining an increased risk. Patients with PEE-IE exhibited very high early and late mortality rates, and surgery during IE hospitalization seemed to be associated with better outcomes
Mitral Valve Infective Endocarditis after Trans-Catheter Aortic Valve Implantation.
Scarce data exist on mitral valve (MV) infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI). This multicenter study included a total of 579 patients with a diagnosis of definite IE after TAVI from the IE after TAVI International Registry and aimed to evaluate the incidence, characteristics, management, and outcomes of MV-IE after TAVI. A total of 86 patients (14.9%) had MV-IE. These patients were compared with 284 patients (49.1%) with involvement of the transcatheter heart valve (THV) only. Two factors were found to be associated with MV-IE: the use of self-expanding valves (adjusted odds ratio 2.49, 95% confidence interval [CI] 1.23 to 5.07, p = 0.012), and the presence of an aortic regurgitation ≥2 at discharge (adjusted odds ratio 3.33; 95% CI 1.43 to 7.73, p <0.01). There were no differences in IE timing and causative microorganisms between groups, but surgical management was significantly lower in patients with MV-IE (6.0%, vs 21.6% in patients with THV-IE, p = 0.001). All-cause mortality rates at 2-year follow-up were high and similar between patients with MV-IE (51.4%, 95% CI 39.8 to 64.1) and patients with THV-IE (51.5%, 95% CI 45.4 to 58.0) (log-rank p = 0.295). The factors independently associated with increased mortality risk in patients with MV-IE were the occurrence of heart failure (adjusted p <0.001) and septic shock (adjusted p <0.01) during the index hospitalization. One of 6 IE episodes after TAVI is localized on the MV. The implantation of a self-expanding THV and the presence of an aortic regurgitation ≥2 at discharge were associated with MV-IE. Patients with MV-IE were rarely operated on and had a poor prognosis at 2-year follow-up
Infective Endocarditis Caused by Staphylococcus aureus After Transcatheter Aortic Valve Replacement.
BACKGROUND
Staphylococcus aureus (SA) has been extensively studied as causative microorganism of surgical prosthetic-valve infective endocarditis (IE). However, scarce evidence exists on SA IE after transcatheter aortic valve replacement (TAVR).
METHODS
Data were obtained from the Infectious Endocarditis After TAVR International Registry, including patients with definite IE after TAVR from 59 centres in 11 countries. Patients were divided into 2 groups according to microbiologic etiology: non-SA IE vs SA IE.
RESULTS
SA IE was identified in 141 patients out of 573 (24.6%), methicillin-sensitive S aureus in most cases (115/141, 81.6%). Self-expanding valves were more common than balloon-expandable valves in patients with early SA IE. Major bleeding and sepsis complicating TAVR, neurologic symptoms or systemic embolism at admission, and IE with cardiac device involvement other than the TAVR prosthesis were associated with SA IE (P < 0.05 for all). Among post-TAVR patients with IE, the likelihood of SA IE increased from 19% in the absence of those risk factors to 84.6% if ≥ 3 risk factors were present. In-hospital (47.8% vs 26.9%; P < 0.001) and 2-year (71.5% vs 49.6%; P < 0.001) mortality rates were higher among patients with SA IE vs non-SA IE. Surgery at the time of index SA IE was associated with a lower mortality rate at follow-up (adjusted hazard ratio 0.46, 95% CI 0.22-0.96; P = 0.038).
CONCLUSIONS
SA IE represented approximately 25% of IE cases after TAVR and was associated with very high in-hospital and late mortality. The presence of some features determined a higher likelihood of SA IE and could help to orientate early antibiotic regimen selection. Surgery at index SA IE was associated with improved outcomes, and its role should be evaluated in future studies
Surgical Treatment of Patients With Infective Endocarditis After Transcatheter Aortic Valve Implantation
International audienceBackground: The optimal treatment of patients developing infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is uncertain.Objectives: The goal of this study was to investigate the clinical characteristics and outcomes of patients with TAVI-IE treated with cardiac surgery and antibiotics (IE-CS) compared with patients treated with antibiotics alone (IE-AB).Methods: Crude and inverse probability of treatment weighting analyses were applied for the treatment effect of cardiac surgery vs medical therapy on 1-year all-cause mortality in patients with definite TAVI-IE. The study used data from the Infectious Endocarditis after TAVI International Registry.Results: Among 584 patients, 111 patients (19%) were treated with IE-CS and 473 patients (81%) with IE-AB. Compared with IE-AB, IE-CS was not associated with a lower in-hospital mortality (HRunadj: 0.85; 95% CI: 0.58-1.25) and 1-year all-cause mortality (HRunadj: 0.88; 95% CI: 0.64-1.22) in the crude cohort. After adjusting for selection and immortal time bias, IE-CS compared with IE-AB was also not associated with lower mortality rates for in-hospital mortality (HRadj: 0.92; 95% CI: 0.80-1.05) and 1-year all-cause mortality (HRadj: 0.95; 95% CI: 0.84-1.07). Results remained similar when patients with and without TAVI prosthesis involvement were analyzed separately. Predictors for in-hospital and 1-year all-cause mortality included logistic EuroSCORE I, Staphylococcus aureus, acute renal failure, persistent bacteremia, and septic shock.Conclusions: In this registry, the majority of patients with TAVI-IE were treated with antibiotics alone. Cardiac surgery was not associated with an improved all-cause in-hospital or 1-year mortality. The high mortality of patients with TAVI-IE was strongly linked to patients' characteristics, pathogen, and IE-related complications
Stroke Complicating Infective Endocarditis After Transcatheter Aortic Valve Replacement.
BACKGROUND
Stroke is one of the most common and potentially disabling complications of infective endocarditis (IE). However, scarce data exist about stroke complicating IE after transcatheter aortic valve replacement (TAVR).
OBJECTIVES
The purpose of this study was to determine the incidence, risk factors, clinical characteristics, management, and outcomes of patients with definite IE after TAVR complicated by stroke during index IE hospitalization.
METHODS
Data from the Infectious Endocarditis after TAVR International Registry (including 569 patients who developed definite IE following TAVR from 59 centers in 11 countries) was analyzed. Patients were divided into two groups according to stroke occurrence during IE admission (stroke [S-IE] vs. no stroke [NS-IE]).
RESULTS
A total of 57 (10%) patients had a stroke during IE hospitalization, with no differences in causative microorganism between groups. S-IE patients exhibited higher rates of acute renal failure, systemic embolization, and persistent bacteremia (p 8 mm were associated with a higher risk of stroke during the index IE hospitalization (p 3 risk factors. S-IE patients had higher rates of in-hospital mortality (54.4% vs. 28.7%; p < 0.001) and overall mortality at 1 year (66.3% vs. 45.6%; p < 0.001). Surgical treatment was not associated with improved outcomes in S-IE patients (in-hospital mortality: 46.2% in surgical vs. 58.1% in no surgical treatment; p = 0.47).
CONCLUSIONS
Stroke occurred in 1 of 10 patients with IE post-TAVR. A history of stroke, short time between TAVR and IE, vegetation size, valve prosthesis type, and residual aortic regurgitation determined an increased risk. The occurrence of stroke was associated with increased in-hospital and 1-year mortality rates, and surgical treatment failed to improve clinical outcomes
Infective Endocarditis After Transcatheter Versus Surgical Aortic Valve Replacement
Abstract Background Scarce data are available comparing infective endocarditis (IE) following surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). This study aimed to compare the clinical presentation, microbiological profile, management, and outcomes of IE after SAVR versus TAVR. Methods Data were collected from the “Infectious Endocarditis after TAVR International” (enrollment from 2005 to 2020) and the “International Collaboration on Endocarditis” (enrollment from 2000 to 2012) registries. Only patients with an IE affecting the aortic valve prosthesis were included. A 1:1 paired matching approach was used to compare patients with TAVR and SAVR. Results A total of 1688 patients were included. Of them, 602 (35.7%) had a surgical bioprosthesis (SB), 666 (39.5%) a mechanical prosthesis, 70 (4.2%) a homograft, and 350 (20.7%) a transcatheter heart valve. In the SAVR versus TAVR matched population, the rate of new moderate or severe aortic regurgitation was higher in the SB group (43.4% vs 13.5%; P < .001), and fewer vegetations were diagnosed in the SB group (62.5% vs 82%; P < .001). Patients with an SB had a higher rate of perivalvular extension (47.9% vs 27%; P < .001) and Staphylococcus aureus was less common in this group (13.4% vs 22%; P = .033). Despite a higher rate of surgery in patients with SB (44.4% vs 27.3%; P < .001), 1-year mortality was similar (SB: 46.5%; TAVR: 44.8%; log-rank P = .697). Conclusions Clinical presentation, type of causative microorganism, and treatment differed between patients with an IE located on SB compared with TAVR. Despite these differences, both groups exhibited high and similar mortality at 1-year follow-up