Many earlier studies reported high mortality and morbidity after TVR in both early and late postoperative peri-ods. Our main finding is that good outcomes for TVR are achievable in properly selected patients. Sixty of 86 patients in our group had preoperative NYHA functional class III and IV, which suggests that surgical timing was late in many patients. Based on our observations, we propose that surgical correction of severe tricuspid valve disease should be considered before the development of advanced HF, when patients are asymptomatic or only oligosymptomatic.
Introduction The data about use of venoarterial ECMO as a temporary circulatory support system in cardiogenic shock (CS) for Central Europe are scarce. Objectives The aim was to disclose the indications, in-hospital and long-term (1 year) mortality along with risk factors. Patients and methods The study is a retrospective investigation of patients who underwent VA ECMO support for the CS in the cardiac and cardiosurgical tertiary centre, from January 2013 to June 2018. We tested a broad spectrum of pre– and post-implantation factors along with their impact on mortality using univariate logistic regression analysis. Results 198 patients met the inclusion criteria. The median duration of support was 207 (IQR 91–339) hours, with no significant disparity in the length of support among hospital survivors and nonsurvivors (p=0.09). 40,4% of all patients deceased during ECMO support, while the joined in-hospital and six-month mortality progressed to 65,2% and one-year mortality to 67,2%. 9% underwent subsequent heart transplantation. The most frequent adverse events were bleeding (76%), infection (56%), neurologic injury (15%) and limb ischemia (15%). Multi-organ failure was identified as the most decisive risk factor of in-hospital mortality (OR 4,45, p<0,001). Patients with postcardiotomy cardiogenic shock had a significantly lower out-of-hospital survival rate than those with decompensated heart failure (32,3% vs 45%, log-rank p=0,037). The learning curve of our centre is noted with the lowest survival in the first two years of ECMO employment in comparison to the following 6-year period. Conclusion The outcomes of the study reinforce the clear survival benefit, despite frequent complications. The protocol focusing on proper candidate selection and timing can positively impact patients survival. The additional risk reduction can be achieved with the further increase of the team experience with ECMO. FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): National Institute of Cardiology in Warsaw, Poland - research grant. Figure 1 Figure 2
Background Driveline infections in continuous-flow left ventricular assist devices (cf-LVAD) remain the most common adverse event. This single-center retrospective study investigated the risk factors, prevalence and management of driveline infections. Methods Patients treated after cf-LVAD implantation from December 2014 to January 2020 were enrolled. Baseline data were collected and potential risk factors were elaborated. The multi-modal treatment was based on antibiotic therapy, daily wound care, surgical driveline reposition, and heart transplantation. Time of infection development, freedom of reinfection, freedom of heart transplantation, and death in the follow-up time were investigated. Results Of 75 observed patients, 26 (34.7%) developed a driveline infection. The mean time from implantation to infection diagnosis was 463 (±399; range, 35–1400) days. The most common pathogen was Staphylococcus aureus (n = 15, 60%). First-line therapy was based on antibiotics, with a primary success rate of 27%. The majority of patients (n = 19; 73.1%) were treated with surgical reposition after initial antibiotic therapy. During the follow-up time of 569 (±506; range 32–2093) days, the reinfection freedom after surgical transposition was 57.9%. Heart transplantation was performed in eight patients due to resistant infection. The overall mortality for driveline infection was 11.5%. Conclusions Driveline infections are frequent in patients with implanted cf-LVAD, and treatment does not efficiently avoid reinfection, leading to moderate mortality rates. Only about a quarter of the infected patients were cured with antibiotics alone. Surgical driveline reposition is a reasonable treatment option and does not preclude subsequent heart transplantation due to limited reinfection freedom.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.