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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.contributor.advisorCabrales Arévalo, Jaime Ramón
dc.contributor.advisorHerrera Galindo, Víctor Mauricio
dc.contributor.authorMantilla Gutiérrez, Hugo Andrés
dc.coverage.spatialFloridablanca (Santander, Colombia)spa
dc.date.accessioned2022-07-11T18:58:37Z
dc.date.available2022-07-11T18:58:37Z
dc.date.issued2021
dc.identifier.urihttp://hdl.handle.net/20.500.12749/16896
dc.description.abstractIntroducción: 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.spa
dc.description.tableofcontentsINCIDENCIA 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 ................................................................................................................................. 58spa
dc.format.mimetypeapplication/pdfspa
dc.language.isospaspa
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/2.5/co/*
dc.titleIncidencia 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 latinoamericanospa
dc.typeThesiseng
dc.title.translatedIncidence 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 centerspa
dc.degree.nameMagíster en Métodos para la Producción y Aplicación de Conocimiento Científico en Saludspa
dc.publisher.grantorUniversidad Autónoma de Bucaramanga UNABspa
dc.rights.localAbierto (Texto Completo)spa
dc.publisher.facultyFacultad Ciencias de la Saludspa
dc.publisher.programMaestría en Métodos para la Producción y Aplicación de Conocimiento Científico en Saludspa
dc.description.degreelevelMaestríaspa
dc.type.driverinfo:eu-repo/semantics/masterThesisspa
dc.type.localTesisspa
dc.type.coarhttp://purl.org/coar/resource_type/c_bdcc
dc.subject.keywordsMedical sciencesspa
dc.subject.keywordsHealth sciencesspa
dc.subject.keywordsHeart blockspa
dc.subject.keywordsArtificial pacemakerspa
dc.subject.keywordsRisk factor'sspa
dc.subject.keywordsArteriesspa
dc.subject.keywordsBlood circulationspa
dc.subject.keywordsCathetersspa
dc.subject.keywordsHeart (Valves)spa
dc.identifier.instnameinstname:Universidad Autónoma de Bucaramanga - UNABspa
dc.identifier.reponamereponame:Repositorio Institucional UNABspa
dc.type.hasversioninfo:eu-repo/semantics/acceptedVersionspa
dc.rights.accessrightsinfo:eu-repo/semantics/openAccessspa
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dc.relation.references66. 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.2017.12.012spa
dc.contributor.cvlacCabrales Arévalo, Jaime Ramón [0001543056]spa
dc.contributor.cvlacHerrera Galindo, Víctor Mauricio [0000068020]spa
dc.contributor.googlescholarHerrera Galindo, Víctor Mauricio [ay0xprEAAAAJ]spa
dc.contributor.orcidCabrales Arévalo, Jaime Ramón [0000-0001-8107-1780]spa
dc.contributor.orcidHerrera Galindo, Víctor Mauricio [0000-0002-6295-1640]spa
dc.contributor.scopusHerrera Galindo, Víctor Mauricio [55402953400]spa
dc.contributor.researchgateCabrales Arévalo, Jaime Ramón [Jaime-Cabrales-2]spa
dc.subject.lembCiencias médicasspa
dc.subject.lembArteriasspa
dc.subject.lembCirculación sanguíneaspa
dc.subject.lembCatéteresspa
dc.subject.lembVálvulas (Cardíacas)spa
dc.identifier.repourlrepourl:https://repository.unab.edu.cospa
dc.description.abstractenglishIntroduction: 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.spa
dc.subject.proposalCiencias de la saludspa
dc.subject.proposalBloqueo cardiacospa
dc.subject.proposalMarcapaso artificialspa
dc.subject.proposalFactores de riesgospa
dc.type.redcolhttp://purl.org/redcol/resource_type/TMspa
dc.rights.creativecommonsAtribución-NoComercial-SinDerivadas 2.5 Colombia*
dc.type.coarversionhttp://purl.org/coar/version/c_ab4af688f83e57aaspa
dc.coverage.campusUNAB Campus Bucaramangaspa
dc.description.learningmodalityModalidad Presencialspa


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