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PURPOSE: To describe our experience over 6 years using a new high-density polyethylene-based spherical integrated porous orbital implants (Oculfit). METHODS: This is an observational retrospective case series study analyzing all cases requiring Oculfit implants between February 2015 and September 2021. Clinical information regarding the population included, the characteristics of the implant, and the outcomes and complications during the follow-up were noted. The success of the implant was defined according to anatomical and functional parameters. RESULTS: The study analyzed 90 cases of anophthalmic patients. The main causes for enucleation or evisceration were ocular decompensations (36.7%) and neoplasms (27.8% uveal melanoma and 7.8% retinoblastoma). Anatomical success was identified in 63 (70.0%) cases, functional success in 79 (87.8%) and complete success (anatomical + functional) in 61 (67.7%) cases. Factors associated with the functional success were age and exposure of the primary orbital implant. Complications appeared in 11 (12.2%) cases, which were completely resolved without sequelae in 4 (4.4%). Orbital explant was required in 5 (5.6%) cases. CONCLUSION: In our experience, Oculfit can be considered a useful alternative among the currently available options for orbital implants and has a good efficacy/safety profile.
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Implantes Orbitales , Polietileno , Humanos , Implantes Orbitales/efectos adversos , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Adulto , Niño , Adolescente , Preescolar , Porosidad , Adulto Joven , Diseño de Prótesis , Anciano de 80 o más Años , Complicaciones Posoperatorias/epidemiología , Enucleación del Ojo , Estudios de Seguimiento , Resultado del Tratamiento , Evisceración del Ojo , Implantación de Prótesis/métodos , Implantación de Prótesis/efectos adversosAsunto(s)
Implantación de Prótesis , Filtros de Vena Cava , Humanos , Resultado del Tratamiento , Implantación de Prótesis/instrumentación , Implantación de Prótesis/efectos adversos , Diseño de Prótesis , Factores de Riesgo , Embolia Pulmonar/prevención & control , Vena Cava Inferior/diagnóstico por imagen , Trombosis de la Vena/terapia , Trombosis de la Vena/diagnóstico por imagen , Selección de Paciente , Toma de Decisiones ClínicasRESUMEN
As an alternative to transvenous ICD systems, two non-transvenous ICD systems have been established in recent years: The subcutaneous ICD (S-ICD), which has been established for several years, has a presternal electrode that is implanted subcutaneously and offers a shock function and, to a limited extent, post-shock pacing. In addition, the extravascular ICD (EV-ICD) has been available in Europe since 2023 which does not require transvenous electrodes and offers the option of providing patients with antibradycardic and antitachycardic stimulation in combination with a conventional ICD function. The lead of this device is implanted substernally. Initial implantation results are promising in terms of safety and effectiveness. Both systems avoid possible complications of transvenous electrodes. This article provides practical guidance for the implantation technique and possible complications.
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Desfibriladores Implantables , Implantación de Prótesis , Humanos , Diseño de Equipo , Medicina Basada en la Evidencia , Guías de Práctica Clínica como Asunto , Implantación de Prótesis/efectos adversos , Implantación de Prótesis/métodos , Implantación de Prótesis/normas , Resultado del TratamientoRESUMEN
Concern regarding the exponential increase in optional utilization of inferior vena cava filters (IVCFs) in the early 2000s with a persistent low retrieval rate nationwide has resulted in increased scrutiny regarding clinical application of IVCFs. IVCFs are used in a variety of clinical scenarios, ranging from thromboembolic protection in patients with deep venous thrombosis and contraindication to anticoagulation to prophylactic deployment in multitrauma and critically ill patients. Evidence supporting IVCFs as mechanical thromboembolic protection in certain clinical scenarios has been established through evidenced-based guidelines. As an adjunct to evidence-based guidelines, appropriateness criteria to address specific clinical scenarios and facilitate clinical decision making when considering placement of an IVCF have been developed. In this review, current evidence-based and appropriateness guidelines are summarized.
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Guías de Práctica Clínica como Asunto , Filtros de Vena Cava , Humanos , Filtros de Vena Cava/normas , Guías de Práctica Clínica como Asunto/normas , Factores de Riesgo , Resultado del Tratamiento , Selección de Paciente , Implantación de Prótesis/instrumentación , Implantación de Prótesis/efectos adversos , Implantación de Prótesis/normas , Toma de Decisiones Clínicas , Medicina Basada en la Evidencia/normas , Trombosis de la Vena/terapia , Trombosis de la Vena/prevención & control , Medición de Riesgo , Diseño de Prótesis , Tromboembolia Venosa/prevención & controlRESUMEN
BACKGROUND: We aimed to investigate the potential correlation between the placement factors of various retrievable inferior vena cava filters and retrieval outcomes. Additionally, we aimed to identify the factors affecting the placement tilt of the filter. METHODS: This retrospective study was conducted at a tertiary care center to investigate patients who had previously undergone retrievable filter placement at our center and who subsequently had their filters removed between January 2020 and December 2021. Patient characteristics and filter-related factors were recorded. Complex filter retrieval was defined as cases that required a minimum of 8 minutes of fluoroscopy or that involved advanced techniques. Regression models were used to explore patient- and placement procedure-related factors that could influence retrieval outcomes and the placement tilt angle. RESULTS: The study included 163 patients, and all filters were successfully retrieved. Thirty-seven (22.7%) retrievals were classified as complex retrievals. The mean diameter of the inferior vena cava in the preplacement position for the entire cohort was 16 ± 1.8 mm. The median filter tilt angles at placement and retrieval were 5.0° (IQR, 1.8°-9°) and 4.6° (IQR, 2.1°-8.0°), respectively. The placement tilt angle was not significantly associated with complex retrieval (P = 0.59). The filter hook abutment to the vena cava wall (OR, 10.76, P = 0.003), dwell time (OR, 1.02, P = 0.029), and diameter of the vena cava (OR, 10.21, P < 0.001) were associated with complex retrieval. The diameter (P = 0.049), age (P = 0.049), and filter brand (P = 0.001) were found to be significantly associated with placement tilt. CONCLUSIONS: The inferior vena cava diameter at the time of placement predicts difficulty in filter retrieval. In addition, the filter hook abutting the inferior vena cava wall and long indwelling time may complicate retrieval. The vena cava diameter is also closely related to the degree of filter tilt.
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Remoción de Dispositivos , Implantación de Prótesis , Filtros de Vena Cava , Vena Cava Inferior , Humanos , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , Vena Cava Inferior/diagnóstico por imagen , Resultado del Tratamiento , Anciano , Implantación de Prótesis/instrumentación , Implantación de Prótesis/efectos adversos , Factores de Riesgo , Adulto , Factores de Tiempo , Diseño de Prótesis , Medición de RiesgoRESUMEN
Objectives. Temporary mechanical circulatory support (TMCS) has become a component in the therapeutic strategy for treatment of cardiogenic shock as a bridge-to-decision. TMCS can facilitate recovery of cardiopulmonary function, end-organ function, and potentially reduce the surgical risk of left ventricular assist device (LVAD) implantation. Despite the improvements of hemodynamics and end-organ function, post-LVAD operative morbidity might be increased in these high-risk patients. The aim of the study was to compare outcomes after Heartmate 3 (HM3) implantation in patients with and without TMCS prior to HM3 implant. Methods. In this retrospective cohort study of all HM3 patients in the period between November 2015 and October 2021, patients with and without prior TMCS were compared. Patients' demographics, baseline clinical characteristics, laboratory tests, intraoperative variables, postoperative outcomes, and adverse events were collected from patient records. Results. The TMCS group showed an improvement in hemodynamics prior to LVAD implantation. Median TMCS duration was 19.5 (14-26) days. However, the TMCS group were more coagulopathic, had more wound infections, neurological complications, and more patients were on dialysis compared with patient without TMCS prior to HM3 implantation. Survival four years after HM3 implantation was 80 and 82% in the TMCS (N = 22) and non-TMCS group (N = 41), respectively. Conclusion. Patients on TMCS had an acceptable short and long-term survival and comparable to patients receiving HM3 without prior TMCS. However, they had a more complicated postoperative course.
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Insuficiencia Cardíaca , Corazón Auxiliar , Hemodinámica , Recuperación de la Función , Choque Cardiogénico , Función Ventricular Izquierda , Humanos , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , Factores de Tiempo , Resultado del Tratamiento , Choque Cardiogénico/fisiopatología , Choque Cardiogénico/mortalidad , Choque Cardiogénico/terapia , Choque Cardiogénico/diagnóstico , Factores de Riesgo , Adulto , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/terapia , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/diagnóstico , Anciano , Implantación de Prótesis/instrumentación , Implantación de Prótesis/efectos adversos , Implantación de Prótesis/mortalidad , Medición de Riesgo , Diseño de PrótesisRESUMEN
INTRODUCTION: The establishment of venous access is one of the driving factors for complications during implantation of pacemakers and defibrillators (cardiac implantable electronic devices [CIED]). Recently, a novel approach of accessing the cephalic vein for CIED by cephalic vein puncture (CVP) using a modified Seldinger technique has been described, promising high success rates and simplified handling with steeper learning curves. In this single-center registry, we analyzed the safety and efficiency of CVP to SVP access after defining CVP as the primary access route in our center. METHODS: A total of 229 consecutive patients receiving a CIED were included in the registry. Sixty-one patients were implanted by primary or bail-out SVP; 168 patients received primary cephalic preparation and CVP was performed when possible, using a hydrophilic transradial sheath. RESULTS: Implantation of at least one lead via CVP was successful in 151 of 168 patients (90%), and implantation of all leads was possible in 122 of 168 patients (72.6%). Total implantation times and fluoroscopy times and doses did not differ between CVP and SVP implantations. Pneumothorax occurred in 0/122 patients implanted via CVP alone, but 8/107 (7.5%) patients received at least one lead via SVP. CONCLUSION: Our data confirms high success rates of the CVP for CIED implantation. Moreover, this method can be used without significantly prolonging the total procedure time or applying fluoroscopy dose compared to the highly efficient SVP while showing lower overall complication rates.
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Desfibriladores Implantables , Marcapaso Artificial , Punciones , Sistema de Registros , Vena Subclavia , Humanos , Masculino , Femenino , Anciano , Resultado del Tratamiento , Cateterismo Venoso Central/métodos , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/instrumentación , Persona de Mediana Edad , Implantación de Prótesis/métodos , Implantación de Prótesis/instrumentación , Implantación de Prótesis/efectos adversos , Estudios Retrospectivos , Anciano de 80 o más Años , Factores de TiempoRESUMEN
BACKGROUND: The treatment of infected bone defects remains a clinical challenge. With the development of three-dimensional printing technology, three-dimensional printed implants have been used for defect reconstruction. The aim of this study was to investigate the clinical outcomes of three-dimensional printed porous prosthesis in the treatment of femoral defects caused by osteomyelitis. METHODS: Eleven patients with femoral bone defects following osteomyelitis who were treated with 3D-printed porous prosthesis at our institution between May 2017 and July 2021, were included. Eight patients were diagnosed with critical-sized defects, and the other three patients were diagnosed with shape-structural defects. A two-stage procedure was performed for all patients, and the infection was eradicated and bone defects were occupied by polymethylmethacrylate spacer during the first stage. The 3D-printed prosthesis was designed and used for the reconstruction of femoral defects in the second stage. Position of the reconstructed prostheses and bone growth were measured using radiography. The union rate, complications, and functional outcomes at the final follow-up were assessed. RESULTS: The mean length of the bone defect was 14.0 cm, union was achieved in 10 (91%) patients. All patients showed good functional performance at the most recent follow-up. In the critical-sized defect group, one patient developed a deep infection that required additional procedures. Two patients had prosthetic dislocations. Radiography demonstrated good osseous integration of the implant-bone interface in 10 patients. CONCLUSION: The 3D printed prostheses enable rapid anatomical and mechanically stable reconstruction of extreme femur bone defects, effectively shortens treatment time, and achieves satisfactory clinical outcomes.
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Fémur , Osteomielitis , Impresión Tridimensional , Diseño de Prótesis , Titanio , Humanos , Osteomielitis/cirugía , Osteomielitis/etiología , Osteomielitis/diagnóstico por imagen , Masculino , Femenino , Fémur/cirugía , Fémur/diagnóstico por imagen , Persona de Mediana Edad , Adulto , Porosidad , Resultado del Tratamiento , Implantación de Prótesis/instrumentación , Implantación de Prótesis/métodos , Implantación de Prótesis/efectos adversos , Estudios Retrospectivos , Anciano , Adulto Joven , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/instrumentaciónRESUMEN
For patients with existing venous thromboembolisms (VTEs), anticoagulation remains the standard of care recommended across multiple professional organizations. However, for patients who developed a deep venous thrombosis (DVT) and/or a pulmonary embolism and cannot tolerate anticoagulation, inferior vena cava (IVC) filters must be considered among other alternative treatments. Although placement of a filter is considered a low-risk intervention, there are important factors and techniques that surgeons and interventionalists should be aware of and prepared to discuss. This overview covers the basics regarding the history of filters, indications for placement, associated risks, and techniques for difficult removal.
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Remoción de Dispositivos , Diseño de Prótesis , Implantación de Prótesis , Embolia Pulmonar , Filtros de Vena Cava , Trombosis de la Vena , Humanos , Embolia Pulmonar/prevención & control , Trombosis de la Vena/prevención & control , Trombosis de la Vena/terapia , Factores de Riesgo , Implantación de Prótesis/instrumentación , Implantación de Prótesis/efectos adversos , Resultado del Tratamiento , Tromboembolia Venosa/prevención & control , Tromboembolia Venosa/diagnóstico , Vena Cava Inferior/diagnóstico por imagen , Medición de Riesgo , Anticoagulantes/uso terapéutico , Anticoagulantes/efectos adversosRESUMEN
PURPOSE: To evaluate outcomes following explantation of percutaneous or transcutaneous bone conduction implants (pBCIs or tBCIs) and subsequent implantation of transcutaneous active bone conduction hearing devices (BCHDs); to provide guidance regarding staging of surgery and adjunctive procedures. MATERIALS AND METHODS: Retrospective chart review of eight adult subjects (ten ears) with pBCIs or tBCIs who underwent explantation of their device and subsequent implantation with a BCHD [MED-EL BONEBRIDGE™ (n = 7, 70 %) or Cochlear™ Osia® (n = 3, 30 %)]. RESULTS: Reasons for pBCI or tBCI explantation were pain (60 %, 6/10), infection (60 %, 6/10), skin overgrowth (50 %, 5/10), and inability to obtain new processors (20 %, 2/10). Median time between pBCI or tBCI removal and BCHD staged implant was 4.7 (IQR 2.2-8.1) months. Two subjects developed complications following BCHD implantation. One had a persistent wound overlying the osseointegrated screw after removal of the pBCI abutment, requiring removal and temporalis rotational flap. Staged Osia® implantation was performed, but ultimately wound dehiscence developed over the device. The second subject experienced an infection after BONEBRIDGE™ implantation (32 days after pBCI explant), necessitating washout and treatment with intravenous antibiotics. There was subsequent device failure. CONCLUSION: The transition from a pBCI or tBCI to a novel transcutaneous device is nuanced. Staged pBCI or tBCI explantation and novel BCHD implantation with sufficient time for wound healing is vital. Adjunctive procedures to augment soft tissue in cases of prior attenuation may be required to avoid complications with larger internal devices.
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Conducción Ósea , Remoción de Dispositivos , Audífonos , Humanos , Audífonos/efectos adversos , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Resultado del Tratamiento , Anciano , Prótesis Anclada al Hueso , Implantación de Prótesis/métodos , Implantación de Prótesis/efectos adversos , Pérdida Auditiva Conductiva/cirugía , Pérdida Auditiva Conductiva/etiologíaRESUMEN
BACKGROUND: The placement of inferior vena cava (IVC) filters often emerges as an alternative preventative measure against pulmonary embolism in patients with upper gastrointestinal (GI) bleeding and isolated distal deep vein thrombosis (DVT). We aimed to investigate the association of IVC filter placement and the incidence of venous thromboembolism (VTE) recurrence in this patient population. METHODS: We performed a retrospective cohort study including 450 patients with upper GI bleeding and isolated distal DVT. Propensity score matching using logistic regression was conducted to mitigate potential selection bias. Logistic regression models and additional sensitivity analyses were conducted to estimate the association between IVC filter implantation and VTE recurrence. Interaction and stratified analyses were also performed according to the background covariates. RESULTS: Patients who underwent IVC filter placement were significantly younger than patients in the surveillance group (55.8 ± 9.0 vs 58.4 ± 11.2 years, p = 0.034). Patients in the IVC filter group demonstrated a higher distal thrombus burden. The VTE recurrence composite was significantly higher in patients who underwent IVC filter placement (44.1% [45/102] vs 25% [87/348], p < 0.001). Unmatched crude logistic regression analysis identified a significant association between IVC filter placement and VTE recurrence composite (OR = 2.37; 95% CI, 1.50-3.75). Sensitivity analyses yielded congruent outcomes. CONCLUSION: This study revealed an increased risk of VTE recurrence among patients receiving IVC filter placement, suggesting that IVC filter placement may not be suitable as a primary treatment for patients with upper GI bleeding and isolated distal DVT.
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Hemorragia Gastrointestinal , Recurrencia , Filtros de Vena Cava , Tromboembolia Venosa , Trombosis de la Vena , Humanos , Filtros de Vena Cava/efectos adversos , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/epidemiología , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/terapia , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/epidemiología , Trombosis de la Vena/etiología , Trombosis de la Vena/terapia , Factores de Riesgo , Anciano , Resultado del Tratamiento , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/epidemiología , Tromboembolia Venosa/prevención & control , Tromboembolia Venosa/etiología , Medición de Riesgo , Adulto , Incidencia , Implantación de Prótesis/efectos adversos , Implantación de Prótesis/instrumentación , Factores de TiempoRESUMEN
BACKGROUND: Clinical outcomes after major lower-limb amputation have been historically poor. The current care provided to most amputees is often disorganized and without physician supervision. The primary purpose of this study is to examine rates of postamputation mobility achieved with a prosthesis by patients with chronic limb-threatening ischemia and/or diabetes who required major lower-limb amputation and were treated under an established physician-led collaborative care pathway. The secondary purpose is to describe the structure and utilization of the care pathway by multiple independent vascular surgery practices in the United States to enable future exploration of its impact on key clinical outcomes within this patient population. METHODS: Clinical records of 2,475 patients from 6 vascular practices that adopted this collaborative care pathway between 2017 and 2020 were retrospectively reviewed. Only records with sufficient documented histories of amputation surgeries, prosthetic services, and mobility status were included. RESULTS: Of 2,475 patient records reviewed, 1,787 patients (2,157 major amputations) were eligible for analysis. Sixty-two-point 2 percent (n = 1,111) of patients achieved mobility with the collaborative care pathway. Mobility rate varied by amputation level in the study. Prosthetic mobility was achieved in 73.5% of transtibial amputations, 40.4% of transfemoral amputations, and 35.7% of through-knee amputations, regardless of patient laterality, which is superior or equivalent to the best published rates of mobility. CONCLUSIONS: The study describes the structure and utilization of a physician-led collaborative care pathway for treating patients who require lower-limb amputation that meets 5 of the 7 recommendations from the 2019 Global Vascular Guidelines on the Management of Chronic Limb Threatening Ischemia. Internal data analysis results suggest that patients treated via this care pathway can potentially achieve improved mobility rates with a prosthesis following amputation. This collaborative care pathway should be further evaluated for its ability to directly improve mobility and other clinically relevant amputation outcomes.
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Amputación Quirúrgica , Amputados , Miembros Artificiales , Extremidad Inferior , Humanos , Estudios Retrospectivos , Masculino , Femenino , Anciano , Resultado del Tratamiento , Persona de Mediana Edad , Extremidad Inferior/irrigación sanguínea , Factores de Tiempo , Estados Unidos , Recuperación de la Función , Conducta Cooperativa , Grupo de Atención al Paciente/organización & administración , Isquemia Crónica que Amenaza las Extremidades/cirugía , Enfermedad Arterial Periférica/fisiopatología , Enfermedad Arterial Periférica/cirugía , Enfermedad Arterial Periférica/terapia , Enfermedad Arterial Periférica/diagnóstico , Prestación Integrada de Atención de Salud/organización & administración , Limitación de la Movilidad , Pautas de la Práctica en Medicina , Anciano de 80 o más Años , Estado Funcional , Implantación de Prótesis/instrumentación , Implantación de Prótesis/efectos adversosRESUMEN
BACKGROUND: Utilization of right ventricular mechanical circulatory support (RV-MCS) devices has been limited by a lack of recognition of RV failure as well as a lack of availability and experience with RV-MCS. AIMS: We report a single-center experience with the use of percutaneous RV-MCS and report predictors of adverse outcomes. METHODS: This was a single-center retrospective cohort study. Data from consecutive patients who received RV-MCS for any indication between June 2015 and January 2022 were included. Data on baseline comorbidities, hemodynamics, and laboratory values were collected. The primary outcome was in-hospital mortality analyzed as a logistic outcome in a multivariable model. These variables were further ranked by their predictive value. RESULTS: Among 58 consecutive patients enrolled, the median age was 66 years, 31% were female and 53% were white. The majority of the patients (48%) were hospitalized for acute on chronic heart failure. The majority of the patients were SCAI SHOCK Stage D (67%) and 34 (64%) patients had MCS placed within 24 h of the onset of shock. Before placement of RV-MCS, median central venous pressure (CVP) and RV stroke work index were 20 mmHg and 8.9 g m/m2, respectively. Median serum lactate was 3.5 (1.6, 6.2) mmol/L. Impella RP was implanted in 50% and ProtekDuo in the remaining 50%. Left ventricular MCS was concomitantly used in 66% of patients. Twenty-eight patients (48.3%) died. In these patients, median serum lactate was significantly higher (4.1 [2.3, 13.0] vs. 2.2 [1.4, 4.0] mmol/L, p = 0.007) and a trend toward higher median CVP (24 [18, 31] vs. 19 [14, 24] mmHg, p = 0.052). In the multivariable logistic model, both serum lactate and CVP before RV-MCS placement were independent predictors of in-hospital mortality. Serum lactate had the highest predictive value. CONCLUSION: In our real-world cohort, 52% of patients treated with RV-MCS survived their index hospitalization. Serum lactate at presentation and CVP were the strongest predictors of in-hospital mortality.
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Insuficiencia Cardíaca , Corazón Auxiliar , Mortalidad Hospitalaria , Recuperación de la Función , Disfunción Ventricular Derecha , Función Ventricular Derecha , Humanos , Femenino , Masculino , Estudios Retrospectivos , Anciano , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/terapia , Insuficiencia Cardíaca/diagnóstico , Resultado del Tratamiento , Persona de Mediana Edad , Factores de Riesgo , Factores de Tiempo , Disfunción Ventricular Derecha/fisiopatología , Disfunción Ventricular Derecha/mortalidad , Disfunción Ventricular Derecha/etiología , Disfunción Ventricular Derecha/terapia , Disfunción Ventricular Derecha/diagnóstico por imagen , Medición de Riesgo , Implantación de Prótesis/instrumentación , Implantación de Prótesis/efectos adversos , Implantación de Prótesis/mortalidad , Biomarcadores/sangreRESUMEN
INTRODUCTION: Ventricular tachycardia storm or electrical storm (ES) is a common complication following left ventricular assist device (LVAD) implantation. The factors contributing to ES and outcomes are less studied. The study aimed to determine the factors associated with ES and the probability of survival in patients undergoing LVAD in three tertiary centers over a span of 15 years. METHODS: We performed a retrospective cohort study on all patients who underwent LVAD implantation at the Mayo Clinic (Rochester, Phoenix, and Jacksonville) from January 1, 2006 to December 31, 2020. ES was defined as ≥3 episodes of sustained ventricular tachycardia over a period of 24 h with no identifiable reversible cause. Detailed chart reviews of the electronic health records within the Mayo Clinic and outside medical records were performed. RESULTS: A total of 883 patients who underwent LVAD implantation were included in our study. ES occurred in 7% (n = 61) of patients with a median of 13 days (interquartile range [IQR]: 5-297 days) following surgery. We found 57% of patients (n = 35) developed ES within 30 days, while 43% (n = 26) patients developed ES at a median of 545 (IQR 152-1032) days after surgery. Following ES, 26% of patients died within 1 year. Patients with ES had a significant association with a history of ventricular arrhythmias and implantable cardioverter defibrillator (ICD) shocks before the procedure. ES was significantly associated with reduced survival compared to patients without ES (hazards ratio [HR]: 1.92, 95% CI: 1.39-2.64, p < .001). CONCLUSION: Following LVAD implantation, the rate of ES was 7% with majority of ES occurring within 30 days of LVAD. Risk factors for ES included pre-implant history of ventricular arrhythmias and ICD shock. ES was significantly associated with reduced survival compared to patients without ES.
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Insuficiencia Cardíaca , Corazón Auxiliar , Implantación de Prótesis , Taquicardia Ventricular , Función Ventricular Izquierda , Humanos , Femenino , Estudios Retrospectivos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Factores de Tiempo , Taquicardia Ventricular/mortalidad , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatología , Taquicardia Ventricular/etiología , Resultado del Tratamiento , Anciano , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/terapia , Implantación de Prótesis/efectos adversos , Implantación de Prótesis/instrumentación , Implantación de Prótesis/mortalidad , Medición de Riesgo , Potenciales de Acción , Frecuencia Cardíaca , AdultoRESUMEN
Anticoagulation is the first-line approach in the prevention and treatment of pulmonary embolism. In some instances, however, anticoagulation fails, or cannot be administered due to a high risk of bleeding. Inferior vena cava filters are metal alloy devices that mechanically trap emboli from the deep leg veins halting their transit to the pulmonary circulation, thus providing a mechanical alternative to anticoagulation in such conditions. The Greenfield filter was developed in 1973 and was later perfected to a model that could be inserted percutaneously. Since then, this model has been the reference standard. The current class I indication for this device includes absolute contraindication to anticoagulants in the presence of acute thromboembolism and recurrent thromboembolism despite adequate therapy. Additional indications have been more recently proposed, due to the development of removable filters and of progressively less invasive techniques. Although the use of inferior vena cava filters has solid theoretical advantages, clinical efficacy and adverse event profile are still unclear. This review analyzes the most important studies related to such devices, open issues, and current guideline recommendations.
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Anticoagulantes , Guías de Práctica Clínica como Asunto , Diseño de Prótesis , Embolia Pulmonar , Filtros de Vena Cava , Filtros de Vena Cava/efectos adversos , Humanos , Embolia Pulmonar/prevención & control , Anticoagulantes/uso terapéutico , Anticoagulantes/efectos adversos , Anticoagulantes/administración & dosificación , Factores de Riesgo , Resultado del Tratamiento , Hemorragia/inducido químicamente , Hemorragia/prevención & control , Medición de Riesgo , Implantación de Prótesis/efectos adversos , Implantación de Prótesis/instrumentación , Vena Cava InferiorRESUMEN
BACKGROUND: Early guidance recommended a bolus of intravenous heparin at the beginning of leadless pacemaker (LP) implantation procedures. However, due to concern about bleeding complications, more recent practice has tended toward omitting the bolus and only running a continuous heparin infusion through the introducer sheath. The impact of omitting the heparin bolus on procedural outcomes is not clear. METHODS: We reviewed all Medtronic Micra LP implants at our institution from 9/2014 to 9/2022. The decision to bolus with heparin was at operator discretion. RESULTS: Among 621 LP implants, 326 received an intravenous heparin bolus, 243 did not, and 52 patients were excluded because heparin bolus status could not be confirmed. There was a trend toward more frequent omission of the heparin bolus with more recent implants. Median follow-up after LP implant was 14.3 (interquartile range [IQR]: 8.4-27.9) months. There was no difference between heparin bolus and no bolus groups in the number of device deployments/recaptures (1.42 ± 0.81 vs. 1.31 ± 0.66, p = .15). Implant-related adverse events were also similar between heparin bolus and no bolus groups: access-site hematoma requiring intervention (7 vs. 5, p = .99), pseudoaneurysm (1 vs. 1, p = .99), cardiac perforation (1 vs. 1, p = .99), intraprocedural device thrombus formation (2 vs. 4, p = .41), 30-day rehospitalization (21 vs. 15, p = .98), and 30-day all-cause mortality (16 vs. 14, p = .70). There was one additional nonfatal cardiac perforation in a patient who was excluded due to unknown heparin bolus status. Regarding device electrical parameters between heparin bolus and no bolus groups, there were no significant differences at the time of implant: pacing capture threshold 0.5 ± 0.4 vs. 0.5 ± 0.3, p = .10; pacing impedance 739.9 ± 226.4 vs. 719.1 ± 215.4, p = .52; R wave sensing 11.7 ± 5.7 vs. 12.0 ± 5.4, p = .34). Long-term device performance was also similar between groups. CONCLUSION: Omission of the systemic heparin bolus at the time of LP implantation appears safe in appropriately selected patients. Heparin bolus may still be considered in long cases requiring multiple device deployments or in patients at high risk for thrombotic complications.
Asunto(s)
Anticoagulantes , Estimulación Cardíaca Artificial , Heparina , Marcapaso Artificial , Humanos , Heparina/administración & dosificación , Heparina/efectos adversos , Masculino , Anciano , Femenino , Anticoagulantes/administración & dosificación , Anticoagulantes/efectos adversos , Resultado del Tratamiento , Estudios Retrospectivos , Factores de Tiempo , Factores de Riesgo , Anciano de 80 o más Años , Persona de Mediana Edad , Esquema de Medicación , Implantación de Prótesis/instrumentación , Implantación de Prótesis/efectos adversos , Diseño de PrótesisRESUMEN
Acquired tracheobronchomalacia (ATBM) is a condition in which the tracheobronchial wall and cartilage progressively lose their rigidity, resulting in dynamic collapse during exhalation. In this report, we present a case of ATBM that developed following voice prosthesis implantation. To the best of our knowledge, this is the first documented case of such a condition in the medical English literature based on a PubMed search. A 63-year-old man was referred to National Kyushu Cancer Center in Japan with complaints of pharyngeal pain and a laryngeal tumor. The tumor was diagnosed as laryngeal cancer, and the patient underwent laryngectomy. Three months after the surgery, we implanted a voice prosthesis through a tracheoesophageal puncture. Two months after implantation, the patient experienced dyspnea. This condition was subsequently diagnosed as ATBM through computed tomography and bronchofiberscope examinations. After the removal of the voice prosthesis, there has been no progression of ATBM for over five years. While ATBM may not be a common occurrence in the practice of head and neck surgeons, it should be considered as a potential complication when patients report dyspnea following voice prosthesis implantation.
Asunto(s)
Neoplasias Laríngeas , Laringectomía , Laringe Artificial , Traqueobroncomalacia , Humanos , Masculino , Persona de Mediana Edad , Laringe Artificial/efectos adversos , Neoplasias Laríngeas/cirugía , Laringectomía/efectos adversos , Traqueobroncomalacia/etiología , Traqueobroncomalacia/cirugía , Disnea/etiología , Tomografía Computarizada por Rayos X , Implantación de Prótesis/efectos adversos , Complicaciones Posoperatorias/etiología , Carcinoma de Células Escamosas/cirugíaRESUMEN
OBJECTIVES: Right ventricular failure following implantation of a durable left ventricular assist device (LVAD) is a major driver of mortality. Reported survival following biventricular (BiVAD) or total artificial heart (TAH) implantation remains substantially inferior to LVAD alone. We report our outcomes with LVAD and BiVAD HeartMate 3 (HM3). METHODS: Consecutive patients undergoing implantation of an HM3 LVAD between November 2014 and December 2021, at The Alfred, Australia were included in the study. Comparison was made between the BiVAD and LVAD alone groups. RESULTS: A total of 86 patients, 65 patients with LVAD alone and 21 in a BiVAD configuration underwent implantation. The median age of the LVAD and BiVAD groups was 56 years (Interquartile range 46-62) and 49 years (Interquartile range 37-55), respectively. By 4 years after implantation, 54% of LVAD patients and 43% of BiVAD patients had undergone cardiac transplantation. The incidence of stroke in the entire experience was 3.5% and pump thrombosis 5% (all in the RVAD). There were 14 deaths in the LVAD group and 1 in the BiVAD group. The actuarial survival for LVAD patients at 1 year was 85% and BiVAD patients at 1 year was 95%. CONCLUSIONS: The application of HM 3 BiVAD support in selected patients appears to offer a satisfactory solution to patients requiring biventricular support.
Asunto(s)
Insuficiencia Cardíaca , Corazón Auxiliar , Humanos , Persona de Mediana Edad , Masculino , Femenino , Insuficiencia Cardíaca/cirugía , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/terapia , Adulto , Estudios Retrospectivos , Resultado del Tratamiento , Trasplante de Corazón/métodos , Australia/epidemiología , Implantación de Prótesis/instrumentación , Implantación de Prótesis/efectos adversos , Implantación de Prótesis/métodosRESUMEN
PURPOSE: This study aims to compare the initial ocular discomfort symptoms resulting from trabeculectomy and Ahmed glaucoma valve implantation surgeries. METHODS: A prospective comparative study was conducted. The evaluation of ocular discomfort employed a questionnaire designed to identify the frequency and severity of distinct symptoms: ocular pain, general discomfort, tearing, foreign body sensation, and burning. This questionnaire was administered prior to surgery as a baseline, and subsequently at 7, 30, and 90 days post-surgery. Simultaneously, the Ocular Surface Disease Index (OSDI) was applied at these same time intervals. RESULTS: The study encompassed a total of 17 patients (9 undergoing trabeculectomy and 8 undergoing Ahmed glaucoma valve implantation). The Ahmed glaucoma valve implantation group exhibited higher tearing levels at baseline (p=0.038). However, no statistically significant differences in symptoms were observed between the two surgeries at 7 and 30 days post-surgery. At the 90-day mark following surgery, patients who had undergone trabeculectomy reported a significantly higher foreign body sensation (p=0.004). Although OSDI scores did not differ between groups at baseline, the trabeculectomy group showed significantly higher OSDI scores than the Ahmed glaucoma valve implantation group at 7, 30, and 90 days after surgery (p<0.05). CONCLUSION: Post-surgery, patients who had undergone trabeculectomy experienced increased foreign body sensation. Trabeculectomy appears to cause greater early postoperative ocular discomfort compared to the Ahmed glaucoma valve implantation group.
Asunto(s)
Cuerpos Extraños , Implantes de Drenaje de Glaucoma , Glaucoma , Trabeculectomía , Humanos , Trabeculectomía/efectos adversos , Estudios Prospectivos , Presión Intraocular , Implantes de Drenaje de Glaucoma/efectos adversos , Glaucoma/etiología , Implantación de Prótesis/efectos adversos , Cuerpos Extraños/complicaciones , Cuerpos Extraños/cirugía , Resultado del Tratamiento , Estudios RetrospectivosRESUMEN
INTRODUCTION: Transsubclavian venous implantation of the Aveir leadless cardiac pacemaker (LCP) has not been previously reported. METHODS AND RESULTS: Three cases of transsubclavian implantation of the Aveir LCP are reported. Two cases were postbilateral orthotopic lung transplant, without appropriate femoral or jugular access due to recent ECMO cannulation and jugular central venous catheters. In one case, there was strong patient preference for same-day discharge. Stability testing confirmed adequate fixation and electrical testing confirmed stable parameters in all cases. All patients tolerated the procedure well without significant immediate complications. CONCLUSIONS: We demonstrate the feasibility of transsubclavian implantation of the Aveir LCP.