scholarly journals Clinical and echocardiographic predictors of delirium in acute cardiac care unit after transfemoral aortic valve implantation

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
F Noriega ◽  
A Viana-Tejedor ◽  
T Luque ◽  
A Travieso ◽  
D Corrochano ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Arterial Disease ◽  
Cardiac Care ◽  
Geriatric Conditions ◽  
Echocardiographic Parameters ◽  
Aortic Valve Implantation ◽  
Peripheral Arterial ◽  
Valve Implantation ◽  
Acute Cardiac Care ◽  
Cardiac Care Unit

Abstract Funding Acknowledgements Type of funding sources: None. Background. Delirium is frequent in patients admitted to critical care units. Its incidence after transcatheter aortic valve implantation (TAVI) is up to 30%. Clinical and demographic factors have been related to delirium, but echocardiographic parameters have not been evaluated. Purpose. The aim of this study was to assess clinical and echocardiographic predictors of delirium in patients admitted to an acute cardiac care unit (ACCU) after transfemoral TAVI. Methods. 501 patients admitted to ACCU after TAVI were included. Delirium was evaluated by Confusion Assessment Method. Clinical cardiovascular and geriatric conditions were assessed, as well as echocardiographic parameters. Results. The incidence of delirium was 22% (110 patients). Delirium was associated with age (83.8 ± 4.6 vs 82.6 ± 6.1 years, p = 0.026), dyslipidaemia (50.0% vs 61.4%, p = 0.032), prior peripheral arterial disease (11.9% vs 5.4%, p = 0.017) and cognitive impairment (10.0% vs 1.8%, p < 0.001). There was no relationship to gender, other cardiovascular risk factors or geriatric conditions. Table shows echocardiographic parameters at baseline and after TAVI, with no statistical association with delirium. Conclusion. Delirium is a common complication after TAVI in ACCU. Age, the absence of dyslipidaemia, or the presence of cognitive impairment or prior peripheral arterial disease are clinical predictors of delirium. There are not echocardiographic predictors of delirium. Echocardiographic parametersWithout delirium(n = 391)With delirium(n = 110)p valueBaseline echocardiographic parametersLeft ventricular ejection fraction (%)57.7 ± 13.457.5 ± 14.10.912Mitral regurgitation (moderate to severe)106 (27.1)34 (30.9)0.433Pulmonary hypertension168 (43.0)53 (49.1)0.258Aortic regurgitation (moderate to severe)74 (18.9)21 (19.1)0.969Peak aortic gradient (mmHg)78.7 ± 25.278.5 ± 23.30.935Mean aortic gradient (mmHg)47.1 ± 16.146.7 ± 14.80.838Aortic valvular area (cm2)0.6 ± 0.20.6 ± 0.20.589Aortic annulus diameter (mm)22.5 ± 2.722.4 ± 2.50.615After TAVI echocardiographic parametersAortic regurgitation (moderate to severe)36 (9.3)11 (10.0)0.813Peak aortic gradient (mmHg)17.6 ± 9.617.7 ± 8.30.916Mean aortic gradient (mmHg)8.9 ± 5.49.3 ± 4.90.481Aortic valvular area (cm2)2.0 ± 0.62.2 ± 0.60.478Values are mean ± standard deviation, or n (%).

Cardiac conditions in peripheral arterial diseases

ESC CardioMed ◽  
2018 ◽  
pp. 2739-2742
Author(s):  
Michal Tendera
Keyword(s):  
Heart Failure ◽  
Combination Therapy ◽  
Cardiac Assist ◽  
Cardiac Assist Device ◽  
Transcatheter Aortic Valve ◽  
Peripheral Arterial Diseases ◽  
Patients With Heart Failure ◽  
Aortic Valve Implantation ◽  
Peripheral Arterial ◽  
Valve Implantation

Cardiac conditions other than CAD are frequent in patients with PADs. This is especially the case for heart failure and atrial fibrillation in patients with LEAD. In patients with symptomatic PADs, screening for heart failure should be considered. In patients with heart failure, screening for LEAD may be considered. Full vascular assessment is indicated in patients planned for heart transplantation or cardiac assist device. In patients with stable PADs who have AF, anticoagulation is the priority and suffices in most cases. In the case of recent endovascular revascularization, a period of combination therapy (anticoagulant + antiplatelet therapies) should be considered according to the bleeding and thrombotic risks. The period of combination therapy should be as brief as possible. In patients undergoing transcatheter aortic valve implantation or other structural interventions, screening for LEAD and UEAD is indicated.

Recommendations for the structure, organization, and operation of intensive cardiac care units

2015 ◽  
Author(s):  
Menachem Nahir ◽  
Doron Zahger ◽  
Yonathan Hasin
Keyword(s):  
Myocardial Infarction ◽  
Major Change ◽  
Cardiac Care ◽  
Complex Patients ◽  
Cardiovascular Patients ◽  
Life Threatening ◽  
The 1960S ◽  
European Society Of Cardiology ◽  
Acute Cardiac Care ◽  
Cardiac Care Unit

Care for the critically ill cardiovascular patients and their families requires a unique environment that is structurally different from other clinical units. Coronary care units were introduced in the 1960s for the main purpose of prevention and prompt treatment of life-threatening cardiac arrhythmias related to acute myocardial infarction. Since then, major progress in cardiology in general and acute cardiac care, in particular, dictated a major change in the structure and organization of these units, symbolically expressed in the new title of ‘intensive cardiac care unit’. Contemporary intensive cardiac care units receive older and more complex patients, often with multiple comorbidities and diverse diagnoses. The modern intensive cardiac care unit incorporates sophisticated monitoring and up-to-date equipment to meet the changing needs of the patient with cardiovascular disease requiring critical care. The intensive cardiac care unit operates in the centre of the hospital’s cardiology service, receiving patients from the mobile care unit (directly or via an ST elevation myocardial infarction network), the emergency department, and other wards, including coronary, structural, and electrophysiology intervention laboratories and operating rooms. Patients are usually unstable and require immediate full attention by highly trained medical and nursing staff. The 2005 recommendations for the structure, organization, and operations of the intensive cardiac care unit were issued by Hasin et al. for the Working Group of Acute Cardiac Care of the European Society of Cardiology, which serves as basis for this chapter. The chapter will focus on the requirements for staffing, training, and accreditation, as well as the structure organization and equipment of the intensive and intermediate cardiac care units.

scholarly journals Cardiogenic Shock Clinical Presentation, Management, and In-Hospital Outcomes in Patients Admitted to the Acute Cardiac Care Unit of a Tertiary Hospital: Does Gender Play a Role?

2020 ◽  
Vol 9 (10) ◽  
pp. 3117
Author(s):  
Adrian Jerónimo ◽  
Marcos Ferrández-Escarabajal ◽  
Carlos Ferrera ◽  
Francisco J. Noriega ◽  
Jesús Diz-Díaz ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Clinical Presentation ◽  
Tertiary Hospital ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cardiac Care ◽  
Hospital Outcomes ◽  
Ventricular Ejection Fraction ◽  
Acute Cardiac Care ◽  
Cardiac Care Unit

Cardiogenic shock (CS), as the most severe form of heart failure, is associated with very high mortality rates despite therapeutic advances in the last decades. Gender differences in outcomes have been widely reported regarding several cardiovascular diseases. The aim of our study was to evaluate potential gender disparities in clinical presentation, management, and in-hospital outcomes of all (n = 138) patients admitted to the Acute Cardiac Care Unit of a tertiary hospital from 2013 to 2019. Information on demographic characteristics, past medical history, haemodynamic and clinical status at admission, therapeutic management, and in-hospital outcomes was retrospectively collected. Women represented 31.88% of the cohort, were significantly older than the men and had a lower proportion of smokers, chronic obstructive pulmonary disease, and previous acute myocardial infarction (AMI). Most CSs in both groups were AMI-related. Left ventricular ejection fraction at admission was higher in women, who were less likely to receive vasopressors. No differences were observed regarding mechanical circulatory support use and in-patient outcomes, with age being the only factor associated with in-hospital mortality on multivariate analysis.

Potentially undiagnosed cognitive impairment in patients with peripheral arterial disease: A systematic review of the literature

The Surgeon ◽  
2021 ◽  
Author(s):  
Doireann Patricia Joyce ◽  
Carlos Sebastian Gracias ◽  
Fiona Murphy ◽  
Muhammed Tubassam ◽  
Stewart Redmond Walsh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cognitive Impairment ◽  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Review Of The Literature ◽  
Peripheral Arterial

scholarly journals Features of echocardiographic assessment on transcatheter aortic valve implantation multiple stages

2021 ◽  
Vol 28 (1) ◽  
pp. 43-51
Author(s):  
G. I. Yemets ◽  
O. V. Telehuzova ◽  
G. B. Mankovsky ◽  
A. V. Maksymenko ◽  
Ye. Yu. Marushko ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Severe Aortic Stenosis ◽  
Full Range ◽  
Valve Prosthesis ◽  
Novel Device ◽  
Transcatheter Aortic Valve ◽  
Echocardiographic Parameters ◽  
Aortic Valve Implantation ◽  
Valve Implantation

The aim – to systematize information on key features of echocardiographic evaluation of transcatheter aortic valve implantation (TAVI) procedure stages and their effectiveness in cardiac surgery, in patients with severe aortic valve stenosis.Materials and methods. We initiated a single-center clinical study to evaluate the XPand device and initial analysis of the primary results was performed. Patients met the inclusion criteria underwent a full range of examinations and TAVI procedures using the XPand device. The key parameters for echocardiographic examination in TAVI, which influence the formation of further procedure strategy, have been determined for the cardiac surgeon.Results and discussion. Based on the determined echocardiographic parameters, we obtained the primary outcomes of TAVI XPand in patients (n=7), the result of implantation was good. Minimal paravalvular insufficiency absence was found in 71.5 % of patients and minimal insufficiency in 14,5 %. In one patient to moderate insufficiency was observed. There was a statistically significant improvement in the ejection fraction (p<0.05) and a decrease in the mean gradient at the aortic valve (p<0.01).Conclusions. Echocardiographic parameters at all TAVI stages in patients over 75 years allow to control the implementation of the procedure and to improve the immediate post procedural outcome. The first experience of using the novel device for transcatheter implantation of the XPand aortic valve prosthesis confirms its effectiveness and safety in elderly patients with severe aortic stenosis.

Sign in / Sign up

Export Citation Format

Share Document