Complications Following MitraClip Implantation

Abstract Purpose of Review To provide a detailed overview of complications associated with MitraClip therapy and its development over time with the aim to alert physicians for early recognition of complications and to offer treatment strategies for each complication, if possible. Recent Findings The MitraClip system (MC) is the leading transcatheter technique to treat mitral regurgitation (MR) and has been established as a safe procedure with very low adverse event rates compared to mitral surgery at intermediate to high risk or in secondary MR. Lately, the fourth MC generation has been launched with novel technical features to facilitate device handling, decrease complication rates, and allow the treatment of even complex lesions. Summary Although the complication rate is low, adverse events are associated with increased morbidity and mortality. The most common complications are bleeding, acute kidney failure, procedure-induced mitral stenosis, and an iatrogenic atrial septal defect with unknown clinical impact.

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Cardiogenic Shock – Developments and Treatment Strategies

European Cardiology Review ◽

10.15420/ecr.2009.5.2.48 ◽

2009 ◽

Vol 5 (2) ◽

pp. 48 ◽

Cited By ~ 1

Author(s):

Ricardo Seabra-Gomes ◽

Jorge Ferreira ◽

◽

Keyword(s):

Cardiogenic Shock ◽

Early Recognition ◽

Treatment Strategies ◽

Left Ventricular ◽

Ventricular Assist Devices ◽

Left Ventricular Assist Devices ◽

Significant Treatment ◽

Ventricular Assist ◽

Hard Data ◽

Oxide Synthase

Cardiogenic shock remains one of the most serious and challenging conditions in cardiology and is responsible for the highest in-hospital mortality associated with ST-elevation myocardial infarction. The only significant treatment strategy that has been shown to reduce its incidence and inherent mortality is emergent coronary revascularisation. Prevention should aim at early recognition of symptoms, appropriate pre-hospital emergency medical care and prompt primary revascularisation. Once established, cardiogenic shock still has an unacceptably high mortality rate. Approaches that include new pharmacological therapies and other forms of mechanical haemodynamic support are under investigation. The possible role of systemic inflammatory response has led to the investigation of nitric oxide synthase inhibition, although initial results with tilarginine were disappointing. The use of percutaneous left ventricular assist devices looks promising, but hard data regarding mortality benefit are still missing. Cardiogenic shock remains a perplexing and often fatal condition. The future may require more basic, translational and clinical research.

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Management of constipation in patients with schizophrenia—a case study and review of literature

Middle East Current Psychiatry ◽

10.1186/s43045-021-00097-6 ◽

2021 ◽

Vol 28 (1) ◽

Author(s):

Ashish Sarangi ◽

Sabiha Armin ◽

Aurelio Vargas ◽

Victoria M. Chu ◽

Kristen Fain ◽

...

Keyword(s):

Side Effect ◽

Negative Symptoms ◽

Early Recognition ◽

Cardiovascular Complications ◽

Cochrane Library ◽

Main Body ◽

Complication Rates ◽

Anticholinergic Effects ◽

Routine Surveillance ◽

Delayed Recognition

Abstract Background Schizophrenia is a disorder that affects about 1% of the US population, with an extensive impact on patients’ health and their risk of later developing comorbidities from treatment. While literature on the side effect profile of antipsychotics is abundant, there are few studies on identification of anticholinergic effects on gut motility and prophylaxis development. The aim of this review is to consider antipsychotic-associated constipation in patients with schizophrenia and to discuss management of antipsychotic-induced constipation as documented in the literature. Main body We present a case of antipsychotic-induced constipation and conducted a literature review assessing the prevalence of this issue in this population. The search was done on Embase, MEDLINE, Cochrane Library, and PubMed databases. Key word searches included constipation with concurrent antipsychotic use, antipsychotics and anticholinergic effects, factors causing constipation in schizophrenia, social disparities involved with constipation, and colorectal cancer screenings. Main findings included high complication rates that may be explained by clozapine-specific side effects, negative health habits, disease, and treatment-related metabolic disorders. Co-existing negative symptoms could also be associated with health outcomes and was found to have adverse consequences on schizophrenia progression. Comorbidities of diabetes and cardiovascular complications contributed to gut hypomotility. Caregiver burden was a factor in delayed recognition of constipation as a side effect. Routine surveillance for symptoms and optimization of medications facilitates early recognition of constipation. Conclusion Overall, there is insufficient trial-based evidence to compare the effectiveness and safety of common pharmacological interventions for constipation, such as lactulose, polyethylene glycol, stool softeners, and lubricant laxatives.

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Nonvascular Complications of Injectable Fillers—Prevention and Management

Indian Journal of Plastic Surgery ◽

10.1055/s-0040-1721872 ◽

2020 ◽

Vol 53 (03) ◽

pp. 335-343

Author(s):

Kuldeep Singh ◽

Shahin Nooreyezdan

Keyword(s):

Early Recognition ◽

Treatment Options ◽

Treatment Strategies ◽

Vascular Complications ◽

Physical Characteristics ◽

Clear Understanding ◽

Type Iv ◽

Acute Infections ◽

Tyndall Effect ◽

Delayed Complications

AbstractInjectable filler treatments have increased in popularity because of enhanced safety profile and improved physical characteristics. ISAPS (International Society of Plastic Surgery) put out global data showing 3.7 million hyaluronic acid (HA) filler procedures in 2018, making it the second most often performed procedure in the world, after botulinum toxin. And these are only ‘those’ performed by qualified plastic surgeons. There was a concomitant increase in both the nonvascular and vascular complications, which coincided with the number and type of filler procedures performed. Filler complications were reviewed from existing literature, and an attempt was made to understand etiology, elucidate clinical features, and clarify optimum treatment strategies for each. Complications can be early or delayed in presentation, early consisting of injection site complications like bruising, edema, and hypersensitivity, Tyndall effect, and intravascular injection. Delayed complications included hypersensitivity type IV, acute infections like cellulitis, abscesses, and herpes and delayed ones like granulomas, biofilms, and atypical mycobacterial infections. These were analyzed and treatment options, protocols, and consensus guidelines were suggested. A clear understanding of facial anatomy, physical characteristics of all fillers used, early recognition, and treatment options of complications will ensure optimum outcomes.

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Treatment strategies for hydrocephalus related to Dandy-Walker syndrome: evaluating procedure selection and success within the Hydrocephalus Clinical Research Network

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.11.peds20806 ◽

2021 ◽

pp. 1-9

Author(s):

Aaron M. Yengo-Kahn ◽

John C. Wellons ◽

Todd C. Hankinson ◽

Jason S. Hauptman ◽

Eric M. Jackson ◽

...

Keyword(s):

Clinical Research ◽

Treatment Success ◽

Treatment Strategies ◽

Research Network ◽

Csf Shunt ◽

Third Ventriculostomy ◽

Separate Analysis ◽

Complication Rates ◽

Primary Analysis ◽

Clinical Research Network

OBJECTIVE Treating Dandy-Walker syndrome–related hydrocephalus (DWSH) involves either a CSF shunt-based or endoscopic third ventriculostomy (ETV)–based procedure. However, comparative investigations are lacking. This study aimed to compare shunt-based and ETV-based treatment strategies utilizing archival data from the Hydrocephalus Clinical Research Network (HCRN) registry. METHODS A retrospective review of prospectively collected and maintained data on children with DWSH, available from the HCRN registry (14 sites, 2008–2018), was performed. The primary outcome was revision-free survival of the initial surgical intervention. The primary exposure was either shunt-based (i.e., cystoperitoneal shunt [CPS], ventriculoperitoneal shunt [VPS], and/or dual-compartment) or ETV-based (i.e., ETV alone or with choroid plexus cauterization [CPC]) initial surgical treatment. Primary analysis included multivariable Cox proportional hazards models. RESULTS Of 8400 HCRN patients, 151 (1.8%) had DWSH. Among these, the 102 patients who underwent shunt placement (79 VPSs, 16 CPSs, 3 other, and 4 multiple proximal catheter) were younger (6.6 vs 18.8 months, p < 0.001) and more frequently had 1 or more comorbidities (37.3% vs 14.3%, p = 0.005) than the 49 ETV-treated children (28 ETV-CPC). Fifty percent of the shunt-based and 51% of the ETV-based treatments failed. Notably, 100% (4/4) of the dual-compartment shunts failed. Adjusting for age, baseline ventricular size, and comorbidities, ETV-based treatment was not significantly associated with earlier failure compared with shunt-based treatment (HR for failure 1.32, 95% CI 0.77–2.26; p = 0.321). Complication rates were low: 4.9% and 6.1% (p = 0.715) for shunt- and ETV-based procedures, respectively. There was no difference in survival between ETV-CPC– and ETV-based treatment when adjusting for age (HR for failure 0.86, 95% CI 0.29–2.55, p = 0.783). CONCLUSIONS In this North American, multicenter, prospective database review, shunt-based and ETV-based primary treatment strategies of DWSH appear similarly durable. Pediatric neurosurgeons can reasonably consider ETV-based initial treatment given the similar durability and the low complication rate. However, given the observational nature of this study, the treating surgeon might need to consider subgroups that were too small for a separate analysis. Very young children with comorbidities were more commonly treated with shunts, and older children with fewer comorbidities were offered ETV-based treatment. Future studies may determine preoperative characteristics associated with ETV treatment success in this population.

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Decision analysis of treatment options for vestibular schwannoma

Journal of Neurosurgery ◽

10.3171/2010.3.jns091802 ◽

2011 ◽

Vol 114 (2) ◽

pp. 400-413 ◽

Cited By ~ 43

Author(s):

Robert G. Whitmore ◽

Christopher Urban ◽

Ephraim Church ◽

Michael Ruckenstein ◽

Sherman C. Stein ◽

...

Keyword(s):

English Language ◽

Treatment Options ◽

Treatment Strategies ◽

Complication Rates ◽

Online Databases ◽

Decision Analytical Model ◽

The Mean ◽

Meta Regression

Object Widespread use of MR imaging has contributed to the more frequent diagnosis of vestibular schwannomas (VSs). These tumors represent 10% of primary adult intracranial neoplasms, and if they are symptomatic, they usually present with hearing loss and tinnitus. Currently, there are 3 treatment options for quality of life (QOL): wait and scan, microsurgery, and radiosurgery. In this paper, the authors' purpose is to determine which treatment modality yields the highest QOL at 5- and 10-year follow-up, considering the likelihood of recurrence and various complications. Methods The MEDLINE, Embase, and Cochrane online databases were searched for English-language articles published between 1990 and June 2008, containing key words relating to VS. Data were pooled to calculate the prevalence of treatment complications, tumor recurrence, and QOL with various complications. For parameters in which incidence varied with time of follow-up, the authors used meta-regression to determine the mean prevalence rates at a specified length of follow-up. A decision-analytical model was constructed to compare 5- and 10-year outcomes for a patient with a unilateral tumor and partially intact hearing. The 3 treatment options, wait and scan, microsurgery, and radiosurgery, were compared. Results After screening more than 2500 abstracts, the authors ultimately included 113 articles in this analysis. Recurrence, complication rates, and onset of complication varied with the treatment chosen. The relative QOL at the 5-year follow-up was 0.898 of normal for wait and scan, 0.953 for microsurgery, and 0.97 for radiosurgery. These differences are significant (p < 0.0052). Data were too scarce at the 10-year follow-up to calculate significant differences between the microsurgery and radiosurgery strategies. Conclusions At 5 years, patients treated with radiosurgery have an overall better QOL than those treated with either microsurgery or those investigated further with serial imaging. The authors found that the complications associated with wait-and-scan and microsurgery treatment strategies negatively impacted patient lives more than the complications from radiosurgery. One limitation of this study is that the 10-year follow-up data were too limited to analyze, and more studies are needed to determine if the authors' results are still consistent at 10 years.

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Safety and Efficacy of Bleb Needling with Antimetabolite after Trabeculectomy Failure in Glaucoma Patients: A Systemic Review and Meta-Analysis

Journal of Ophthalmology ◽

10.1155/2020/4310258 ◽

2020 ◽

Vol 2020 ◽

pp. 1-13

Author(s):

Xuhao Chen ◽

Lingge Suo ◽

Ying Hong ◽

Chun Zhang

Keyword(s):

Success Rate ◽

Meta Analysis ◽

Systemic Review ◽

Cochrane Library ◽

Subconjunctival Injection ◽

Complication Rates ◽

Safe Procedure ◽

Success Rates ◽

Whole Process ◽

Before And After

Background. Bleb needling with subconjunctival injection of antimetabolites had become a widely accepted approach for trabeculectomy failure. However, IOP reduction effects, success rates, and complications occurrence for this procedure showed great inconsistency among the different studies. Methods. We conducted a literature search on PubMed, Embase, Cochrane Library, and ClinicalTrials.gov. A random-effects model was performed on the extracted data based on the included studies. The intraocular pressure (IOP) and number of antiglaucomatous medications before and after the surgery were pooled for meta-analysis. The success and complication rates were estimated based on the results. Subgroup analysis, sensitivity analysis, and metaregression were applied to explore the origination of heterogeneity. Results. Thirty-seven studies with a total of 2182 patients were finally included in our review. For the present meta-analysis, the overall effects of bleb needling at the last visit revealed a reduction in IOP of 9.74 mmHg (95% confidence interval (CI) [8.85, 10.63]), 45.9% (95% CI [39.0%, 53.0%]) for complete success rate, and 70.4% (95% CI [63.5%, 77.0%]) for qualified success rate. Application of mitomycin C (MMC) and 5-fluorouracil (5-Fu) during the procedure were efficacious for IOP control during the follow-up. Metaregression revealed that possible origination of heterogeneity was baseline IOP before bleb needling, revealing a trend that higher baseline IOP correlated with a greater IOP reduction results p < 0.001 . For safety profile, conjunctival haemorrhage (5.7%, 95% CI [2.5%, 10.1%]), hyphema (5.5%, 95% CI [3.0%, 8.7%]), and bleb leakage (5.0%, 95% CI [3.2%, 7.3%]) had the highest estimate of incidence. An increasing number of needling was the main risk factor for needling failure. Conclusion. Bleb needling with antimetabolites could be considered an effective and safe procedure after trabeculectomy failure. After the process, patients will gain IOP control and reduce antiglaucomatous medications for at least six months with 5-Fu or MMC. Meanwhile, the overall estimates for complications were relatively low in the whole process.

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Prevalence and echocardiographic features of iatrogenic atrial septal defect after catheter-based mitral valve repair with the mitraclip system

Catheterization and Cardiovascular Interventions ◽

10.1002/ccd.23485 ◽

2012 ◽

Vol 80 (4) ◽

pp. 678-685 ◽

Cited By ~ 36

Author(s):

Thomas Smith ◽

Patrick McGinty ◽

William Bommer ◽

Reginald I. Low ◽

Scott Lim ◽

...

Keyword(s):

Mitral Valve ◽

Atrial Septal Defect ◽

Mitral Valve Repair ◽

Septal Defect ◽

Valve Repair ◽

Iatrogenic Atrial Septal Defect ◽

Mitraclip System

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The place of computed tomography as a guidance modality in percutaneous nephrostomy: analysis of a 10-year single-center experience

Acta Radiologica ◽

10.1080/02841850701416528 ◽

2007 ◽

Vol 48 (7) ◽

pp. 806-813 ◽

Cited By ~ 30

Author(s):

H. Egilmez ◽

I. Oztoprak ◽

M. Atalar ◽

A. Cetin ◽

C. Gumus ◽

...

Keyword(s):

Computed Tomography ◽

Percutaneous Nephrostomy ◽

Complication Rates ◽

Safe Procedure ◽

Single Center ◽

Macroscopic Hematuria ◽

Ct Guided ◽

Single Center Experience ◽

Major Complications ◽

Inpatient Settings

Background: Percutaneous nephrostomy (PCN) has been established as an effective technique for urinary decompression or diversion. This procedure may be performed with the guidance of fluoroscopy, ultrasonography, a combination of fluoroscopy and ultrasonography, computed tomography (CT), or magnetic resonance imaging. Purpose: To retrospectively review experience with CT-guided PCN over a 10-year period in a single center. Material and Methods: All CT-guided PCN procedures performed in adults at our institution between 1995 and 2005 were evaluated. In 882 patients, 1113 nephrostomy catheters were inserted. Interventional radiologists or radiology residents under direct attending supervision inserted all catheters. During the PCN procedure, bleeding, sepsis, and injuries to adjacent organs were regarded as major complications. Clinical events requiring nominal therapy with no sequelae were regarded as minor complications. Results: PCN procedures were performed via 1–3 punctures in patients with grades 0–1 and 2 hydronephrosis, and via 1–2 punctures in patients with grade 3 hydronephrosis. They were carried out with a procedure time ranging from 9 to 26 min. All PCNs were considered as technically successful, and no major complications were observed. There were minor complications including transient macroscopic hematuria (28.6%, 19.9%, and 4.9% in patients with hydronephrosis grades 0–1, 2, and 3, respectively) and perirenal hematomas in a total of eight patients. No patient required additional intervention secondary to complications of the PCN procedure. Conclusion: CT-guided PCN is an efficient and safe procedure with major and minor complication rates below the accepted thresholds. It can be used for the management of patients requiring nephrostomy insertion in inpatient settings, and might be a preferable procedure in patients with minimal or no dilatation of the renal pelvis.

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