Factors influencing upon the patient satisfaction during the hospitalization period

More often the patient estimates the medical activity and the relationships, in which he enters with the doctor and the nurse during the hospitalization period. The purpose of the investigation is to identify and analyse the factors, which influence upon the patient satisfaction during his stay in the department. The investigation is executed among 1054 patients, hospitalised in multiprofile hospitals for active treatment, situated in eight cities. The estimate of the different factors showed that with the increase of the hospitalisations number (up to the third hospitalisation) the patient satisfaction of the attitude of the doctor and nurse, the servicing and the nursing cares still increases, but the satisfaction regarding the necessary equipment, the obtained information and the medical supervision decreases. The patients, who live in villages, remain more satisfied unlike the people, who live in bigger cities. Regarding the education the patients, who have a higher educational degree and are younger, are more satisfied by the servicing and the cares in the department unlike the respect of their patient rights and the obtaining of regular information

SNARE MANEUVER FOR MANAGEMENT OF LOW TAVI IMPLANTATION - CLINICAL CASE

Even though TAVI is a relatively new procedure it managed to become the default method for treatment of aortic stenosis in patients with high surgical risk. It is minimally invasive but not entirely free of complications. One of those is a paravalvular leak following a low implantation. In this article we present the different courses of action in this situation and share our experience on one such occasion

DURABILITY OF BIOLOGICAL PROSTHESES USED FOR MANAGEMENT OF DEGENERATIVE AORTIC STENOSIS – TAVR vs. SAVR

The only known treatment for high grade degenerative aortic stenosis until the beginning of this century was surgical replacement with a biological or mechanical valve. For the high risk or inoperable patients this treatment was unacceptable, with a high mortality rate in both operated and non-operated cases. The new concept of transcatheter valve implantation was developed especially for this group of patients, which number continues to increase. It is a really attractive idea, being able to offer a non-invasive and low risk procedure for a patient who is not considered a good candidate for conventional operation. The increase in the operators experience reduces the rate of mortality in TAVI even more. Both TAVI and surgical valves are biological. The technology used for production of the balloon expandable and self-expandable valves is much more advanced. The biological tissue used in both types of valve is prone to degeneration due to different factors and can lead to valvular dysfunction. The surgical valves are made from porcine or bovine tissue and have a lifespan between 10 and 15 years. In some cases, the dysfunction occurs much sooner. If that happens the patient needs a re-replacement valve surgery. Since such a procedure is risky the patient is usually referred for valve-in-valve TAVI

Dynamic change of NT- PROBNP in patients with ST-elevation myocardial infarction treated with primary coronary intervention

In the recent years important biomarkers have  emerged as  tools for diagnosis and risk stratification in cardiovascular diseases. Such markers are B- type natriuretic peptide ( BNP) and N- terminal B- type  natriuretic peptide (NT-proBNP).Peripheral blood for the serum levels of  NT-proBNP was taken from patients with STEMI before PCI and 24-48hours after the onset of the symptoms of myocardial infarction. Three of the samples  from all 53 turned out to be positive to NT - proBNP  concentration on Day 0. On day 1 there was   a significant  elevation of the positive samples 11 from 53 patients ( 20,7%) ( p = 0,01). All  patients with STEMI and elevated serum levels of NT- proBNP  have left ventricular ejection fraction <50%.  Our results imply that  NT -proBNP level and its increase in the serum  may be used as a biomarker for the severity of the ischemic heart disease

Usefulness of the updated logistic clinical SYNTAX score after percutaneous coronary intervention in patients with prior coronary artery bypass graft surgery: Insights from the GLOBAL LEADERS trial

Objectives: We aimed to investigate the prognostic utility of the anatomical CABG SYNTAX and logistic clinical SYNTAX scores for mortality after percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass grafts (CABG). Background: The anatomical SYNTAX score evaluated the anatomical complexity of coronary artery disease and helped predict the prognosis of patients undergoing PCI. The anatomical CABG SYNTAX score was derived from the anatomical SYNTAX score in patients with prior CABG, whilst the logistic clinical SYNTAX score was developed by incorporating clinical factors into the anatomical SYNTAX score. Methods: We calculated the anatomical CABG SYNTAX score and logistic clinical SYNTAX score in 205 patients in the GLOBAL LEADERS trial. The predictive abilities of these scores for 2-year all-cause mortality were evaluated. Results: Using the median scores as categorical thresholds between low and high score groups, the logistic clinical SYNTAX score was able to discriminate the risk of 2-year mortality, unlike the anatomical CABG SYNTAX score. The logistic clinical SYNTAX was significantly better at predicting 2-year mortality, compared to the anatomical CABG SYNTAX score, as evidenced by AUC values in receiver-operating characteristic curve analysis (0.806 vs. 0.582, p <.001) and integrated discrimination improvement (0.121, p <.001). Conclusions: The logistic clinical SYNTAX score was superior to the anatomical CABG SYNTAX score in predicting 2-year mortality

Impact of Transcatheter Aortic Valve Implantation on the Left Ventricular Remodelling /// Въздействие на транскатетърното имплантиране на аортна клапа върху ремоделирането на лявата камера

[EN] The objective of this study was monitor and analyse the impact of transcatheter aortic valve implantation (TAVI) on left ventricular remodelling process. The study included 141 patients with severe degenerative aortic stenosis and high perioperative surgical aortic valve replacement (SAVR) risk, which underwent TAVI via femoral artery access. The treatment was conducted in the Charite University Hospital, Campus Mitte (Berlin, Germany). TAVI lead to an immediate hemodynamic effect and rapid onset reduction of the symptoms of left-sided heart failure. In the majority of patients, functional class of heart failure NYHA reduced early after TAVI and this result maintained unchanged during the long-term follow-up of the patients. In terms of the degree of heart failure reduction there was no difference between the two genders. During the long-term follow-up in patients after TAVI a marked beneficial effect on the left ventricular remodelling was revealed. It occurs relatively later in comparison with the hemodynamic and clinical improvement in those patients. Women reacted to the aortic stenosis with concentric hypertrophy more often, and the function of the LV was better preserved than in men, in which there was a higher frequency of eccentric hypertrophy and more often had reduced left ventricular function. Reverse remodelling of the left ventricle after TAVI occurred in both genders. However, women reacted faster and had better recovery of the function and geometry of the LV. In men with concentric hypertrophy its frequency also decreased significantly but a slight increase in the frequency of eccentric hypertrophy was observed. The serum levels of neurohumoral and biochemical markers, such as the NT-proBNP, CRP and IL-6, went through changes after TAVI and can be used as an addition to the ultrasound criteria in the evaluation of left ventricular remodelling. The diagnostic value of NT-proBNP and CRP was higher in women, while no difference in IL-6 levels in both genders was observed. TNF-α holded no value for evaluation of left ventricular remodelling. TAVI had a beneficial effect on the degree of concomitant mitral regurgitation. In turn the mitral regurgitation adversely affected the remodelling of the left ventricle after TAVI. TAVI was associated with a relatively high incidence of aortic paraprosthetic regurgitation, which was not hemodynamically significant and did not affect the process of reverse remodelling.[BG] Целта на тази дисертация е да се проследи и анализира въздействието на TAVI върху процесите на ремоделиране на ЛК. В научното проучване са обхванати общо 141 болни с тежка дегенеративна аортна стеноза и висок периоперативен риск при конвенционална кардиохирургия за смяна на аортната клапа, при които е проведена TAVI чрез достъп през феморална артерия. Изследването е проведено в Charite University Hospital, Campus Mitte (Berlin, Germany). TAVI води до незабавен хемодинамичен ефект и бързо настъпваща редукция на проявите на левостранна сърдечна недостатъчност. При болшинството от болните, функционалния клас на сърдечната недостатъчност по NYHA намалява рано след TAVI и този резултат се запазва при дългосрочно проследяване на болните. При дългосрочно проследяване при болните след TAVI се отчита подчертан благоприятен ефект върху ремоделирането на лява камера. Жените по-често реагират с концентрична хипертрофия на аортната стеноза и функцията на ЛК е по-съхранена от тази на мъжете, при които е по-висока честотата на ексцентрична хипертрофия и по-често са с подтисната функция на лява камера. След TAVI настъпва обратно ремоделиране на лява камера и при двата пола. Жените обаче реагират по-бързо и с по-пълно възстановяване на функцията и геометрията на ЛК. Серумните нива на неврохуморални и биохимични маркери, като NT-proBNP, CRP и IL-6 търпят динамика при болните след TAVI и могат да имат значение, като допълнителен критерии освен ехографските при оценка на ремоделирането на лява камера. Диагностичната стойност на NT-proBNP и CRP е по-висока при жените, докато за IL-6 няма разлика при двата пола. TAVI има благоприятен ефект по отношение на степента на съпътстващата митрална регургитация. От своя страна митралната регургитация оказва неблагоприятно влияние върху ремоделирането на лява камера след TAVI. TAVI е свързана с относително висока честота на парапротезна аортна регургитация, която е рядко хемодинамично значима

PERFORMING TRANSCATHETER AORTIC VALVE IMPLANTATION IN PATIENTS WITH CAROTID STENOSIS

The management of carotid artery disease in patients with severe aortic stenosis referred for transcatheter aortic valve implantation is challenging. By reviewing the very limited amount of literature we will try to answer the question should we perform carotid revascularization before or after the TAVI procedure

TRANSCATHETER AORTIC VALVE IMPLANTATION IN A PATIENT WITH PROSTHETIC MITRAL VALVE- CLINICAL CASE

TAVI is a relatively new interventional procedure designed for management of aortic stenosis in patients with high surgical risk. Performing it on someone with a prosthetic mitral valve is a challenge, made much easier by the new delivery systems and valves. We present one such procedure and try to put some light on the difficulties that await along the way to successful implantation