scholarly journals Lead Dependent Tricuspid Valve Dysfunction-Risk Factors, Improvement after Transvenous Lead Extraction and Long-Term Prognosis

2021 ◽  
Vol 11 (1) ◽  
pp. 89
Author(s):  
Anna Polewczyk ◽  
Wojciech Jacheć ◽  
Dorota Nowosielecka ◽  
Andrzej Tomaszewski ◽  
Wojciech Brzozowski ◽  
...  
Keyword(s):  
Risk Factors ◽  
Tricuspid Valve ◽  
Lead Extraction ◽  
Common Mechanism ◽  
Term Survival ◽  
Long Term Survival ◽  
Valve Dysfunction ◽  
Valve Function ◽  
Long Term Prognosis

Background: Lead-related tricuspid valve dysfunction (LDTVD) has not been studied in a large population and its management remains controversial. Methods: An analysis of the clinical data of 2678 patients undergoing transvenous lead extraction (TLE) in years 2008–2021 was conducted, with a separate group of 119 patients with LDTVD. Potential risk factors for LDTVD, improvement in valve function, and long-term prognosis after TLE were assessed. Results: LDTVD was diagnosed in 4.44% of patients referred for lead extraction due to different reasons. The most common mechanism of LDTVD was propping upward or clamping down the leaflet by the lead (85.71%). The probability of LDTVD was higher in female sex, patients with valvular heart disease, atrial fibrillation, heart failure, large right ventricle and high pulmonary artery systolic pressure, the presence of only pacing lead, and in case of collision of the lead with tricuspid valve and adhesion of the lead to the heart structures. The prognosis of patients with LDTVD was worse, however, patients with improved valve function after TLE showed a significantly better long-term survival. Conclusions: Lead dependent tricuspid valve dysfunction is a potentially serious condition that requires thorough diagnostics and thoughtful management. The risk factors for LDTVD are primarily related to the course of the lead and its adhesion to the heart structures. Improvement of tricuspid valve function after TLE is observed in 35.29% of patients Patients with LDTVD have a worse long-term survival, but the improvement in valve function following TLE contributes to a significant reduction in mortality.

Risk factors for short- and long-term survival in patients undergoing re-replacement due to prosthetic valve dysfunction

2006 ◽  
Vol 21 (6) ◽  
pp. 339-343 ◽  
Author(s):  
Bilgehan Savaş Oz ◽  
Hikmet Iyem ◽  
Hakki Tankut Akay ◽  
Cengiz Bolcal ◽  
Mehmet Yokusoglu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prosthetic Valve ◽  
Term Survival ◽  
Long Term Survival ◽  
Valve Dysfunction ◽  
Prosthetic Valve Dysfunction ◽  
Short And Long Term

Risk Factors and Long-Term Survival of Octogenarians and Nonagenarians Undergoing Transvenous Lead Extraction Procedures

Gerontology ◽  
2020 ◽  
pp. 1-13
Author(s):  
Wojciech Jacheć ◽  
Anna Polewczyk ◽  
Luca Segreti ◽  
Maria Grazia Bongiorni ◽  
Andrzej Kutarski
Keyword(s):  
Risk Factors ◽  
Cardiac Resynchronization Therapy ◽  
The Elderly ◽  
Cardiac Resynchronization ◽  
Lead Extraction ◽  
Resynchronization Therapy ◽  
Term Survival ◽  
Long Term Survival ◽  
Related Risk

<b><i>Introduction:</i></b> Transvenous lead extraction (TLE) has become a frequently used tool for the management of complications related to pacemakers, implantable cardiac defibrillators and cardiac resynchronization therapy devices. However, it is still a matter of debate whether the lead extraction procedure is a safe treatment choice in the elderly. <b><i>Methods:</i></b> We collected the clinical information from 3,810 patients undergoing TLE in 2 high-volume centers (Poland and Italy) between 2006 and 2017. We tested risk factors, effectiveness, safety and long-term survival in 3 groups of patients: those aged 80–89.99 years, ≥90 years and 30–79.99 years. <b><i>Results:</i></b> Lower BMI, lower levels of hemoglobin and more comorbidities characterized the patients, whose ages ranged from 80 to 89.99 years. Those aged ≥90 years most often had single-chamber pacemakers. Octogenarians and nonagenarians were more often undergoing TLE due to infectious indications (57.19 and 74.29 vs. 45.35% in younger individuals). Lead age and the number of leads extracted were comparable in the 3 groups. In octogenarians, leads were more often removed using standard extraction techniques: simple traction and mechanical dilatators, whereas in nonagenarians TLE was more complex. The duration of the procedure was shorter in older patients, while clinical and procedural effectiveness was similar to that in younger individuals. The rate of major complications related to TLE did not differ between octogenarians and younger subjects (2.0 vs. 1.38%, <i>p</i> = ns), and the number of procedure-related risk factors was smaller in older people. Nonagenarians did not develop any major complication related to TLE. Long-term mortality after TLE was similar among octogenarians and nonagenarians (39.67 and 40.00%) but higher than in younger patients (24.41; <i>p</i> &#x3c; 0.001 and 0.05). <b><i>Conclusions:</i></b> Lead extraction procedures appear effective and safe in octogenarians and nonagenarians, comparable to younger individuals. Procedure-related risk in the elderly is not associated with most of the typical risk factors encountered in younger subjects, but only with the higher number of pacemaker, implantable cardiac defibrillator and cardiac resynchronization therapy device procedures before TLE. Long-term survival after TLE was found to be similar among octogenarians and nonagenarians being about 60% at over 3 years of follow-up. Age alone should not be considered a risk factor for the occurrence of major complications or procedure-related death, and therefore it should not prevent candidacy for TLE.

P3135Tricuspid valve dysfunction caused by transvenous lead extraction. Can we predict this complication?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Polewczyk ◽  
D Nowosielecka ◽  
A Tomaszewski ◽  
W Brzozowski ◽  
D Szczesniak Stanczyk ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Tricuspid Valve ◽  
Dwell Time ◽  
Lead Extraction ◽  
Function Evaluation ◽  
Main Risk Factor ◽  
Valve Dysfunction ◽  
Valve Function

Abstract Background Accidental damage of tricuspid apparatus is known complication of TLE procedure risk factors of this complication remain unknown. Purpose The goal of this study was to search factors which can predict damage of tricuspid apparatus during TLE. Methods Between 2006 and 2018 we performed 2002 TLE procedures using conventional mechanical sheaths. 3366 leads (mean implant duration 95,2 months) were removed due to non-infective indications in 62,0%. Tricuspid valve function was examined with preoperative and post-operative TTE and during monitoring of procedure. Patients with incomplete TV function evaluation were excluded from the study. Three groups of patients were compared Results TLE procedure brings risk (7%) of different degree damage or tricuspid leflet or even chordae tendinae (2%). The detailed results are presented in the table. Conclusions TLE using conventional mechanical sheaths is effective but brings risk of extraction related tricuspid valve dysfunction. Main risk factor of this complication seems to be implant dwell time, number of leads presence of abandoned leads and lead loop in the heart remaining in conflict with tricuspid valve.

Permanent pacemaker implantation following mitral valve surgery: a retrospective cohort study of risk factors and long-term outcomes

2021 ◽  
Author(s):  
Mark R Helmers ◽  
Max Shin ◽  
Amit Iyengar ◽  
Gabriel R Arguelles ◽  
Jarvis Mays ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mitral Valve ◽  
Tricuspid Valve ◽  
Mitral Valve Surgery ◽  
Permanent Pacemaker ◽  
Valve Surgery ◽  
Term Survival ◽  
Long Term Survival ◽  
Valvular Surgery

Abstract OBJECTIVES Conduction disturbances requiring permanent pacemaker (PPM) implantation remain a complication following valvular surgery. PPMs confer the risk of infection, tricuspid valve regurgitation and pacing-induced cardiomyopathy. Literature examining PPM placement in mitral valve surgery (MVS) is limited. METHODS Our institutional mitral valve (MV) database was retrospectively reviewed for adult patients undergoing surgery from 2011 to 2019. Patients with preoperative PPM were excluded. Patients were stratified by the receipt of PPM following their index operations. Multivariable logistic regression was performed to determine patient and operative risk factors for PPM. Subgroup analysis was performed on patients who underwent isolated MVS. Kaplan–Meier analysis and a multivariable Cox proportional hazards model were utilized to assess the association between PPM implantation and long-term survival. RESULTS A total of 3391 (2991 non-PPM and 400 PPM) patients met the study criteria. Significant predictors of PPM included increased decade of age (odds ratio: 1.23; 95% confidence interval: 1.12–1.35), concomitant aortic (1.44; 1.10–1.90) and tricuspid valve procedures (2.21; 1.64–2.97) and prior history of myocardial infarction (1.48; 1.07–1.86). In the isolated MV repair population, annuloplasty with ring prosthesis was associated with PPM (3.09; 1.19–8.02). Patients in the replacement population did not have significant identifiable risk factors. There was no survival difference found, and postoperative PPM placement was not found to be an independent predictor of mortality. CONCLUSIONS Our primary aim was to elucidate predictors for PPM implantation in MVS and found increasing age and concomitant procedures to be risk factors. Receipt of PPM is associated with worse long-term survival but does not independently predict survival. Among patients undergoing isolated MV repair, use of an annuloplasty ring confers a higher risk of PPM compared to an annuloplasty band.

scholarly journals Risk Factors and Long-Term Prognosis for Chylothorax After Total Cavopulmonary Connection in Children: A Retrospective Study From a Single Center

2021 ◽  
Vol 9 ◽  
Author(s):  
Liting Bai ◽  
Zhengyi Feng ◽  
Ju Zhao ◽  
Shengwen Guo ◽  
Yuanyuan Tong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Pressure ◽  
Survival Rates ◽  
Total Cavopulmonary Connection ◽  
Term Survival ◽  
Long Term Survival ◽  
Hospital Patients ◽  
Long Term Prognosis ◽  
Cavopulmonary Connection

Background: Chylothorax is a severe complication after total cavopulmonary connection (TCPC) in children. This study was performed to evaluate the incidence, risk factors, and short- and long-term prognosis for chylothorax.Methods: We retrospectively reviewed the electronic records of patients who underwent TCPC between January 2008 and December 2020 in Fuwai Hospital. Patients were divided into two groups based on the occurrence of post-operative chylothorax. Univariate and multivariate analyses were performed to identify risk factors, and long-term survival was estimated by the Kaplan–Meier method.Results: Of 386 patients included in our study, chylothorax occurred in 60 patients (15.5%). Compared with the non-chylothorax group, the prevalence of prolonged intensive care unit (ICU) stay (p = 0.000) and post-operative hospital stay (p = 0.000) were greater in patients with chylothorax. Post-operative adverse events in terms of infection (p = 0.002), ascites (p = 0.001), prolonged pleural effusion (p = 0.000), and diaphragmatic paralysis (p = 0.026) were more frequent in chylothorax patients. The median follow-up duration was 4.0 (2.0, 6.8) years. The chylothorax group had significantly lower survival rates at 1 year (92.4 vs. 99.3%, p &lt; 0.001) and 10 years (84.6 vs. 91.6%, p &lt; 0.001), respectively. Having a right dominant ventricle [odds ratio (OR) = 2.711, 95% confidence interval (CI) = 1.285–5.721, p = 0.009] and a higher peak central venous pressure (CVP) on post-operative day (POD) 0 (OR = 1.116, 95% CI = 1.011–1.233, p = 0.030) were the risk factors for the development of chylothorax after TCPC operation.Conclusion: The incidence of chylothorax in patients undergoing TCPC is lower than previously reported but is associated with poor early- and long-term survival. Having a right dominant ventricle and a higher peak CVP on POD 0 are the risk factors for chylothorax after TCPC operation.

scholarly journals Long-term survival after Carpentier-Edwards Perimount aortic valve replacement in Western Denmark: a multi-centre observational study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Lytfi Krasniqi ◽  
Mads P. Kronby ◽  
Lars P. S. Riber
Keyword(s):  
Risk Factors ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Significant Risk ◽  
Valve Prosthesis ◽  
Term Survival ◽  
Long Term Survival ◽  
All Cause Mortality

Abstract Background This study describes the long-term survival, risk of reoperation and clinical outcomes of patients undergoing solitary surgical aortic valve replacement (SAVR) with a Carpentier-Edwards Perimount (CE-P) bioprosthetic in Western Denmark. The renewed interest in SAVR is based on the questioning regarding the long-term survival since new aortic replacement technique such as transcatheter aortic-valve replacement (TAVR) probably have shorter durability, why assessment of long-term survival could be a key issue for patients. Methods From November 1999 to November 2013 a cohort of a total of 1604 patients with a median age of 73 years (IQR: 69–78) undergoing solitary SAVR with CE-P in Western Denmark was obtained November 2018 from the Western Danish Heart Registry (WDHR). The primary endpoint was long-term survival from all-cause mortality. Secondary endpoints were survival free from major adverse cardiovascular and cerebral events (MACCE), risk of reoperation, cause of late death, patient-prothesis mismatch, risk of AMI, stroke, pacemaker or ICD implantation and postoperative atrial fibrillation (POAF). Time-to-event analysis was performed with Kaplan-Meier curve, cumulative incidence function was performed with Nelson-Aalen cumulative hazard estimates. Cox regression was applied to detect risk factors for death and reoperation. Results In-hospital mortality was 2.7% and 30-day mortality at 3.4%. The 5-, 10- and 15-year survival from all-cause mortality was 77, 52 and 24%, respectively. Survival without MACCE was 80% after 10 years. Significant risk factors of mortality were small valves, smoking and EuroSCORE II ≥4%. The risk of reoperation was < 5% after 7.5 years and significant risk factors were valve prosthesis-patient mismatch and EuroSCORE II ≥4%. Conclusions Patients undergoing aortic valve replacement with a Carpentier-Edwards Perimount valve shows a very satisfying long-term survival. Future research should aim to investigate biological valves long-term durability for comparison of different SAVR to different TAVR in long perspective.

The influence of thrombophilia on the long-term survival of patients with a history of venous thromboembolism

2013 ◽  
Vol 109 (01) ◽  
pp. 79-84 ◽  
Author(s):  
Sylvia Reitter-Pfoertner ◽  
Thomas Waldhoer ◽  
Michaela Mayerhofer ◽  
Ernst Eigenbauer ◽  
Cihan Ay ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Multivariable Analysis ◽  
Factor V Leiden ◽  
Arterial Disease ◽  
Factor V ◽  
Term Survival ◽  
Long Term Survival ◽  
History Of

SummaryData on the long-term survival following venous thromboembolism (VTE) are rare,and the influence of thrombophilia has not been evaluated thus far. Our aim was to assess thrombophilia-parameters as predictors for long-term survival of patients with VTE. Overall, 1,905 outpatients (99 with antithrombin-, protein C or protein S deficiency, 517 with factor V Leiden, 381 with elevated factor VIII and 160 with elevated homocysteine levels, of these 202 had a combination and 961 had none of these risk factors) were included in the study between September 1, 1994 and December 31, 2007. Retrospective survival analysis showed that a total of 78 patients (4.1%) had died during the analysis period, among those four of definite or possible pulmonary embolism and four of bleeding. In multivariable analysis including age and sex an association with increased mortality was found for hyperhomocysteinemia (hazard ratio 2.0 [1.1.-3.5]) whereas this was not the case for all other investigated parameters. We conclude that the classical hereditary thrombophilia risk factors did not have an impact on the long-term survival of patients with a history of VTE. Thus our study supports the current concept that thrombophilia should not be a determinant for decision on long term anticoagulation. However, hyperhomocysteinaemia, known as a risk factor for recurrent VTE and arterial disease, might impact survival.

64 STATISTICAL ANALYSIS OF PROGNOSTIC FACTORS AFFECTING LONG-TERM PROGNOSIS AFTER ENDOSCOPIC TREATMENT OF ESOPHAGEAL VARICES

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
T Nishimura
Keyword(s):  
Prognostic Factors ◽  
Esophageal Varices ◽  
Endoscopic Treatment ◽  
Survival Period ◽  
Term Survival ◽  
Gastroesophageal Varices ◽  
Long Term Survival ◽  
Factors Affecting ◽  
Long Term Prognosis

Abstract   Gastroesophageal varices are present in approximately 50% of patients with cirrhosis, and their rupture is a life-threatening complication. However, mortality rates have declined due to the progress in the management of these patients. Especially advances in endoscopic treatment have contributed to the improved survival rates. In this study, we investigated the prognostic factors associated with long-term survival after endoscopic treatment for esophageal varices. Methods The subjects were 260 patients who underwent initial endoscopic treatment for esophageal varices in our hospital between January 1997 and June 2019. Among them, 160 successfully followed up. The patients’ characteristics were: mean age, 65.4 years (29–85); 109 men and 51 women; and median survival period, 53 months. For analysis, subjects were divided into long-term survival and non-long-term survival groups (n = 59 for each) with a 53-month survival period as a cut-off value. Results The long-term/non-long-term survival group had a preoperative Child-Pugh score of 6.2 ± 1.1/7.4 ± 2.0 (p &lt; 0.01) and hepatocellular carcinoma (HCC) presence rate was 25.4%/55.9% (p &lt; 0.01), significantly higher in the non-long-term group. Analysis of the factors affecting survival period using Cox proportional hazards model showed that Child-Pugh score B or C [hazard ratio(HR):2.0143, p &lt; 0.05], total bilirubin value≧ 2 [HR:2.5573, p &lt; 0.05], and presence of HCC [HR:2.2450, p &lt; 0.01] were noted as significant factors. Only presence of HCC was found to be a significant factor affecting the long-term survival using multiple logistic regression analysis [odds ratio:0.3463, p &lt; 0.05]. Conclusion Our study revealed that liver function and the presence of HCC affect long-term prognosis after endoscopic treatment for esophageal varices.

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