During the last decade, most studies on totally implanted venous access-associated adverse events (TIVA-AE) were conducted retrospectively and/or were based on a limited sample size. The aim of our ...survey was two-fold: to estimate the incidence of TIVA-AE and to identify risk factors in patients with cancer.
Data from our routine surveillance of TIVA-AE were collected prospectively between October 2009 and January 2011 in two oncology referral centers in Northern France. The open cohort under surveillance during the same time period was reconstituted retrospectively using data from the hospital information systems. Incidences of first TIVA-AE per 1000 TIVA-days were calculated. Risk factors were identified using multivariate logistic regressions.
We included 2286 cancer patients, corresponding to 582,347 TIVA-days. Among the 133 first TIVA-AE observed (incidence 0.23 per 1000 TIVA-days 0.19-0.27), there were 50 infectious AE (incidence 0.09 0.06-0.11) and 83 non-infectious AE (incidence 0.14 0.11-0.17). Compared to non-metastatic solid cancers, metastatic cancers (aOR=2.3 0.9-6.0), and hematologic malignancies (aOR=3.2 1.1-8.8) tended to be associated with a higher risk of infectious TIVA-AE (P=0.087). Solid cancer type was associated with non-infectious TIVA-AE (P=0.030), especially digestive cancers.
We report accurate estimations of TIVA-AE incidences in one of the largest populations among previously published studies. As in previous studies, metastatic cancers and hematologic malignancies tended to be associated with a higher risk of infectious TIVA-AE. Further studies are warranted to confirm the effect of digestive cancers.
The accepted standard in estimating the stay prolongation attributable to surgical site infections is the matched-cohort study method (MCS), which is associated with selection bias. The ...Appropriateness Evaluation Protocol (AEP) has been used to estimate stay prolongation attributable to nosocomial infections but has not been validated specifically for surgical site infections.
To compare estimates of stay prolongation attributable to surgical site infections after digestive surgery, obtained by AEP and by MCS.
Sixty-five surgical site infections after digestive tract surgery were analyzed by AEP and MCS. AEP stay prolongation was the number of days judged specifically appropriate for the care of surgical site infections. MCS stay prolongation was the difference of stay duration in surgical site infection cases and two controls matched by age, sex, and diagnosis-related groups. Sensitivity and specificity of AEP, and agreement between both methods, were calculated.
The mean AEP stay prolongation was 3.5 days vs 7.2 days for MCS. The sensitivity of AEP was 58% and the specificity was 75%. The agreement between the two methods was poor.
Surgical site infections after digestive tract surgery increased the hospital stay. Accurate estimations of a prolongation of stay will vary according to the method selected.
Background: The accepted standard in estimating the stay prolongation attributable to surgical site infections is the matched-cohort study method (MCS), which is associated with selection bias. The ...Appropriateness Evaluation Protocol (AEP) has been used to estimate stay prolongation attributable to nosocomial infections but has not been validated specifically for surgical site infections.
Aim of the study: To compare estimates of stay prolongation attributable to surgical site infections after digestive surgery, obtained by AEP and by MCS.
Methods: Sixty-five surgical site infections after digestive tract surgery were analyzed by AEP and MCS. AEP stay prolongation was the number of days judged specifically appropriate for the care of surgical site infections. MCS stay prolongation was the difference of stay duration in surgical site infection cases and two controls matched by age, sex, and diagnosis-related groups. Sensitivity and specificity of AEP, and agreement between both methods, were calculated.
Results: The mean AEP stay prolongation was 3.5 days vs 7.2 days for MCS. The sensitivity of AEP was 58% and the specificity was 75%. The agreement between the two methods was poor.
Conclusion: Surgical site infections after digestive tract surgery increased the hospital stay. Accurate estimations of a prolongation of stay will vary according to the method selected.
Idiopathic or iatrogenic left bundle branch block (LBBB) is a unique model of electro-mechanical ventricular dyssynchrony with concordant changes in electrical activation sequence and mechanical ...ventricle synchronization. In chronic animal models, isolated LBBB induces structural remodeling with progressive left ventricular (LV) dysfunction. Most abnormalities can be reverted after cardiac resynchronization therapy (CRT). In humans, 2 principal models of LBBB dyssynchronopathy can be observed: the chronic model of isolated LBBB and an acute iatrogenic model of new-onset LBBB after aortic valve interventions. Although epidemiological evidence and clinical data need to be strengthened, there is a strong presumption that they may lead to LBBB-induced cardiomyopathy and benefit from CRT to prevent progression to heart failure. A large cohort study with prospective follow-up would be required to better define actual incidence, evolution over time, and predisposing factors. Parallel randomized CRT clinical trials should be conducted in selected at-risk populations: namely, patients with persistent LBBB after transcatheter aortic valve replacement.
High-degree atrioventricular block (HAVB) is a common complication of ST segment elevation myocardial infarction (STEMI). HAVB in STEMI is historically considered as a marker of worse outcome but ...overall data about HAVB in the contemporary era of mechanical reperfusion and potent antiplatelet therapies are scarce.
Analysing incidence, clinical correlates and impact on inhospital outcomes of HAVB in a large prospective registry (Observatoire Régional Breton sur l'Infarctus, ORBI) of modern management of STEMI with a special focus on potential differences between patients with HAVB on admission and those who developed HAVB during hospitalisation.
All patients enrolled in ORBI between June 2006 and December 2013 were included in the present analysis and were divided into 3 groups: patients without HAVB at any time, patients with HAVB on admission and those who developed HAVB during hospitalisation.
A total of 6662 patients (age: 62.0 (52.0-74.0) years; male: 76.3%) were included in the present analysis. HAVB was documented in 3.5% of patients, present on admission in 63.7% of patients and occurring during hospitalisation in 36.3%. Patients with HAVB on admission or occurring during the first 24 h of hospitalisation had higher inhospital mortality rates (18.1% and 28.6%, respectively) than patients without (4.5%) or with HAVB occurring beyond the first 24 h of hospitalisation (8.0%). However by multivariable analysis, HAVB was not independently associated with inhospital mortality contrarily to age, presentation as cardiac arrest, anterior STEMI location, reperfusion therapy, cardiogenic shock, mechanical ventilation and occurrence of sustained ventricular tachyarrhythmias or mechanical complication.
Patients with HAVB had a higher mortality rate than patients without. However HAVB is not an independent predictor of inhospital mortality.
Idiopathic or iatrogenic left bundle branch block (LBBB) is a unique model of electro-mechanical ventricular dyssynchrony with concordant changes in electrical activation sequence and mechanical ...ventricle synchronization. In chronic animal models, isolated LBBB induces structural remodeling with progressive left ventricular (LV) dysfunction. Most abnormalities can be reverted after cardiac resynchronization therapy (CRT). In humans, 2 principal models of LBBB dyssynchronopathy can be observed: the chronic model of isolated LBBB and an acute iatrogenic model of new-onset LBBB after aortic valve interventions. Although epidemiological evidence and clinical data need to be strengthened, there is a strong presumption that they may lead to LBBB-induced cardiomyopathy and benefit from CRT to prevent progression to heart failure. A large cohort study with prospective follow-up would be required to better define actual incidence, evolution over time, and predisposing factors. Parallel randomized CRT clinical trials should be conducted in selected at-risk populations: namely, patients with persistent LBBB after transcatheter aortic valve replacement.
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Objectives. The aim of this study was to assess the potential acute benefit of multisite cardiac pacing with optimized atrioventricular synchrony and simultaneous biventricular pacing in patients ...with drug-refractory congestive heart failure (CHF).
Background. Prognosis and quality of life in severe CHF are poor. Various nonpharmacological therapies have been evaluated but are restricted in their effectiveness and applications. In the early 1990s, dual chamber pacing (DDD) pacing was proposed as primary treatment of refractory CHF but results were controversial. Recently, tests to evaluate the effect of simultaneous pacing of both ventricles have elicited a significant improvement of cardiac performance.
Methods. Acute hemodynamic study was conducted in 18 patients with severe CHF (New York Heart Association class III and IV) and major intraventricular conduction block (IVCB) (QRS duration = 170 ± 37 ms). Using a Swan-Ganz catheter, pulmonary artery pressure, pulmonary capillary wedge pressure (PCWP) and cardiac index (CI) were measured in different pacing configurations: atrial pacing (AAI) mode, used as reference, single-site right ventricular DDD pacing and biventricular pacing with the right ventricular lead placed either at the apex or at the outflow tract.
Results. The CI was significantly increased by biventricular pacing in comparison with AAI or right ventricular (RV). DDD pacing (2.7 ± 0.7 vs. 2 ± 0.5 and 2.4 ± 0.6 l/min/m2, p < 0.001). The PCWP also decreased significantly during biventricular pacing, compared with AAI (22 ± 8 vs. 27 ± 9 mm Hg; p < 0.001).
Conclusions. This acute hemodynamic study demonstrated that biventricular DDD pacing may significantly improve cardiac performance in patients with IVCB and with severe heart failure, in comparison with intrinsic conduction and single-site RV DDD pacing.
Left bundle branch block (LBBB) induces mechanical dyssynchrony that may lead to left ventricular systolic dysfunction.
To evaluate the incidence, predictors and clinical impact of new LBBB in ...patients undergoing surgical aortic valve replacement (SAVR).
After exclusion of patients with pre-existing LBBB, a previous pacemaker or a paced rhythm at hospital discharge, 547 consecutive patients undergoing SAVR were included. All-cause death, cardiovascular death and the combined outcome of all-cause death or a first heart failure event were assessed at 3months and 1year. Patients with and without new LBBB were compared.
New LBBB occurred in 4.6% of patients after SAVR (compared with 16.4% of patients treated by transcatheter aortic valve implantation during the study period). Previous valve surgery and an immediate postoperative paced rhythm were independent predictors of new LBBB. At 1-year follow-up, there were no significant differences in all-cause death, cardiovascular death, or the combined outcome of all-cause death or a first heart failure event between patients with and without new LBBB. However, new LBBB was associated with a trend towards functional deterioration and more heart failure events at 1year.
At 1-year follow-up, new LBBB did not have a significant impact on clinical outcome, but was associated with worse functional status and more heart failure events.
Le bloc de branche gauche (BBG) induit un asynchronisme mécanique pouvant provoquer une dysfonction systolique ventriculaire gauche.
Évaluer l’incidence, les facteurs prédictifs et les conséquences cliniques d’un BBG acquis suite à un remplacement valvulaire aortique (RVA) chirurgical.
Après avoir exclu les patients ayant un BBG préexistant ou porteurs d’un stimulateur cardiaque avant le RVA chirurgical et les patients ayant un rythme électro-entraîné à la sortie d’hospitalisation, 547 patients consécutifs opérés d’un RVA ont été inclus. La mortalité toute cause, la mortalité cardiovasculaire et le critère combiné mortalité toute cause ou premier événement d’insuffisance cardiaque ont été évalués à 3mois et 1an. Les patients avec et sans BBG acquis ont été comparés.
Un BBG acquis est retrouvé chez 4,6 % des patients opérés d’un RVA (pour comparaison, sur la même période, un BBG est retrouvé chez 16,4 % des patients après TAVI). Les facteurs prédictifs indépendants de BBG acquis sont un antécédent de chirurgie valvulaire et un rythme électro-entraîné en postopératoire immédiat. À 1 an de suivi, il n’y pas de différence entre les patients ayant un BBG acquis et ceux n’ayant pas de BBG pour la mortalité toute cause, la mortalité cardiovasculaire et le critère combiné mortalité toute cause ou premier événement d’insuffisance cardiaque. Toutefois, les patients avec BBG acquis avaient un plus mauvais statut fonctionnel et davantage d’événements d’insuffisance cardiaque à 1an.
À 1an de suivi, un BBG acquis n’a pas d’influence pronostique significative.
The natural history of congenital or childhood non-immune, isolated atrioventricular (AV) block is poorly defined.
We retrospectively studied 141 children with isolated, non-immune AV block diagnosed ...in utero, or up to 15 years of age, at 13 French medical centres, between 1980 and 2009. Patients with structural heart disease or maternal antibodies were excluded. Atrioventricular block was asymptomatic in 119 (84.4%) and complete in 100 (70.9%) patients. There was progression to complete AV block in 29/41 (70.7%) patients with incomplete AV block over 2.8 ± 3.4 years (1-155 months), but all patients with incomplete AV block may not have been included in the study. Narrow QRS complex was present in 18 of 26 patients (69.2%) with congenital, and 106 of 115 (92.2%) with childhood AV block. Pacemakers were implanted in 112 children (79.4%), during the first year of life in 18 (16.1%) and before 10 years of age in 90 (80.4%). The mean interval between diagnosis of AV block and pacemaker implants was 2.6 ± 3.9 years (0-300 months). The pacing indication was prophylactic in 70 children (62.5%). During a mean follow-up of 11.6 ± 6.7 years (1-32 years), no patient died or developed dilated cardiomyopathy (DCM). The long-term follow-up was uncomplicated in 127 children (90.1%).
In this large multicentre study, the long-term outcome of congenital or childhood non-immune, isolated AV block was favourable, regardless of the patient's age at the time of diagnosis. No patient died or developed DCM, and pacemaker-related complications were few.
SCN5A Mutation and ST Segment Elevation in Inferior Leads. Mutations in the SCN5A gene can lead to the Brugada syndrome, a genetically inherited form of idiopathic ventricular fibrillation that has a ...characteristic ECG phenotype usually restricted to precordial leads V1–V3. We identified a novel G752R SCN5A missense mutation leading to various degrees of the Brugada ECG phenotype in members of a French family. In the proband, the G752R mutation produced ST segment elevation and prominent J wave in leads II, III, and aVF. In four other relatives, ST segment elevation in the right precordial but not in the inferior leads was observed either spontaneously or under flecainide challenge. Recombinant G752R mutant exhibited a markedly reduced Na+ current amplitude and a voltage shift in both activation and inactivation curves. The mutant was found in all affected but not in nonaffected family members. One additional gene‐carrier had an almost normal ECG (silent gene‐carrier). We provide genetic demonstration that Brugada ECG anomalies related to a unique SCN5A mutation can be observed either in the inferior or the right precordial leads. (J Cardiovasc Electrophysiol, Vol. 14, pp. 200‐203, February 2003)
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