scholarly journals OUTCOMES IN THE COREVALVE US HIGH-RISK PIVOTAL TRIAL IN PATIENTS WITH A SOCIETY OF THORACIC SURGEONS PREDICTED RISK OF MORTALITY LESS THAN OR EQUAL TO 7

2016 ◽  
Vol 67 (13) ◽  
pp. 121
Author(s):  
Michael J. Reardon ◽  
David Adams ◽  
Neal Kleiman ◽  
G. Michael Deeb ◽  
Steven Yakubov ◽  
...  
Keyword(s):  
High Risk ◽  
Pivotal Trial ◽  
Risk Of Mortality ◽  
Predicted Risk

scholarly journals Outcomes after the MitraClip Procedure in Patients at Very High Risk for Conventional Mitral Valve Surgery

2018 ◽  
Vol 13 (6) ◽  
pp. 433-437
Author(s):  
Joshua L. Manghelli ◽  
Daniel I. Carter ◽  
Ali J. Khiabani ◽  
Hersh S. Maniar ◽  
Ralph J. Damiano ◽  
...  
Keyword(s):  
New York ◽  
High Risk ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Heart Association ◽  
Mitral Valve Surgery ◽  
Risk Of Mortality ◽  
New York Heart Association ◽  
Predicted Risk

Objective Approximately 50% of patients with severe symptomatic mitral regurgitation are deemed too high risk for surgery. The MitraClip procedure is a viable option for this population. Our goal was to assess outcomes and survival of patients who underwent the MitraClip procedure at an institution where mitral valve surgery is routinely performed. Methods A retrospective study of patients undergoing the MitraClip procedure was performed. Baseline characteristics, perioperative outcomes, and follow-up echocardiographic and clinical outcomes were examined. Primary end point was survival. Secondary end points included technical failure (residual 3/4+ mitral regurgitation), reoperation, New York Heart Association symptoms, 30-day mortality, and other clinical outcomes. Predictors of mortality were determined using multivariable regression analysis. Results Fifty consecutive patients underwent the MitraClip procedure during the 4-year period. The average age was 83, the Society of Thoracic Surgeons predicted risk of mortality mean was 9.4%, 88% (44/50) had New York Heart Association III/IV symptoms, 86% (43/50) had 4+ mitral regurgitation, and 72% (36/50) had degenerative mitral disease etiology. Echocardiographic data (median [interquartile range] follow-up = 43 [26–392]) showed that 86% (43/50) of patients had 2+ or less mitral regurgitation. Sixty percent (24/40) had New York Heart Association I/II symptoms at last follow-up. Predictors of mortality were higher Society of Thoracic Surgeons predicted risk of mortality ( P = 0.042, hazard ratio = 1.098) and previous cardiac surgery ( P = 0.013, hazard ratio = 3.848). Survival at 1 and 2 years was 75% and 63%, respectively. Conclusions Many patients with mitral valve regurgitation who are high risk for open surgery can be treated with the MitraClip procedure. In our study, most patients (86%) had a technically successful operation and postoperative outcomes including survival were acceptable.

scholarly journals Tiotropium might improve survival in subjects with COPD at high risk of mortality

2014 ◽  
Vol 15 (1) ◽  
pp. 64 ◽  
Author(s):  
Pierre-Régis Burgel ◽  
Jean-Louis Paillasseur ◽  
Daniel Dusser ◽  
Nicolas Roche ◽  
Dacheng Liu ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Of Mortality

scholarly journals Surgical Explantation of Transcatheter Aortic Valve Bioprostheses

2021 ◽  
Vol 14 (4) ◽  
Author(s):  
Alexander A. Brescia ◽  
G. Michael Deeb ◽  
Stephane Leung Wai Sang ◽  
Daizo Tanaka ◽  
P. Michael Grossman ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Aortic Valve ◽  
Operative Mortality ◽  
Artery Bypass ◽  
Paravalvular Leak ◽  
Transcatheter Aortic Valve ◽  
Risk Of Mortality ◽  
Risk Patients ◽  
Transcatheter Valve ◽  
Predicted Risk

Background: Despite the rapid adoption of transcatheter aortic valve replacement (TAVR) since its initial approval in 2011, the frequency and outcomes of surgical explantation of TAVR devices (TAVR-explant) is poorly understood. Methods: Patients undergoing TAVR-explant between January 2012 and June 2020 at 33 hospitals in Michigan were identified in the Society of Thoracic Surgeons Database and linked to index TAVR data from the Transcatheter Valve Therapy Registry through a statewide quality collaborative. The primary outcome was operative mortality. Indications for TAVR-explant, contraindications to redo TAVR, operative data, and outcomes were collected from Society of Thoracic Surgeons and Transcatheter Valve Therapy databases. Baseline Society of Thoracic Surgeons Predicted Risk of Mortality was compared between index TAVR and TAVR-explant. Results: Twenty-four surgeons at 12 hospitals performed TAVR-explants in 46 patients (median age, 73). The frequency of TAVR-explant was 0.4%, and the number of explants increased annually. Median time to TAVR-explant was 139 days and among known device types explanted, most were self-expanding valves (29/41, 71%). Common indications for TAVR-explant were procedure-related failure (35%), paravalvular leak (28%), and need for other cardiac surgery (26%). Contraindications to redo TAVR included need for other cardiac surgery (28%), unsuitable noncoronary anatomy (13%), coronary obstruction (11%), and endocarditis (11%). Overall, 65% (30/46) of patients underwent concomitant procedures, including aortic repair/replacement in 33% (n=15), mitral surgery in 22% (n=10), and coronary artery bypass grafting in 16% (n=7). The median Society of Thoracic Surgeons Predicted Risk of Mortality was 4.2% at index TAVR and 9.3% at TAVR-explant ( P =0.001). Operative mortality was 20% (9/46) and 76% (35/46) of patients had in-hospital complications. Of patients alive at discharge, 37% (17/37) were discharged home and overall 3-month survival was 73±14%. Conclusions: TAVR-explant is rare but increasing, and its clinical impact is substantial. As the utilization of TAVR expands into younger and lower-risk patients, providers should consider the potential for future TAVR-explant during selection of an initial valve strategy.

scholarly journals Fecal impaction and colon obstruction

2021 ◽  
Vol 8 (3) ◽  
pp. 988
Author(s):  
Haitham A. Saimeh
Keyword(s):  
Gastrointestinal Tract ◽  
High Risk ◽  
Dietary Fiber ◽  
Water Intake ◽  
Early Recognition ◽  
Fecal Impaction ◽  
Lower Gastrointestinal Tract ◽  
Mortality And Morbidity ◽  
Risk Of Mortality ◽  
Lethal Complications

Fecal impaction is an important cause of lower gastrointestinal tract obstruction and carries high risk of mortality and morbidity, it is highly emphasized to early identify it to minimize any risk of complication. Recurrence is common, therefore preventive modalities as increasing the dietary fiber content to 30 gm/day, water intake, or discontinuation of medications that contribute to colon hypomotility. In this paper, I am pointing off the early recognition and treatment of fecal impaction to avoid lethal complications, therefore physicians should have higher level of suspicions because if fecal impaction goes unrecognized this will lead to fatal morbidity and mortality.

scholarly journals Inguinal abscess in twin infants

2020 ◽  
Vol 7 (5) ◽  
pp. 1704
Author(s):  
Meghmala Sadhukhan ◽  
Baikuntha N. Mishra ◽  
Ranjit K. Joshi ◽  
Prabin Prakash Pahi
Keyword(s):  
Immune System ◽  
High Risk ◽  
Normal Flora ◽  
Delayed Treatment ◽  
Quick Recovery ◽  
Risk Of Mortality ◽  
Haematogenous Spread ◽  
Groin Swelling ◽  
Immature Immune System ◽  
In Infants And Children

Inguinal abscess is uncommon in infants and children. Majority of cases in the infantile period is primary and they present as leg or groin swelling, limitation of limb movement and pain. The source of microorganism is from the haematogenous spread of normal flora of the skin due to immature immune system. Ultrasound is the investigation of choice which confirms the diagnosis and delineates the areas of collection. Antibiotic alone is insufficient in most cases and drainage is required. Delayed treatment and inadequate drainage carry a high risk of mortality and sequelae due to damage to the underlying joint. We present 2 cases of primary inguinal abscess in twin infants who presented at 1 month and 2 months of age correspondingly, in whom early diagnosis and management lead to quick recovery.

Comparison of IDRS and ADA Diabetes Risk Assessment Tools Reveals Different Rsk Score in Same Population: A Cross-Sectional Analysis in a Tertiary Care Hospital

2021 ◽  
Vol 5 (1) ◽  
pp. 10-18
Author(s):  
N. Akter ◽  
N.K. Qureshi
Keyword(s):  
Type 2 Diabetes ◽  
Risk Assessment ◽  
High Risk ◽  
Risk Score ◽  
Diabetes Risk ◽  
Assessment Tools ◽  
Cross Sectional ◽  
Risk Assessment Tools ◽  
Predicted Risk

Background: To identify individuals at high risk of developing type2 diabetes (T2DM), use of a validated risk-assessment tool is currently recommended. Nevertheless, recent studies have shown that risk scores that are developed in the same country can lead to different results of an individual. The Objective of study was to reveal whether two different risk-assessment tools predict similar or dissimilar high-risk score in same population. Method: This cross-sectional analytical study was carried upon 336 non-diabetic adults visiting the outpatient department (OPD) of Medicine, MARKS Medical College & Hospital, Bangladesh from October 2018 to March 2019. Woman having previous history of Gestational Diabetes Mellitus (GDM) were also included. Both the Indian Diabetes risk Score (IDRS) and the American Diabetes (ADA) Risk Score questionnaire were used to collect the data on demographic and clinical characteristics, different risk factors of an individual subject, and to calculate predicted risk score for developing T2DM. Results: Among 336 subjects, 53.6% were female. The mean (±SD) age of the study subjects was 38.25±1.12 years. The average IDRS predicted risk score of developing T2DM was more in female subjects than male [p<0.05]. Whereas the ADA predicted increased risk score of developing type 2 diabetes was more in male subjects than female (p<0.05). IDRS categorized 37.2 % of individuals at high risk for developing diabetes; [p=0.10], while the ADA risk tool categorized 20.2% subjects in high risk group; [p<0.001]. Conclusions: The results indicate that risk for developing type 2 diabetes varies considerably according to the scoring system used. To adequately prevent T2DM, risk scoring systems must be validated for each population considered.

Percutaneous device closure of a large complex aortic root pseudoaneurysm

2020 ◽  
Vol 13 (9) ◽  
pp. e235545
Author(s):  
Patrick Tran ◽  
Jamal Nasir Khan ◽  
David Hildick-Smith ◽  
Martin Been
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Significant Risk ◽  
Unique Case ◽  
Risk Of Mortality ◽  
Percutaneous Device ◽  
Procedural Complication ◽  
Endovascular Approach ◽  
A Minor ◽  
Percutaneous Device Closure

Pseudoaneurysm of the aorta is a rare and high-risk complication of native aortic valve endocarditis and can develop following cardiac surgery for aortic valve and root disease. If left untreated, there is a significant risk of aortic wall rupture and fatality. Given the high risk of mortality associated with traditional open surgical repair of aortic pseudoaneurysms, endovascular approach is a potentially favourable alternative. We describe a unique case of a young woman with a large and complex paraprosthetic pseudoaneurysm with multiple communicating fistulae which was successfully percutaneously treated with two occluder devices. In this technically challenging case, a minor but unique procedural complication is also illustrated.

Identifying Older Adults at High Risk of Mortality Using the Medicare Health Outcomes Survey

2012 ◽  
Vol 35 (4) ◽  
pp. 277-291 ◽  
Author(s):  
Judy H. Ng ◽  
Marc N. Elliott ◽  
Sarah Hudson Scholle ◽  
Kazi Ahmed ◽  
Rachel L. Collins ◽  
...  
Keyword(s):  
Older Adults ◽  
High Risk ◽  
Health Outcomes ◽  
Risk Of Mortality
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