Management and follow-up of valvular disease in the geriatric population

2015 ◽  
pp. 77-92
Author(s):  
WR Eric Jamieson ◽  
Michael H Yamashita ◽  
Lawrence H Burr ◽  
Stuart A Suttie ◽  
Jian Ye
Keyword(s):  
Valvular Disease ◽  
Geriatric Population

482Direct oral anticoagulant rivaroxaban in very old and frail patients: A one-year prospective follow-up of a large-scale cohort (SAFIR-AC)

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
O Hanon ◽  
J Vidal ◽  
E Chaussade ◽  
J P David ◽  
N Boulloche ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Major Bleeding ◽  
Large Scale ◽  
Bleeding Risk ◽  
Geriatric Population ◽  
Very Old ◽  
The Mean ◽  
One Year ◽  
The One

Abstract Background/Introduction Age is one of the strongest predictors/risk factors for ischemic stroke in subjects with atrial fibrillation (AF). Direct oral anticoagulants (DOACs) have been shown to be effective in the prevention of this condition; however, clinical evidence on bleeding risk with this therapeutic strategy in very old and frail geriatric patients is poor. Purpose To assess bleeding risk in French geriatric patients aged ≥80 years and diagnosed with AF newly treated with rivaroxaban. Methods Subjects, presenting to one of 33 geriatric centers, with non-valvular AF and recent initiation of a treatment with rivaroxaban were enrolled in the study and followed-up every 3 months for 12 months. Clinical and routine laboratory data and evaluation scores, such as HAS-BLED, HEMORR2HAGES, ATRIA, and CHA2DS2-VASc, as well as comprehensive geriatric evaluation were reported. Major bleeding, as defined in ROCKET AF study, was reported at each visit, and this primary outcome was adjudicated by an independent committee. Results of this cohort were compared with findings from a similar cohort treated with vitamin K antagonists (VKAs) from the same centers (n=924). Results A total of 1045 subjects were enrolled in the study of whom 995 (95%) had a one-year follow-up (analyzed population). The mean (standard deviation (SD)) age was 86.0 (4.3) years, with the majority of patients being female (61%), 23% aged 90 years or older, and 48% having an estimated glomerular filtration rate (eGFR) <50 mL/min. The main comorbidities were hypertension in 77% of subjects, malnutrition 49%, anemia 43%, dementia 39%, heart failure 36%, and falls 27%. The mean (SD) score for CHA2DS2-VASc was 4.8 (1.4), HAS-BLED 2.4 (0.9), Mini-Mental State Examination (MMSE) 21.5 (6.9), Activities of Daily Living (ADL) 4.4 (1.9), and Charlson Comorbidity Index 6.7 (2.0). The one-year rate of major bleeding events was 6.4% of which 0.8% were fatal and 1.1% intracranial hemorrhages (ICH), whereas the one-year rate of ischemic stroke was 1.4% and all-cause mortality 17.9%. Computed with VKA cohort findings and adjusted for age, gender, eGFR and Charlson score, this would result in a hazard ratio of 0.54 (95% confidence interval [CI], 0.38 to 0.78) for major bleeding, 0.36 (0.17 to 0.76) for ICH, 0.62 (0.29 to 1.33) for ischemic stroke, and 0.82 (0.65 to 1.02) for all-cause mortality, in favor of rivaroxaban. Conclusions This is the first large-scale prospective study in geriatric population in AF subjects treated with DOAC (rivaroxaban) Major bleeding risk appeared higher in very old than younger population, however major bleeding and ICH rates were significantly lower with rivaroxaban than with VKAs when used in the same geriatric population. This study indicates that Rivaroxaban can be used in very old and frail patients for the treatment of non-valvular AF. Acknowledgement/Funding Unrestricted grant from Bayer

scholarly journals P1304 Is antibiotic profilaxis really not needed in mitral valve prolapse?

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Suma ◽  
S Coli ◽  
W Serra ◽  
I Spaggiari ◽  
A Botti ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Antibiotic Therapy ◽  
Mitral Valve Prolapse ◽  
Valvular Disease ◽  
Posterior Leaflet ◽  
Class Iii ◽  
Level Of Evidence ◽  
Native Valve ◽  
Dental Procedures

Abstract Patient Presentation A 54 years old woman with dyslipidemia was admitted to the hospital due to the onset of persistent fever. She had no significant comorbidities and she had a known mitral valve prolapse, which was in clinical and echocardiographic follow-up since more than 15 years before. Two months before the hospitalization she underwent dental hygiene procedure without taking any antibiotic before. The procedure included scaling and polishing of the teeth, and she referred just a mild bleeding. After few days she reported the onset of fever and therefore she started to take amoxicilline/clavulanic acid but without any significant improvement of symptoms. Initial work up At the blood chemistry she had a mild leucocytosis with neutrophilia and a rise in inflammatory indices. The Chest x-ray was normal. A systolic murmur was evident at the physical examination. Therefore, Transthoracic Echocardiogram was performed, followed by Transesophageal Echocardiogram (see Figure). At the Echo there was a significant endocarditic involvement of the mitral valve with multiple vegetations, two on the posterior leaflet (scallop P1 and P3) and one on the anterior one (scallop A3); moreover, there was a flail of the posterior leaflet (scallop P1) with subsequent moderate to severe eccentric valve regurgitation. Diagnosis and management Diagnosis of Endocarditis was made and, thus, antibiotic therapy was started with gentamicin and daptomycin, then switched to ampicillin and ceftriaxone after the isolation at the blood culture of Enterococcus Faecalis sensitive to them. Cerebral CT was performed with no evidence of embolization. Finally, owing to the significant endocarditis of the mitral valve with associate moderate to severe regurgitation, the patient underwent surgical intervention with mitral valve replacement with bioprosthesis. Follow-up The post-operative period was regular with no significant complications. She had no more fever and the antibiotics were stopped after six weeks. Conclusion We reported the case of a severe endocarditic involvement of the mitral valve in a patient with known valvular prolapse, who did not take any antibiotic before a minor dental procedure. 2015 ESC guidelines on Endocarditis recommend to not perform antibiotic prophylaxis in patient with no valvular prosthesis but with other form of valvular disease, including mitral valve prolapse (Class III, level of evidence C). Most of the time, patients with other form of valvular disease (e.g. mitral valve prolapse, bicuspid aortic valve, calcific aortic stenosis) do not experience endocarditis, neither after dental procedures. However, this case shows that sometimes it can happen due to the abnormal conformation of the native valve and, hence, it makes us wonder whether the antibiotic therapy should be indicated before dental procedures in those kind of patients. Abstract P1304 Figure.

scholarly journals 1158 Autograft degeneration, clinical outcomes and predictors after 21 years follow up in Ross procedure. A single center experience

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
C Pericet Rodriguez ◽  
L Pardo Gonzalez ◽  
A Fernandez Ruiz ◽  
R Gonzalez Manzanares ◽  
M Ruiz Ortiz ◽  
...  
Keyword(s):  
Learning Curve ◽  
Valvular Disease ◽  
Ross Procedure ◽  
Aortic Lesion ◽  
Probability Of Survival ◽  
Single Center Experience ◽  
Echocardiographic Evaluation ◽  
Long Term Follow Up

Abstract Background Autograft regurgitation and the need of autograft reintervention are possible complications of Ross procedure. Purpose Our Aim was to identify rates of autograft degeneration, reintervention and predictive factors valvular disease in a prospective series of a reference cardiovascular surgery hospital. Methods Since November 1997 to July 2009, a total of 107 patients diagnosed of aortic valvular disease requiring surgical treatment underwent Ross surgery (mean age 30 ± 11 years, 69% male, 21 patients &lt;18 years). In all of them, a comprehensive clinical and echocardiographic evaluation was performed before the intervention and at discharge, at 6, 12 months and annually after surgery. Results At the end of follow-up (21 years, median: 17 years, interquartile rank 12-19 years), echocardiographic and clinical data were available in 95 (89%) and 105 (98%) patients, respectively. 30 patients (32%) developed at least moderate aortic regurgitation and 18 of them (17%) required autograft reintervention. Probability of survival free from at least moderate autograft regurgitation and reintervention at the end of follow up was 71% and 83% respectively. Two patients died because of reintervention related complications. A larger native pulmonary annulus size was the only factor, associated to autograft reintervention (HR 1.24 95% [CI] 1.04-1.48, p = 0.01) and at least moderate autograft regurgitation (HR 1.19 95% [CI] 1.03-1.37, p = 0.02). Autograft reintervention was also associated to intervention in the learning curve period (first 12 cases, HR 3.78, [CI] 95% 1.42-10.08, p = 0.008). We found no significant association of these outcomes with previous cardiac surgery, age, sex, aetiology of aortic lesion or native aortic annulus diameter. Conclusion At long term follow-up after Ross procedure, 32% of patients developed at least moderate autograft regurgitation and 17% required autograft reintervention. A larger size of the native pulmonary annulus and intervention in the learning curve period were associated with the need of autograft surgery in the long term follow up.

scholarly journals Polypharmacy, hospitalization, and mortality risk: a nationwide cohort study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Tae Ik Chang ◽  
Haeyong Park ◽  
Dong Wook Kim ◽  
Eun Kyung Jeon ◽  
Connie M. Rhee ◽  
...  
Keyword(s):  
Public Health ◽  
Cohort Study ◽  
Prescription Drugs ◽  
Mortality Risk ◽  
Residential Area ◽  
Public Health Issue ◽  
Geriatric Population ◽  
Major Public Health Issue ◽  
Elderly Individuals

Abstract Polypharmacy is a growing and major public health issue, particularly in the geriatric population. This study aimed to examine the association between polypharmacy and the risk of hospitalization and mortality. We included 3,007,620 elderly individuals aged ≥ 65 years who had at least one routinely-prescribed medication but had no prior hospitalization within a year. The primary exposures of interest were number of daily prescribed medications (1–2, 3–4, 5–6, 7–8, 9–10, and ≥ 11) and presence of polypharmacy (≥ 5 prescription drugs per day). The corresponding comparators were the lowest number of medications (1–2) and absence of polypharmacy. The study outcomes were hospitalization and all-cause death. The median age of participants was 72 years and 39.5% were men. Approximately, 46.6% of participants experienced polypharmacy. Over a median follow-up of 5.0 years, 2,028,062 (67.4%) hospitalizations and 459,076 (15.3%) all-cause deaths were observed. An incrementally higher number of daily prescribed medications was found to be associated with increasingly higher risk for hospitalization and mortality. These associations were consistent across subgroups of age, sex, residential area, and comorbidities. Furthermore, polypharmacy was associated with greater risk of hospitalization and death: adjusted HRs (95% CIs) were 1.18 (1.18–1.19) and 1.25 (1.24–1.25) in the overall and 1.16 (1.16–1.17) and 1.25 (1.24–1.25) in the matched cohorts, respectively. Hence, polypharmacy was associated with a higher risk of hospitalization and all-cause death among elderly individuals.

P6471Pronostic impact of significant valvular disease in long-term survivors of out-of-hospital-cardiac arrest

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Rodriguez ◽  
J Caro-Codon ◽  
J R Rey-Blas ◽  
S O Rosillo ◽  
O Gonzalez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Percutaneous Treatment ◽  
Valvular Disease ◽  
Temperature Management ◽  
P Value ◽  
Coronary Syndrome ◽  
Hospital Cardiac Arrest

Abstract Background There is scarce evidence about the prevalence and clinical relevance of moderate to severe valvular heart disease (VHD) in survivors of out of hospital cardiac arrest (OHCA). Purpose To determine whether VHD influence prognosis of OHCA survivors. Methods All consecutive patients admitted to the Acute Cardiac Care Unit after OHCA and surviving until hospital discharge were included. All patients received targeted-temperature management according to our local protocol. Univariate and multivariate Cox-proportional hazard models were employed. Results A total of 201 patients were included in the analysis. Mean age was 57.6±14.2 years and 168 (83.6%) were male. Eighteen patients (9.0%) had moderate or severe VHD during index admission (Table 1). Patients with VHD were less frequently of male sex, [11 (61.1%) vs 157 (85.8%), p=0.014], experienced less acute coronary syndrome-related arrhytmias [2 (11.1%) vs 85 (46.5%), p=0.005], and had a lower pH at hospital admission (6.9±1.6 vs 7.2±0.15, p=0.008). During a median follow-up of 40.3 (18.9–69.1) months, patients with VHD showed higher mortality [7 (38.9%) vs 28 (15.3%), p=0.004] and more heart failure-related admissions [7 (38.9%) vs 15 (8.2%), p<0.001]. Only five patients received surgical or percutaneous treatment for VHD during follow-up, with no deaths in this subgroup. Moderate or severe VHD proved to be an independent predictor of global cardiovascular events and specifically heart failure episodes (Figure 1). Table1 Variable With valvular disease Without valvular disease p value Age, mean±DS, years 63.5±13.2 57.0±14.1 0.066 Hypertension, n (%) 12 (66.7) 95 (51.9) 0.231 Diabetes, n (%) 5 (27.8) 24 (13.1) 0.149 Dyslipidaemia, n (%) 7 (38.9) 79 (43.2) 0.726 Smokin habit, n (%) 4 (22.2) 90 (49.2) 0.045 Witnessed cardiac arrest, n (%) 18 (100) 175 (95.6) 1.000 Time from CA to ROSC, mean±DS, minute 19.1±7.5 21.2±13.1 0.506 Shockable rhythm, n (%) 13 (72.2) 163 (89.1) 0.055 LVEF at hospital discharge (%) 42.8±12.1 46.9±14.6 0.254 Figure 1 Conclusion The presence of significant VHD in survivors after OHCA is a predictor of poor outcomes. Specific management of VHD may be specially relevant in this high-risk patients and guideline-oriented therapy, including surgery and percutaneous intervention should be encouraged when indicated.

scholarly journals Low Rates of All-Cause Revision in Displaced Subcapital Femoral Neck Fractures Treated with Hip Hemiarthroplasty - A Retrospective Review of 4516 Patients from a Single Institute

2020 ◽  
Author(s):  
Chi-Yung Yeung ◽  
Shang-Wen Tsai ◽  
Po-Kuei Wu ◽  
Cheng-Fong Chen ◽  
Ming-Chau Chang ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Revision Rate ◽  
Femoral Stem ◽  
Recurrent Dislocation ◽  
Study Data ◽  
Geriatric Population ◽  
Choice Of Treatment ◽  
Neck Fracture ◽  
Therapeutic Study

Abstract Background: Femoral neck fracture (FNF) is among the commonest fractures affecting the geriatric population. Hemiarthroplasty (HA) is a standard treatment procedure and has been performed by hip surgeons for decades. Recently, primary total hip replacement has proved advantageous for the treatment of such fractures. The aim of this study is to retrospectively review all causes of failure of all patients who underwent HA in our institute and reevaluated whether HA remains a favourable choice of treatment for patients with displaced FNFs.Methods: A total of 4516 patients underwent HA at our centre from 1998 to 2017. The HA implants included unipolar and bipolar prostheses. Patients diagnosed with displaced FNF, underwent primary HA initially, required second revision procedures, and followed up for a minimum of 36 months were included in this study. Data were collected and comprehensively analysed.Results: In 4516 cases, 99 patients underwent second surgeries. The revision rate was 2.19%. Reasons for failure were acetabular wear (n = 30, 30.3%), femoral stem subsidence (n = 24, 24.2%), periprosthetic fracture (n = 22, 22.2%), infection (n = 16, 16.2%), and recurrent dislocation (n = 7, 7.1%). The mean follow-up period was 78.1 months. The interval between failed HA and revision surgery was 22.8 months.Conclusion: HA has a low revision rate and remains a favourable choice of treatment for patients with displaced FNFs.Levels of Evidence: Level III, Retrospective Cohort Study, Therapeutic Study

Distal Femur Tumor Megaprosthesis for Non-union of Supracondylar Femur Fracture after Failed Osteosynthesis. An Ingenious Solution.

2021 ◽  
Vol 11 (9) ◽  
Author(s):  
Bikram Kesari Kar ◽  
Mukund Madhav Ojha ◽  
Sandeep Kumar Yadav ◽  
Alok Chandra Agrawal ◽  
Sharath Kowshik
Keyword(s):  
Distal Femur ◽  
Femur Fracture ◽  
Poor Quality ◽  
Implant Failure ◽  
Geriatric Population ◽  
Early Ambulation ◽  
Non Union ◽  
Distal Femur Replacement ◽  
Knee Society Function Score

Introduction: Incidence of non-union of fracture involving the supracondylar region of femur in an elderly is increasing due to bone loss from trauma and availability of poor quality bone in geriatric population. Distal femur megaprosthesis can provide a single stage solution for resistant non-union of supracondylar femur. Case Report: We are reporting two cases of non-union of supracondylar femur with implant failure treated with distal femoral tumor megaprosthesis. We achieved excellent improvement of the Knee Society Score from 15 to 75; Knee Society Function Score from 0 to 60, good range of motion, and pain free ambulation without support at 3 months follow-up. Conclusion: Management of non-union of supracondylar femur with implant failure is challenging task. Distal femur replacement using tumor megaprosthesis is useful option for such resistant cases in achieving early ambulation and overall good functional outcome. Keywords: Non-union, distal femur fracture, megaprosthesis, supracondylar femur fracture.

scholarly journals Value of brain natriuretic peptide in the perioperative follow-up of children with valvular disease

2008 ◽  
Vol 34 (6) ◽  
pp. 1109-1113 ◽  
Author(s):  
Pierre Tissières ◽  
Eduardo da Cruz ◽  
Walid Habre ◽  
Yacine Aggoun ◽  
Noury Mensi ◽  
...  
Keyword(s):  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Valvular Disease
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