Dokument: Der Einfluss von Komorbiditäten auf das Komplikationsrisiko von transösophagealer Echokardiographie bei Herzinterventionen
| Titel: | Der Einfluss von Komorbiditäten auf das Komplikationsrisiko von transösophagealer Echokardiographie bei Herzinterventionen | |||||||
| Weiterer Titel: | Impact of comorbidities on safety of transesophageal echocardiography during structural heart interventions | |||||||
| URL für Lesezeichen: | https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=59003 | |||||||
| URN (NBN): | urn:nbn:de:hbz:061-20220309-112427-3 | |||||||
| Kollektion: | Dissertationen | |||||||
| Sprache: | Deutsch | |||||||
| Dokumententyp: | Wissenschaftliche Abschlussarbeiten » Dissertation | |||||||
| Medientyp: | Text | |||||||
| Autor: | Hofsähs, Jurek Timo [Autor] | |||||||
| Dateien: |
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| Beitragende: | Dr. Zeus, Tobias [Gutachter] Prof. Dr. med. Fenk, Roland [Gutachter] | |||||||
| Dewey Dezimal-Klassifikation: | 600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit | |||||||
| Beschreibungen: | Strukturelle Herzerkrankungen spielen eine zunehmend große Rolle in der Kardiologie. Neben dem demografischen Wandel ist dies begründet durch die Entwicklung kathetergestützter Interventionen über die vergangenen zwei Jahrzehnte. Degenerative Herzklappenerkrankungen können dadurch genauso therapiert werden wie angeborene Herzfehler, wodurch ein inhomogenes Patientenkollektiv mit variablen Vorerkrankungen entsteht. Kathetergestützte Herzinterventionen benötigen eine periinterventionelle Bildgebung zur Überwachung. Nachdem zunächst vornehmlich Fluoroskopie eingesetzt wurde, rückt zurzeit eine strahlenfreie Bildgebung mittels transösophagealer Echokardiographie (TEE) mehr in den Vordergrund. Aufgrund jahrelanger Erfahrung in der Diagnostik gilt diese als sicher. Zu ihrem Einsatz in Herzinterventionen existieren jedoch aktuell kaum Daten. Zudem ist unklar, ob Vorerkrankungen einen Einfluss auf die Komplikationen haben. Mit dieser Arbeit soll darum der mögliche Zusammenhang von Vorerkrankungen der Patienten und dem Auftreten von Komplikationen der TEE-Überwachung bei Herzinterventionen aufgezeigt werden.
Dazu wurden Daten von 898 Patienten betrachtet, die sich in den Jahren 2012 bis 2017 am Universitätsklinikum Düsseldorf einer Herzintervention mit TEE-Überwachung unterzogen hatten. Prä- und postinterventionelle Patientendaten wurden der elektronischen Akte entnommen und Komplikationen dokumentiert. Anschließend wurden die Patienten ohne und mit Komplikationen gegenübergestellt. Mithilfe einer uni- und multivariaten Regressionsanalyse wurden einzelne Vorerkrankungen als Risikofaktoren für Komplikationen identifiziert. Insgesamt wurden 67 Komplikationen dokumentiert, die bei 48 (5,3%) Patienten auftraten. Der Endpunkt Infektion wurde dabei am häufigsten erreicht (n = 27, 3,0%), gefolgt vom Endpunkt Blutungskomplikation (n = 16, 1,8%). Patienten mit Komplikationen waren im Durchschnitt älter und zeigten einige Vorerkrankungen häufiger, darunter das multivalvuläre Vitium cordis, die Anämie und das obstruktive Schlafapnoe-Syndrom (OSAS). Sie nahmen häufiger eine orale Antikoagulation ein, zeigten geringere Werte für Hämoglobin und hatten eine längere Prozedurdauer. Insbesondere die Subgruppen von Patienten, die eine Pneumonie oder eine Blutungskomplikation erlitten hatten, unterschieden sich hinsichtlich ihres Profils an Vorerkrankungen von der restlichen Population. In der multivariaten Regressionsanalyse wurden OSAS und niedriges Hämoglobin als unabhängige Prädiktoren identifiziert. In der Gesamtpopulation sind sowohl junge und gesunde, als auch alte und kranke Patienten vertreten. Komplikationen kommen während der periinterventionellen TEE selten vor, jedoch häufiger als in den Vergleichsstudien zu diagnostischer TEE. Patienten mit Komplikation leiden durchschnittlich unter mehr und schwereren Vorerkrankungen als das restliche Kollektiv. Einen konkreten Einfluss auf das Auftreten von Komplikationen haben die Parameter OSAS und Hämoglobin. Dies sollte bei der Prozedurplanung, Durchführung und Nachsorge berücksichtigt werden.Structural heart diseases are playing an increasingly important role in cardiology. In addition to the demographic change, this is due to the development of catheter-based interventions over the last two decades. These allow to treat degenerative valvular heart disease as well as congenital heart defects, creating an inhomogeneous patient population with variable preexisting conditions. Catheter-based cardiac interventions require periinterventional imaging for monitoring. After initially using primarily fluoroscopy, radiation-free imaging by transesophageal echocardiography (TEE) is currently becoming more prominent. Based on years of experience in its use for diagnostic purposes, this is considered safe. However, currently there is hardly any data on its use in cardiac interventions and it is unclear whether preexisting conditions have an influence on complications. The purpose of this study is to examine a possible relation between preexisting conditions and compliactions occurring due to TEE monitoring of cardiac interventions. We analysed data from 898 patients who had undergone cardiac interventions with TEE monitoring at Universitätsklinikum Düsseldorf between 2012 and 2017. Pre- and postinterventional patient data were obtained from the electronic medical record and complications were documented. We compared patients without and with complications. Using univariate and multivariate regression analysis, individual preexisting conditions were identified as potential risk factors for complications. A total of 67 complications, occurring in 48 (5.3%) patients were documented. The infection endpoint was most common (n = 27, 3.0%), followed by the bleeding complication endpoint (n = 16, 1.8%). Patients with complications were older and more likely to present with several preexisting conditions, including multivalvular vitium cordis, anemia and obstructive sleep apnea (OSA). They were more likely to be taking oral anticoagulation, had lower hemoglobin levels and a longer procedure duration. Especially the subgroups of patients who had experienced pneumonia or a bleeding complication differed markedly from the rest of the population in terms of their profile of preexisting conditions. OSA and low hemoglobin were proved to be independent predictors. The sample of this study comprised young, healthy patients as well as those of age and less health. Complications occur infrequently during periinterventional TEE, but more frequently than in comparative studies of diagnostic TEE. Patients with complications suffer on average from more and more severe preexisting conditions than the rest of the collective. The parameters OSA and hemoglobin have a specific influence on the occurrence of complications. This should be taken into account when planning and executing procedures as well as in follow-up. | |||||||
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| Lizenz: |  Urheberrechtsschutz | |||||||
| Fachbereich / Einrichtung: | Medizinische Fakultät | |||||||
| Dokument erstellt am: | 09.03.2022 | |||||||
| Dateien geändert am: | 09.03.2022 | |||||||
| Promotionsantrag am: | 20.10.2021 | |||||||
| Datum der Promotion: | 08.03.2022 |
