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Rodriguez E, Smith R, Castro L, Baker CJ, Yu Y, Prillinger JB, Gutfinger D, Starnes VA. Ten-Year Follow-Up of Mitral Valve Replacement With the Epic Porcine Valve in a Medicare Population. Ann Thorac Surg 2024:S0003-4975(24)00649-0. [PMID: 39147118 DOI: 10.1016/j.athoracsur.2024.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 06/15/2024] [Accepted: 07/22/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Bioprosthetic surgical mitral valve replacement (SMVR) remains an important treatment option in the era of transcatheter valve interventions. This study presents 10-year clinical outcomes of Medicare beneficiaries who underwent SMVR with a contemporary low-profile mitral porcine valve. METHODS This was a single-arm observational study using Medicare fee-for-service claims data. Deidentified patients undergoing SMVR with the Epic mitral valve (Abbott) in the United States between January 1, 2008 and December 31, 2019 were selected by International Classification of Diseases, Ninth and Tenth Revision procedure codes and then linked to a manufacturer device tracking database. All-cause mortality, heart failure (HF) rehospitalization, and mitral valve reintervention (surgical or transcatheter valve-in-valve) were evaluated at 10 years by using the Kaplan-Meier method. RESULTS Among 75,739 Medicare beneficiaries undergoing SMVR during the study period, 14,015 received the Epic mitral valve (Abbott), 76.5% (10,720) of whom had underlying HF. The mean age was 74 ± 8 years. Survival at 10 years in patients without preoperative HF was 40.4% (95% CI, 37.4%-43.4%) compared with 25.4% (95% CI ,23.8%-27.0%) for patients with HF (P < .001). The 10-year freedom from HF rehospitalization was 51.3% (95% CI, 49.4%-53.1%). Freedom from mitral valve reintervention was 91.4% (95% CI, 89.7%-92.7%) at 10 years. CONCLUSIONS This real-world nationwide study of Medicare beneficiaries receiving the Epic mitral valve demonstrates >90% freedom from all-cause valve reintervention and >50% freedom from HF rehospitalization at 10 years after implantation. Long-term survival and HF rehospitalization in this population with mitral valve disease treated with SMVR was found to be affected by underlying HF.
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Affiliation(s)
- Evelio Rodriguez
- Department of Cardiac Surgery, Ascension Saint Thomas Hospital, Nashville, Tennessee.
| | - Robert Smith
- Division of Cardiothoracic Surgery, Baylor Scott & White The Heart Hospital, Plano, Texas
| | - Luis Castro
- Department of Cardiovascular Surgery, Sequoia Hospital, Redwood City, California
| | - Craig J Baker
- Division of Cardiac Surgery, Keck Hospital of the University of Southern California, Los Angeles, California
| | - Yang Yu
- Abbott, Santa Clara, California
| | | | | | - Vaughn A Starnes
- Division of Cardiac Surgery, Keck Hospital of the University of Southern California, Los Angeles, California
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Kilani Y, Aldiabat M, Lim CY, Kamal SAF, Puelo PC, Vohra A, Fnu V, Saqr A, Kassab M, Faye AS. Subtypes of Venous Thromboembolism in Inflammatory Bowel Disease: A Nationwide Assessment. CLINICAL RESEARCH AND CLINICAL TRIALS 2024; 9:186. [PMID: 38577383 PMCID: PMC10990435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Background Data detailing the risk of Venous Thromboembolism (VTE) subtypes among individuals with Inflammatory bowel disease (IBD) remain limited.Aims: We looked to assess the odds of VTE subtypes among hospitalized individuals with IBD as compared to those without IBD. Materials & Methods Using the Nationwide Inpatient Sample database, we applied a multivariable regression analysis to compare the odds of primary VTE-related hospitalizations among individuals with and without IBD from 2016 to 2020, including deep venous thrombosis (DVT), pulmonary embolism (PE), portal vein thrombosis (PVT), Budd Chiari syndrome (BCS), renal vein thrombosis (RVT), and cerebral venous sinus thrombosis (CVST). Results Overall, there were 15,565 primary VTE-related hospitalizations among individuals with IBD, as compared to 1,449,164 among individuals without IBD. Having IBD increased the odds for DVT (aOR = 1.34, 95%CI: 1.25-1.43), PVT (aOR = 3.16, 95%CI: 2.65-3.76), and CVST (aOR=1.45, 95%CI: 1.05-2.00), without significant increase in the odds of a PE, BCS, or RVT. Further, individuals with ulcerative colitis (UC) were at a higher risk for the majority of VTE-subtypes as compared to those with Crohn's disease (CD). Among individuals with a VTE-related hospitalization, the presence of IBD was not associated with increased mortality (aOR = 0.77, 95%CI: 0.40-1.50), but was associated with an increased length of stay (CD - 4.8 days, UC - 5.3 days, without IBD - 4.3 days, p<0.01). Conclusions Clinicians should retain a high index of suspicion when evaluating VTE-related symptoms among individuals with IBD, as the presence of IBD confers a higher risk of DVT, PVT and CVST related-hospitalizations, and longer stays as compared to individuals without IBD.
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Affiliation(s)
- Yassine Kilani
- Department of Medicine, Lincoln Medical Center/Weill Cornell Medicine, New York, NY, USA
| | | | - Chee Yao Lim
- Department of Medicine, Lincoln Medical Center/Weill Cornell Medicine, New York, NY, USA
| | | | - Priscila Castro Puelo
- Department of Medicine, Lincoln Medical Center/Weill Cornell Medicine, New York, NY, USA
| | - Ammar Vohra
- Department of Medicine, Lincoln Medical Center/Weill Cornell Medicine, New York, NY, USA
| | - Vikash Fnu
- Department of Medicine, Jacobi Medical Center, New York, NY
| | - Alsakarneh Saqr
- Department of Medicine, University of Missouri-Kansas City, MO, USA
| | - Maria Kassab
- Department of Gastroenterology & Hepatology, Lincoln Medical Center, New York, NY, USA
| | - Adam S Faye
- Inflammatory Bowel Disease Center at New York University Langone Health, Division of Gastroenterology and Hepatology, New York, NY, USA
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Kilani Y, Kamal SAF, Vikash F, Vikash S, Aldiabat M, Alsakarneh S, Aljabiri Y, Sohail H, Kumar V, Numan L, Al Khalloufi K. Racial Disparities in Liver Transplantation for Hepatocellular Carcinoma in the United States: An Update. Dig Dis Sci 2023; 68:4050-4059. [PMID: 37584869 DOI: 10.1007/s10620-023-08084-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/07/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Previous studies have demonstrated a disparity in liver transplantation (LT) for hepatocellular carcinoma (HCC) among races in the United States (U.S.). AIMS We aimed to update the literature on the odds, trends, and complications of LT in the treatment of hepatocellular carcinoma (HCC), among individuals of different racial backgrounds. METHODS This is a nationwide study of adult individuals admitted for LT with a primary diagnosis of HCC. Using weighted data from the National Inpatient Sample (NIS) database, we compared the odds of LT among different races from 2016 to 2020, using a multivariate regression analysis. We further assessed the trends and outcomes of LT among races. RESULTS A total of 112,110 adult were hospitalized with a primary diagnosis of HCC. 3020 underwent LT. When compared to Whites, the likelihood of undergoing LT for HCC was significantly reduced in Blacks (OR = 0.60, 95% CI = 0.46-0.78). Further, Blacks had increased mortality rates (7% in Blacks vs. 1% in Whites, p < 0.001), sepsis (11% in Blacks vs. 3% in Whites, p = 0.015), and acute kidney injury (AKI) (54% in Blacks vs. 31% in Whites, p < 0.001) following LT. CONCLUSIONS Individuals identifying as Blacks were less likely to undergo LT for HCC, and more likely to develop complications. Further initiatives are warranted to mitigate the existing disparities among racial groups.
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Affiliation(s)
- Yassine Kilani
- Department of Medicine, Lincoln Medical Center/Weill Cornell Medicine, New York, NY, USA.
| | | | - Fnu Vikash
- Department of Medicine, Jacobi Medical Center, New York, NY, USA
| | - Sindhu Vikash
- Department of Medicine, Jacobi Medical Center, New York, NY, USA
| | | | - Saqr Alsakarneh
- Department of Medicine, University of Missouri, Kansas City, MO, USA
| | - Yazan Aljabiri
- Department of Medicine, Lincoln Medical Center/Weill Cornell Medicine, New York, NY, USA
| | - Haris Sohail
- Department of Medicine, Lincoln Medical Center/Weill Cornell Medicine, New York, NY, USA
| | - Vikash Kumar
- Department of Medicine, Brooklyn Hospital Center, New York, NY, USA
| | - Laith Numan
- Department of Gastroenterology, Saint Louis University, Saint Louis, MO, USA
| | - Kawtar Al Khalloufi
- Department of Transplant Hepatology, University of South Florida, Tampa, FL, USA
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Ning Y, Wang KY, Min X, Hou XG, Wu TT, Ma YT, Xie X. Cystatin C to Left Ventricular Ejection Fraction Ratio as a Novel Predictor of Adverse Outcomes in Patients with Coronary Artery Disease: A Prospective Cohort Study. Rev Cardiovasc Med 2023; 24:260. [PMID: 39076386 PMCID: PMC11270069 DOI: 10.31083/j.rcm2409260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/16/2023] [Accepted: 04/19/2023] [Indexed: 07/31/2024] Open
Abstract
Background While both cystatin C and left ventricular ejection fraction (LVEF) revealed established prognostic efficacy in coronary artery disease (CAD), the relationship between cystatin C/left ventricular ejection fraction ratio (CLR) and adverse clinical outcomes among patients with CAD following percutaneous coronary intervention (PCI) remains obscure, to date. Therefore, we sought to assess the predictive efficacy of CLR among CAD patients who underwent PCI in current study. Methods A total of 14,733 participants, including 8622 patients with acute coronary syndrome (ACS) and 6111 patients with stable coronary artery disease (SCAD), were enrolled from a prospective cohort of 15,250 CAD patients who underwent PCI and were admitted to the First Affiliated Hospital of Xinjiang Medical University from 2016 to 2021. The primary outcome of this study was mortality, including all-cause mortality (ACM) and cardiac mortality (CM). The secondary outcomes were major adverse cardiovascular events (MACEs), major adverse cardiac and cerebrovascular events (MACCEs) and nonfatal myocardial infarction (NFMI). For CLR, the optimal cut-off value was determined by utilizing receiver operating characteristic curve analysis (ROC). Subsequently, patients were assigned into two groups: a high-CLR group (CLR ≥ 0.019, n = 3877) and a low-CLR group (CLR < 0.019, n = 10,856), based on optimal cut-off value of 0.019. Lastly, the incidence of outcomes between the two groups was compared. Results The high-CLR group had a higher incidence of ACM (8.8% vs. 0.9%), CM (6.7% vs. 0.6%), MACEs (12.7% vs. 5.9%), MACCEs (13.3% vs. 6.7%), and NFMIs (3.3% vs. 0.9%). After adjusting for confounders, multivariate Cox regression analyses revealed that patients with high-CLR had an 8.163-fold increased risk of ACM (HR = 10.643, 95% CI: 5.525~20.501, p < 0.001), a 10.643-fold increased risk of CM (HR = 10.643, 95% CI: 5.525~20.501, p < 0.001), a 2.352-fold increased risk of MACE (HR = 2.352, 95% CI: 1.754~3.154, p < 0.001), a 2.137-fold increased risk of MACCEs (HR = 2.137, 95% CI: 1.611~2.834, p < 0.001), and a 1.580-fold increased risk of NFMI (HR = 1.580, 95% CI: 1.273~1.960, p < 0.001) compared to patients with low-CLR. Conclusions The current study indicated that a high CLR is a novel and powerful predictor of adverse long-term outcomes in CAD patients who underwent PCI, and that, it is a better predictor for patients wtih SCAD and ACS. Clinical Trial Registration NCT05174143, http://Clinicaltrials.gov.
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Affiliation(s)
- Yi Ning
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical
University, 830011 Urumqi, Xinjiang, China
| | - Kai-Yang Wang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical
University, 830011 Urumqi, Xinjiang, China
| | - Xuan Min
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical
University, 830011 Urumqi, Xinjiang, China
| | - Xian-Geng Hou
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical
University, 830011 Urumqi, Xinjiang, China
| | - Ting-Ting Wu
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical
University, 830011 Urumqi, Xinjiang, China
| | - Yi-Tong Ma
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical
University, 830011 Urumqi, Xinjiang, China
| | - Xiang Xie
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical
University, 830011 Urumqi, Xinjiang, China
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Martin AK, Feinman JW, Bhatt HV, Fritz AV, Subramani S, Malhotra AK, Townsley MM, Sharma A, Patel SJ, Ha B, Gui JL, Zaky A, Labe S, Teixeira MT, Morozowich ST, Weiner MM, Ramakrishna H. The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights from 2022. J Cardiothorac Vasc Anesth 2023; 37:201-213. [PMID: 36437141 DOI: 10.1053/j.jvca.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022]
Abstract
This special article is the 15th in an annual series for the Journal of Cardiothoracic and Vascular Anesthesia. The authors thank the editor-in-chief Dr. Kaplan and the editorial board for the opportunity to continue this series, namely the research highlights of the past year in the specialties of cardiothoracic and vascular anesthesiology. The major themes selected for 2022 are outlined in this introduction, and each highlight is reviewed in detail in the main body of the article. The literature highlights, in the specialties for 2022, begin with an update on COVID-19 therapies, with a focus on the temporal updates in a wide range of therapies, progressing from medical to the use of extracorporeal membrane oxygenation and, ultimately, with lung transplantation in this high-risk group. The second major theme is focused on medical cardiology, with the authors discussing new insights into the life cycle of coronary disease, heart failure treatments, and outcomes related to novel statin therapy. The third theme is focused on mechanical circulatory support, with discussions focusing on both right-sided and left-sided temporary support outcomes and the optimal timing of deployment. The fourth and final theme is an update on cardiac surgery, with a discussion of the diverse aspects of concomitant valvular surgery and the optimal approach to procedural treatment for coronary artery disease. The themes selected for this 15th special article are only a few of the diverse advances in the specialties during 2022. These highlights will inform the reader of key updates on a variety of topics, leading to the improvement of perioperative outcomes for patients with cardiothoracic and vascular disease.
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Affiliation(s)
- Archer Kilbourne Martin
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL.
| | - Jared W Feinman
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Himani V Bhatt
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ashley Virginia Fritz
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Sudhakar Subramani
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Anita K Malhotra
- Division of Cardiothoracic Anesthesiology and Critical Care, Penn State Hershey Medical Center, Hershey, PA
| | - Matthew M Townsley
- Department of Anesthesiology and Perioperative Medicine, The University of Alabama at Birmingham School of Medicine, Birmingham, AL; Bruno Pediatric Heart Center, Children's of Alabama, Birmingham, AL
| | - Archit Sharma
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Saumil J Patel
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Bao Ha
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jane L Gui
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ahmed Zaky
- Department of Anesthesiology and Perioperative Medicine, The University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - Shelby Labe
- Division of Cardiothoracic Anesthesiology and Critical Care, Penn State Hershey Medical Center, Hershey, PA
| | - Miguel T Teixeira
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Steven T Morozowich
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Scottsdale, AZ
| | - Menachem M Weiner
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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