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Value of a comprehensive geriatric assessment for predicting one-year outcomes in patients undergoing transcatheter aortic valve implantation: results from the CGA-TAVI multicentre registry

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Journal of Geriatric Cardiology 2019年第6期16卷 468-477页

作者： martijn s.van mourik Nathalie van der Velde Giulio Mannarino Marie-Pierre Thibodeau Jean-Bernard Masson Gennaro santoro Jan Baan sofie Jansen Jana Kurucova Martin Thoenes Cornelia Deutsch ANDreas W.schoenenberger ANDrea Ungar Peter Bramlage M Marije Vis Department of Cardiology Amsterdam UMC University of Amsterdam Department of Internal Medicine Section of Geriatric Medicine Amsterdam UMC University of Amsterdam Geriatric Intensive Care Unit Department of Geriatrics and Medicine Careggi Hospital and University of Florence Centre Hospitalier de l’Université de Montréal Edwards Lifesciences Edwards Lifesciences Nyon Switzerland Institute for Pharmacology und Preventive Medicine Department of Geriatrics Inselspital Bern University Hospital University of Bern Switzerland

Background In a three-month report from the CGA-TAVI registry, we found the Multidimensional Prognostic Index (MPI) and short Physical Performance Battery (sPPB) to be of value for predicting short-term outcomes in elderly patients undergoing transcatheter aortic valve implantation (TAVI). In the present analysis, we examined the association of these tools with outcomes up to one year post-TAVI. Methods CGA-TAVI is an international, observational registry of geriatric patients undergoing TAVI. Patients were assessed using the MPI and sPPB. Efficacy of baseline values and any postoperative change for predicting outcome were established using logistic regression. Kaplan- Meier analysis was carried out for each comprehensive geriatric assessment tool, with survival stratified by risk category. Results One year after TAVI, 14.1% of patients deceased, while 17.4% met the combined endpoint of death and/or non-fatal stroke, and 37.7% the combined endpoint of death and/or hospitalisation and/or non-fatal stroke. A high-risk MPI score was associated with an increased risk of all-cause mortality (aOR = 36.13, 95% CI: 2.77–470.78, P = 0.006) and death and/or non-fatal stroke (aOR = 10.10, 95% CI: 1.48–68.75, P = 0.018). No significant associations were found between a high-risk sPPB score and mortality or two main combined endpoints. In contrast to a worsening sPPB, an aggravating MPI score at three months post-TAVI was associated with an increased risk of death and/or non-fatal stoke at one year (aOR = 95.16, 95% CI: 3.41–2657.01). Conclusions The MPI showed value for predicting the likelihood of death and a combination of death and/or non-fatal stroke by one year after TAVI in elderly patients.

关键词： Comprehensive geriatric assessment Multidimensional prognostic index short physical performance battery silver code Transcatheter aortic valve implantation

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Arterial complications, venous thromboembolism and deep venous thrombosis prophylaxis after anterior cruciate ligament reconstruction: A systematic review

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World Journal of Orthopedics 2016年第9期7卷 604-617页

作者： Rob Paulus Augustinus Janssen Max Reijman Daan martijn Janssen Jan Bernardus Antonius.van mourik Department of sports Medicine and Orthopaedic surgery Máxima Medical Center Department of Orthopaedics and Trauma Máxima Medical Center Department of Orthopaedic surgery Erasmus MC University Medical Center Rotterdam

AIM To summarize the current knowledge on vascular complications and deep venous thrombosis(DVT) prophylaxis after anterior cruciate ligament(ACL) *** A systematic review was conducted according to the Preferred Reporting Items for systematic reviews and Meta-Analyses statement. MEDLINE, EMBAsE, Cochrane,Web of science, CINAHL, PubMed publisher, and Google scholar medical literature databases were searched up to November 10, 2015. Any arthroscopic surgical method of primary or revision intra-articular ACL reconstruction of all graft types in humans was included. A risk of bias assessment was *** Fourty-seven studies were included in the *** were the most frequently reported arterial complication after ACL reconstruction, irrespective of graft type or method of graft fixation with an incidence of 0.3%. The time to diagnosis of arterial complications after ACL reconstruction varied from days to mostly weeks but even years. After ACL reconstruction without thromboprophylaxis, the incidence of DVT was 9.7%, of which 2.1% was symptomatic. The incidence of pulmonary embolism was 0.1%. Tourniquet time > 2 h was related to venous *** is indicated in patients with risk factors for venous *** After ACL reconstruction, the incidence of arterial complications,symptomatic DVT and pulmonary embolism was 0.3%, 2.1% and 0.1% respectively. Arterial complications may occur with all types of arthroscopic ACL reconstruction, methods of graft fixation as well as any type of graft. Patients considered to be at moderate or high risk of venous thromboembolism should routinely receive thromboprophylaxis after ACL reconstruction.

关键词： Anterior cruciate ligament reconstruction Arterial complication Pseudoaneurysm Venous thromboembolism Pulmonary embolism Thromboprophylaxis

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