Device-related Complications (device-related + complications)

Distribution by Scientific Domains

Selected Abstracts

Australian implantable cardiac defibrillator recipients: Quality-of-life issues

Dianne Pelletier RN BSci(Nurs), DipEd, FRCNA, MasterSci(Soc)
Implantable cardioverter defibrillators (ICDs) have become a well-established therapy for people experiencing potentially lethal dysrhythmias. Australian recipients' quality of life and adjustment to the device over time, device-related complications, shock and associated sensations, and potential sequelae have not been widely explored. This paper reports a longitudinal prospective study of Australian ICD recipients (n = 74) to determine their responses to the device, health-related quality of life over time and shock experiences. A questionnaire designed for the study and the Medical Outcomes Trust Quality of Life Instrument, the SF36, were completed by recipients prior to and at 3 and 12 months post insertion. Results show that quality of life decreased for general health and social function between 3 and 12 months. Nearly half (49%) of the recipients received shocks within 12 months and the majority (92%) of these experienced sequelae that could make driving hazardous. Half of the population (49%) were driving at 3 months and 69% by 12 months, including 67% of those who had been shocked. Twenty-seven percent were hospitalized with device-related complications. Driving, the shock experience and rehospitalization, the shock experience and driving behaviour are significant issues for those with the implanted device. While it is a limitation of the study that partners and carers were not included, these findings will also be of interest to them. [source]


Kate L. A. Borchard
Background: To review our 7 year experience of endovascular abdominal aortic aneurysm repair (EVR) and to compare this to open repair (OR) during the same time period. Methods: One hundred and one EVR and 65 OR patients were studied. Parameters analysed included patient and procedure details, intensive care unit (ICU) and hospital admission time, and morbidity and mortality with particular emphasis on procedure-related problems. Results: Endovascular grafts were deployed with successful abdominal aortic aneurysm (AAA) exclusion in 100 patients. Primary technical success was achieved in 84%, clinical success in 86% and secondary success in 90% of cases. Complications occurred in 63% and 88% of EVR and OR patients, respectively. Early device-related complications occurred in 40 EVR patients (40%); 24 (60%) were corrected immediately by further stenting. Late device-related complications occurred in 15 EVR patients (15%); four (27%) required additional stenting. Most of the complications in the OR group were systemic (89%) resulting in longer ICU and hospital stays (median 48 vs 17 h and 13 vs 4 days for OR and EVR, respectively). Death within 30 days of the procedure occurred in three EVR patients. There was no perioperative mortality in the OR group. Conclusion: Endovascular AAA repair can be undertaken successfully in a district general hospital. The majority of local and device-related complications can be corrected immediately, while those persisting beyond the initial procedure usually resolve spontaneously. EVR offers a minimally invasive approach to a problem that in the past has involved major surgery. [source]

Management of Deep Wound Complications With Vacuum-Assisted Therapy After Berlin Heart EXCOR Ventricular Assist Device Placement in the Pediatric Population

Peter C. Kouretas
Abstract Wound complications after ventricular assist device (VAD) placement remain a formidable challenge to surgeons. The Berlin Heart EXCOR VAD is a versatile pulsatile system that has been successful in pediatric patients of all ages and sizes. Prevention of device-related complications such as infection, particularly in pediatric patients, remains an essential issue in minimizing patient morbidity and mortality. The introduction of vacuum-assisted wound closure (VAC) therapy and its application in VAD-related wound complications provide an efficient and effective method for wound healing. We report our experience in the management of deep wound complications in two pediatric patients after placement of the Berlin Heart EXCOR VAD. The wound VAC system proved to achieve complete wound healing without any infectious complications. [source]

Adjunctive use of the Rinspiration system for fluidic thrombectomy during primary angioplasty: The Rinspiration international registry,

Marco De Carlo MD
Abstract Background: Atherothrombotic embolization during primary percutaneous coronary intervention (PCI) induces microvascular obstruction and reduces myocardial tissue reperfusion. A variety of thrombectomy devices have been evaluated as an adjunct to primary PCI in patients with ST-elevation myocardial infarction (STEMI) to reduce distal embolization. Results have been inconsistent and difficult to predict. The aim of this study was to investigate the safety and efficacy of an innovative thrombectomy device, the Rinspiration System, which simultaneously "rinses" the vessel with turbulent flow and aspirates thrombus. Methods: We prospectively enrolled 109 patients at six academic institutions in three countries referred for primary or rescue PCI for STEMI presenting within 12 hr of symptom onset. The primary endpoint was ,50% ST-segment elevation resolution (STR) measured 60 min after PCI by continuous elctrocardiographic recording, Secondary end points included STR > 70% at 60 min, final TIMI flow, myocardial blush score, and 30-day major adverse cardiac events (MACE). Results: Mean symptom-to-PCI time was 4.7 2.7 hr. Rinspiration was successfully delivered in 98% of cases. Final TIMI three flow was achieved in 89% of patients and myocardial blush ,2 in 78%. Rates of STR , 50% and >70% at 60 min were 97 and 80%, respectively. No device-related complications were observed. Thirty-day MACE rate was 4.6%. Conclusions: This international multicenter registry demonstrates that the adjunctive use of Rinspiration during primary PCI is safe and feasible. The excellent STR data compare favorably with results of previous trials using different devices for thrombus management, indicating a potential clinical benefit. 2008 Wiley-Liss, Inc. [source]