Incidencia y factores de riesgo asociados a los bloqueos aurículo-ventriculares avanzados y necesidad de marcapaso permanente en pacientes llevados a reemplazo aórtico transcatéter. Experiencia de un centro de referencia latinoamericano

Introducción: El implante valvular aórtico transcatéter (TAVR) ha revolucionado el manejo de los pacientes de alto riesgo con patología valvular aórtica. Sin embargo, la presentación de alteraciones de la conducción y su asociación al implante de marcapasos permanente (MPP) sigue siendo las complica...

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Autores:
Mantilla Gutiérrez, Hugo Andrés
Tipo de recurso:
Fecha de publicación:
2021
Institución:
Universidad Autónoma de Bucaramanga - UNAB
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Repositorio UNAB
Idioma:
spa
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oai:repository.unab.edu.co:20.500.12749/16896
Acceso en línea:
http://hdl.handle.net/20.500.12749/16896
Palabra clave:
Medical sciences
Health sciences
Heart block
Artificial pacemaker
Risk factor's
Arteries
Blood circulation
Catheters
Heart (Valves)
Ciencias médicas
Arterias
Circulación sanguínea
Catéteres
Válvulas (Cardíacas)
Ciencias de la salud
Bloqueo cardiaco
Marcapaso artificial
Factores de riesgo
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http://creativecommons.org/licenses/by-nc-nd/2.5/co/
id UNAB2_b143cebb185efb1251d6effe25d6ecad
oai_identifier_str oai:repository.unab.edu.co:20.500.12749/16896
network_acronym_str UNAB2
network_name_str Repositorio UNAB
repository_id_str
dc.title.spa.fl_str_mv Incidencia y factores de riesgo asociados a los bloqueos aurículo-ventriculares avanzados y necesidad de marcapaso permanente en pacientes llevados a reemplazo aórtico transcatéter. Experiencia de un centro de referencia latinoamericano
dc.title.translated.spa.fl_str_mv Incidence and risk factors associated with advanced atrioventricular blocks and the need for a permanent pacemaker in patients undergoing transcatheter aortic replacement. Experience of a Latin American reference center
title Incidencia y factores de riesgo asociados a los bloqueos aurículo-ventriculares avanzados y necesidad de marcapaso permanente en pacientes llevados a reemplazo aórtico transcatéter. Experiencia de un centro de referencia latinoamericano
spellingShingle Incidencia y factores de riesgo asociados a los bloqueos aurículo-ventriculares avanzados y necesidad de marcapaso permanente en pacientes llevados a reemplazo aórtico transcatéter. Experiencia de un centro de referencia latinoamericano
Medical sciences
Health sciences
Heart block
Artificial pacemaker
Risk factor's
Arteries
Blood circulation
Catheters
Heart (Valves)
Ciencias médicas
Arterias
Circulación sanguínea
Catéteres
Válvulas (Cardíacas)
Ciencias de la salud
Bloqueo cardiaco
Marcapaso artificial
Factores de riesgo
title_short Incidencia y factores de riesgo asociados a los bloqueos aurículo-ventriculares avanzados y necesidad de marcapaso permanente en pacientes llevados a reemplazo aórtico transcatéter. Experiencia de un centro de referencia latinoamericano
title_full Incidencia y factores de riesgo asociados a los bloqueos aurículo-ventriculares avanzados y necesidad de marcapaso permanente en pacientes llevados a reemplazo aórtico transcatéter. Experiencia de un centro de referencia latinoamericano
title_fullStr Incidencia y factores de riesgo asociados a los bloqueos aurículo-ventriculares avanzados y necesidad de marcapaso permanente en pacientes llevados a reemplazo aórtico transcatéter. Experiencia de un centro de referencia latinoamericano
title_full_unstemmed Incidencia y factores de riesgo asociados a los bloqueos aurículo-ventriculares avanzados y necesidad de marcapaso permanente en pacientes llevados a reemplazo aórtico transcatéter. Experiencia de un centro de referencia latinoamericano
title_sort Incidencia y factores de riesgo asociados a los bloqueos aurículo-ventriculares avanzados y necesidad de marcapaso permanente en pacientes llevados a reemplazo aórtico transcatéter. Experiencia de un centro de referencia latinoamericano
dc.creator.fl_str_mv Mantilla Gutiérrez, Hugo Andrés
dc.contributor.advisor.none.fl_str_mv Cabrales Arévalo, Jaime Ramón
Herrera Galindo, Víctor Mauricio
dc.contributor.author.none.fl_str_mv Mantilla Gutiérrez, Hugo Andrés
dc.contributor.cvlac.spa.fl_str_mv Cabrales Arévalo, Jaime Ramón [0001543056]
Herrera Galindo, Víctor Mauricio [0000068020]
dc.contributor.googlescholar.spa.fl_str_mv Herrera Galindo, Víctor Mauricio [ay0xprEAAAAJ]
dc.contributor.orcid.spa.fl_str_mv Cabrales Arévalo, Jaime Ramón [0000-0001-8107-1780]
Herrera Galindo, Víctor Mauricio [0000-0002-6295-1640]
dc.contributor.scopus.spa.fl_str_mv Herrera Galindo, Víctor Mauricio [55402953400]
dc.contributor.researchgate.spa.fl_str_mv Cabrales Arévalo, Jaime Ramón [Jaime-Cabrales-2]
dc.subject.keywords.spa.fl_str_mv Medical sciences
Health sciences
Heart block
Artificial pacemaker
Risk factor's
Arteries
Blood circulation
Catheters
Heart (Valves)
topic Medical sciences
Health sciences
Heart block
Artificial pacemaker
Risk factor's
Arteries
Blood circulation
Catheters
Heart (Valves)
Ciencias médicas
Arterias
Circulación sanguínea
Catéteres
Válvulas (Cardíacas)
Ciencias de la salud
Bloqueo cardiaco
Marcapaso artificial
Factores de riesgo
dc.subject.lemb.spa.fl_str_mv Ciencias médicas
Arterias
Circulación sanguínea
Catéteres
Válvulas (Cardíacas)
dc.subject.proposal.spa.fl_str_mv Ciencias de la salud
Bloqueo cardiaco
Marcapaso artificial
Factores de riesgo
description Introducción: El implante valvular aórtico transcatéter (TAVR) ha revolucionado el manejo de los pacientes de alto riesgo con patología valvular aórtica. Sin embargo, la presentación de alteraciones de la conducción y su asociación al implante de marcapasos permanente (MPP) sigue siendo las complicaciones más frecuentes, con una tendencia al aumento con las válvulas de última generación. Objetivos: Estimar la incidencia del implante de MPP, así como determinar factores de riesgo en pacientes llevados a TAVR. Métodos: Estudio de cohorte retrospectiva en pacientes adultos programados para TAVR, que desarrollaron trastornos de conducción interventricular avanzados posteriores al procedimiento y que requirieron marcapaso permanente durante la hospitalización. Se compararon los grupos según el implante de MPP y se evaluaron los factores asociados preoperatorios reconocidos, así como factores anatómicos relacionados al procedimiento medidos con ecocardiografía. Se estimaron los “odds ratios” (OR) para los factores de interés mediante regresión logística múltiple. Resultados: Un total de 234 pacientes fueron analizados. Encontramos 14% de Incidencia de MPP, los factores de riesgo independientes asociados fueron la edad (OR = 1.10; IC 1.01-1.22), el genero (OR = 0.11; IC 0.01-0.61), la superficie de área corporal mayor de 1.51 m2 (OR = 9.78; IC 2.13-73.6), alteraciones en la conducción previa como bloqueo de rama derecha (OR = 22.5; IC 2.62-242) o bloqueo AV primer grado (OR = 18.8; IC 3.04-150) y la profundidad de implantación medida en ecocardiografía (OR = 1.76; IC 1.26-2.64). El modelo demostró una muy buena capacidad predictiva con AUC en la curva ROC = 0.934 [P < 0,001, IC 95% (0.8780.988)]. Conclusiones: Desarrollamos un modelo predictivo aplicado a nuestra población con 6 factores de riesgo independientes para MPP posterior a TAVR con alto poder predictivo, añadiendo a los factores clásicos mediciones anatómicas ecocardiografías.
publishDate 2021
dc.date.issued.none.fl_str_mv 2021
dc.date.accessioned.none.fl_str_mv 2022-07-11T18:58:37Z
dc.date.available.none.fl_str_mv 2022-07-11T18:58:37Z
dc.type.eng.fl_str_mv Thesis
dc.type.driver.spa.fl_str_mv info:eu-repo/semantics/masterThesis
dc.type.local.spa.fl_str_mv Tesis
dc.type.hasversion.spa.fl_str_mv info:eu-repo/semantics/acceptedVersion
dc.type.redcol.spa.fl_str_mv http://purl.org/redcol/resource_type/TM
status_str acceptedVersion
dc.identifier.uri.none.fl_str_mv http://hdl.handle.net/20.500.12749/16896
dc.identifier.instname.spa.fl_str_mv instname:Universidad Autónoma de Bucaramanga - UNAB
dc.identifier.reponame.spa.fl_str_mv reponame:Repositorio Institucional UNAB
dc.identifier.repourl.spa.fl_str_mv repourl:https://repository.unab.edu.co
url http://hdl.handle.net/20.500.12749/16896
identifier_str_mv instname:Universidad Autónoma de Bucaramanga - UNAB
reponame:Repositorio Institucional UNAB
repourl:https://repository.unab.edu.co
dc.language.iso.spa.fl_str_mv spa
language spa
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61. Almeida JG, Ferreira SM, Fonseca P, Dias T, Guerreiro C, Barbosa AR, et al. Association between implantation depth assessed by computed tomography and new-onset conduction disturbances after transcatheter aortic valve implantation. J Cardiovasc Comput Tomogr [Internet]. 2017;11(5):332–7. Available from: http://dx.doi.org/10.1016/j.jcct.2017.08.003
62. Mauri V, Reimann A, Stern D, Scherner M, Kuhn E, Rudolph V, et al. Predictors of Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement With the SAPIEN 3. JACC Cardiovasc Interv [Internet]. 2016;9(21):2200–9. Available from: http://dx.doi.org/10.1016/j.jcin.2016.08.034
63. Lee JJ, Goldschlager N, Mahadevan VS. Atrioventricular and intraventricular block after transcatheter aortic valve implantation. J Interv Card Electrophysiol. 2018;52(3):315–22
64. Maan A, Refaat MM, Heist EK, Passeri J, Inglessis I, Ptaszek L, et al. Incidence and Predictors of Pacemaker Implantation in Patients Undergoing Transcatheter Aortic Valve Replacement. PACE - Pacing Clin Electrophysiol. 2015;38(7):878–86.
65. Shivamurthy P, Vejpongsa P, Gurung S, Jacob R, Zhao Y, Anderson HV, et al. Validation of scoring system predicting permanent pacemaker implantation after transcatheter aortic valve replacement. PACE - Pacing Clin Electrophysiol. 2020;43(5):479–85.
66. Oestreich BA, Mbai M, Gurevich S, Nijjar PS, Adabag S, Bertog S, et al. Computed tomography (CT) assessment of the membranous septal anatomy prior to transcatheter aortic valve replacement (TAVR) with the balloonexpandable SAPIEN 3 valve. Cardiovasc Revascularization Med [Internet]. 2018;19(5):626–31. Available from: https://doi.org/10.1016/j.carrev.2017.12.012
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spelling Cabrales Arévalo, Jaime Ramón8e5aae48-9705-4bca-a4ef-bfdc164526b6Herrera Galindo, Víctor Mauricio82736c90-93c9-4f26-86c7-0c8ae52dea2fMantilla Gutiérrez, Hugo Andrés5cf6148b-2fbf-4409-9cc8-67d4f00e781dCabrales Arévalo, Jaime Ramón [0001543056]Herrera Galindo, Víctor Mauricio [0000068020]Herrera Galindo, Víctor Mauricio [ay0xprEAAAAJ]Cabrales Arévalo, Jaime Ramón [0000-0001-8107-1780]Herrera Galindo, Víctor Mauricio [0000-0002-6295-1640]Herrera Galindo, Víctor Mauricio [55402953400]Cabrales Arévalo, Jaime Ramón [Jaime-Cabrales-2]Floridablanca (Santander, Colombia)UNAB Campus Bucaramanga2022-07-11T18:58:37Z2022-07-11T18:58:37Z2021http://hdl.handle.net/20.500.12749/16896instname:Universidad Autónoma de Bucaramanga - UNABreponame:Repositorio Institucional UNABrepourl:https://repository.unab.edu.coIntroducción: El implante valvular aórtico transcatéter (TAVR) ha revolucionado el manejo de los pacientes de alto riesgo con patología valvular aórtica. Sin embargo, la presentación de alteraciones de la conducción y su asociación al implante de marcapasos permanente (MPP) sigue siendo las complicaciones más frecuentes, con una tendencia al aumento con las válvulas de última generación. Objetivos: Estimar la incidencia del implante de MPP, así como determinar factores de riesgo en pacientes llevados a TAVR. Métodos: Estudio de cohorte retrospectiva en pacientes adultos programados para TAVR, que desarrollaron trastornos de conducción interventricular avanzados posteriores al procedimiento y que requirieron marcapaso permanente durante la hospitalización. Se compararon los grupos según el implante de MPP y se evaluaron los factores asociados preoperatorios reconocidos, así como factores anatómicos relacionados al procedimiento medidos con ecocardiografía. Se estimaron los “odds ratios” (OR) para los factores de interés mediante regresión logística múltiple. Resultados: Un total de 234 pacientes fueron analizados. Encontramos 14% de Incidencia de MPP, los factores de riesgo independientes asociados fueron la edad (OR = 1.10; IC 1.01-1.22), el genero (OR = 0.11; IC 0.01-0.61), la superficie de área corporal mayor de 1.51 m2 (OR = 9.78; IC 2.13-73.6), alteraciones en la conducción previa como bloqueo de rama derecha (OR = 22.5; IC 2.62-242) o bloqueo AV primer grado (OR = 18.8; IC 3.04-150) y la profundidad de implantación medida en ecocardiografía (OR = 1.76; IC 1.26-2.64). El modelo demostró una muy buena capacidad predictiva con AUC en la curva ROC = 0.934 [P < 0,001, IC 95% (0.8780.988)]. Conclusiones: Desarrollamos un modelo predictivo aplicado a nuestra población con 6 factores de riesgo independientes para MPP posterior a TAVR con alto poder predictivo, añadiendo a los factores clásicos mediciones anatómicas ecocardiografías.INCIDENCIA Y FACTORES DE RIESGO ASOCIADOS A LOS BLOQUEOS AURÍCULO-VENTRICULARES AVANZADOS Y NECESIDAD DE MARCAPASO PERMANENTE EN PACIENTES LLEVADOS A REMPLAZO AÓRTICO TRANSCATÉTER. EXPERIENCIA DE UN CENTRO DE REFERENCIA LATINOAMERICANO. ................. 4 RESUMEN ESTRUCTURADO: ........................................................................................................... 4 1. INTRODUCCIÓN ......................................................................................................................... 7 1.1. PLANTEAMIENTO DEL PROBLEMA ..................................................................................................... 7 1.2. JUSTIFICACIÓN .................................................................................................................................. 8 2. MARCO TEÓRICO .................................................................................................................... 10 3. ESTADO DEL ARTE................................................................................................................. 21 4. PREGUNTA DE INVESTIGACIÓN ........................................................................................... 29 5. OBJETIVOS .............................................................................................................................. 30 6. METODOLOGÍA ....................................................................................................................... 30 6.1. TIPO Y DISEÑO DE ESTUDIO ............................................................................................................ 30 6.2. POBLACIÓN Y MUESTRA.................................................................................................................. 30 6.3. CRITERIOS DE ELEGIBILIDAD .......................................................................................................... 31 6.3.1. Criterios de inclusión .......................................................................................................... 31 6.3.2. Criterios de exclusión......................................................................................................... 31 6.4. TAMAÑO DE LA MUESTRA................................................................................................................ 31 6.5. MUESTREO...................................................................................................................................... 31 6.6. DEFINICIÓN Y OPERACIONALIZACIÓN DE VARIABLES ..................................................................... 31 6.7. TÉCNICAS, PROCEDIMIENTOS E INSTRUMENTOS DE LA RECOLECCIÓN DE DATOS ....................... 35 6.8. PLAN DE PROCESAMIENTO DE MUESTRAS BIOLÓGICAS................................................................. 36 6.9. PLAN ANÁLISIS DE DATOS ............................................................................................................... 36 7. RESULTADOS .......................................................................................................................... 38 8. DISCUSIÓN ............................................................................................................................... 42 9. LIMITACIONES DEL ESTUDIO. .............................................................................................. 46 10. FORTALEZAS DEL ESTUDIO ............................................................................................. 48 11. CONCLUSIONES: ................................................................................................................ 49 12. ASPECTOS ÉTICOS ............................................................................................................ 50 13. ADMINISTRACIÓN DEL PROYECTO ................................................................................. 51 13.1. PRESUPUESTO ................................................................................................................................ 51 13.2. CRONOGRAMA ................................................................................................................................ 52 14. ÍNDICE DE TABLAS ............................................................................................................ 53 15. ANEXOS ............................................................................................................................... 56 BIBLIOGRAFÍA ................................................................................................................................. 58MaestríaIntroduction: Transcatheter aortic valve implantation (TAVR) has revolutionized the management of high-risk patients with aortic valve disease. However, the presentation of conduction disturbances and their association with permanent pacemaker implantation (PPM) continues to be the most frequent complications, with a tendency to increase with the latest generation valves. Objectives: To estimate the incidence of PPM implantation, as well as to determine risk factors in patients undergoing TAVR. Methods: Retrospective cohort study in adult patients scheduled for TAVR, who developed post-procedure advanced interventricular conduction disorders and required permanent pacemaker during hospitalization. Groups were compared according to PPM implantation and recognized preoperative associated factors were evaluated, as well as anatomical factors related to the procedure measured with echocardiography. The “odds ratios” (OR) for the factors of interest were estimated using multiple logistic regression. Results: A total of 234 patients were analyzed. We found 14% incidence of PPM, the associated independent risk factors were age (OR = 1.10; CI 1.01-1.22), gender (OR = 0.11; CI 0.01-0.61), body surface area greater than 1.51 m2 (OR = 9.78; CI 2.13-73.6), alterations in previous conduction such as right bundle branch block (OR = 22.5; CI 2.62-242) or first degree AV block (OR = 18.8; CI 3.04-150) and the depth of implantation measured in echocardiography (OR = 1.76; CI 1.26-2.64). The model demonstrated a very good predictive capacity with AUC in the ROC curve = 0.934 [P < 0.001, CI 95% (0.8780.988)]. Conclusions: We developed a predictive model applied to our population with 6 independent risk factors for PPM after TAVR with high predictive power, adding anatomical echocardiographic measurements to the classic factors.Modalidad Presencialapplication/pdfspahttp://creativecommons.org/licenses/by-nc-nd/2.5/co/Abierto (Texto Completo)Atribución-NoComercial-SinDerivadas 2.5 Colombiahttp://purl.org/coar/access_right/c_abf2Incidencia y factores de riesgo asociados a los bloqueos aurículo-ventriculares avanzados y necesidad de marcapaso permanente en pacientes llevados a reemplazo aórtico transcatéter. Experiencia de un centro de referencia latinoamericanoIncidence and risk factors associated with advanced atrioventricular blocks and the need for a permanent pacemaker in patients undergoing transcatheter aortic replacement. Experience of a Latin American reference centerThesisinfo:eu-repo/semantics/masterThesisTesisinfo:eu-repo/semantics/acceptedVersionhttp://purl.org/redcol/resource_type/TMMagíster en Métodos para la Producción y Aplicación de Conocimiento Científico en SaludUniversidad Autónoma de Bucaramanga UNABFacultad Ciencias de la SaludMaestría en Métodos para la Producción y Aplicación de Conocimiento Científico en SaludMedical sciencesHealth sciencesHeart blockArtificial pacemakerRisk factor'sArteriesBlood circulationCathetersHeart (Valves)Ciencias médicasArteriasCirculación sanguíneaCatéteresVálvulas (Cardíacas)Ciencias de la saludBloqueo cardiacoMarcapaso artificialFactores de riesgo1. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med [Internet]. 2011 Jun 9;364(23):2187–98. Available from: http://www.ncbi.nlm.nih.gov/pubmed/216398112. 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