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Dumitriu Carcoana AO, Scoma CB, Maletz SN, Malavet JA, Crousillat DR, Matar FA. Most hospitalized patients with significant tricuspid regurgitation have advanced disease preventing transcatheter tricuspid valve intervention. Cardiovasc Revasc Med 2024:S1553-8389(24)00093-9. [PMID: 38503645 DOI: 10.1016/j.carrev.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/04/2024] [Accepted: 03/06/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND More than moderate tricuspid regurgitation (TR) is associated with high mortality. Surgical tricuspid valve repair and replacements are rarely performed due to high operative mortality risk, mainly attributed to late presentation. Novel transcatheter tricuspid valve intervention (TTVI) devices are being developed as an alternative to surgery. The population of patients presenting to tertiary care centers who can benefit from TTVI has not been well defined. METHODS We retrospectively analyzed 12,677 consecutive 2D echocardiograms completed at our tertiary care center between March 2021 and March 2022 and identified hospitalized patients with more than moderate TR. A total of 569 patients were included in this study. Clinical and echocardiographic data were collected by individual chart review. We used the European Society of Cardiology (ESC) guidelines on the management of valvular disease to retrospectively assign patients to medical, surgical, or transcatheter therapy. RESULTS 458 patients (80.5 %) were assigned to medical therapy, 57 (10.0 %) were assigned to TTVI, and 54 (9.5 %) were assigned to tricuspid valve surgery. Of note, 75.7 % (431/569) of patients were precluded from any intervention due to advanced disease, and only 4.7 % (27/569) presented too early for intervention, being both asymptomatic and without RV dilatation. CONCLUSION Only 10.0 % of patients presenting to a tertiary care center with significant TR would be candidates for TTVI when these technologies are approved in the United States. Earlier identification and treatment of TR could increase the number of patients who may benefit from interventions including TTVI.
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Affiliation(s)
| | | | - Sebastian N Maletz
- The University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
| | - Jose A Malavet
- The University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
| | - Daniela R Crousillat
- The University of South Florida Health Morsani College of Medicine, Tampa, FL, USA; The Heart & Vascular Institute, Tampa General Hospital, Tampa, FL, USA
| | - Fadi A Matar
- The University of South Florida Health Morsani College of Medicine, Tampa, FL, USA; The Heart & Vascular Institute, Tampa General Hospital, Tampa, FL, USA.
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Dumitriu Carcoana AO, Labib KM, Fiedler CR, Marek JC, Ladehoff LC, West WJ, Malavet JA, Doyle WN, Moodie CC, Garrett JR, Tew JR, Baldonado JJAR, Fontaine JP, Toloza E. A High Preoperative Blood Urea Nitrogen to Serum Albumin Ratio Does Not Predict Worse Outcomes Following the Robotic-Assisted Pulmonary Lobectomy for Lung Cancer. Cureus 2023; 15:e50468. [PMID: 38222193 PMCID: PMC10786433 DOI: 10.7759/cureus.50468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND The blood urea nitrogen to serum albumin ratio (BAR) is an emerging prognostic parameter of interest. The utility of BAR as a prognostic factor has not been analyzed in lung cancer patients undergoing pulmonary lobectomy. We evaluated the ability of High BAR to predict worse outcomes after robotic-assisted pulmonary lobectomy (RAPL) for lung cancer. METHODS We retrospectively analyzed 400 patients who underwent RAPL from September 2010 to March 2022 by one surgeon. Patients were stratified by Low BAR (<6.25 mg/g) and High BAR (≥6.25 mg/g). Patients' demographics, tumor characteristics, comorbidities, surgical complications, outcomes, and survival were collected and compared by High and Low BAR groups. The primary outcome of interest was 30-day mortality. RESULTS Receiver operator curves (ROC) confirmed that 6.25 was an optimal threshold for estimating mortality based on Low and High BAR. There were no differences in surgical complications or outcomes between the Low and High BAR groups. The ability of BAR to predict 30-day mortality was evaluated with the area under the curve (AUC) analysis, which showed that higher BAR could not predict mortality (AUC=0.655; 95% CI, 0.435-0.875; p=0.166). Similarly, survival analysis revealed no difference in five-year overall survival between the Low and High BAR groups (p=0.079). CONCLUSION High BAR did not predict worse outcomes after RAPL for lung cancer in our study. Further studies are needed to better determine the prognostic ability of BAR in lower-risk populations.
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Affiliation(s)
| | - Kristie M Labib
- Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - Cole R Fiedler
- Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - Jenna C Marek
- Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - Lauren C Ladehoff
- Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - William J West
- Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - Jose A Malavet
- Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - William N Doyle
- Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | | | | | - Jenna R Tew
- Thoracic Oncology, Moffitt Cancer Center, Tampa, USA
| | - Jobelle Joyce Anne R Baldonado
- Thoracic Oncology, Moffitt Cancer Center, Tampa, USA
- Surgery and Oncologic Sciences, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - Jacques P Fontaine
- Thoracic Oncology, Moffitt Cancer Center, Tampa, USA
- Surgery and Oncologic Sciences, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - Eric Toloza
- Thoracic Oncology, Moffitt Cancer Center, Tampa, USA
- Surgery and Oncologic Sciences, University of South Florida Health Morsani College of Medicine, Tampa, USA
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Doyle WN, Nguyen D, West WJ, Fiedler CR, Labib KM, Ladehoff L, Dumitriu Carcoana AO, Marek JC, Malavet JA, Moodie CC, Garrett JR, Tew JR, Baldonado JJAR, Fontaine JP, Toloza EM. Changes in Perioperative Outcomes after Robotic-Assisted Pulmonary Lobectomy during the COVID-19 Era. Surg Pract Sci 2023; 13:100172. [PMID: 37139165 PMCID: PMC10125211 DOI: 10.1016/j.sipas.2023.100172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 04/24/2023] [Indexed: 05/05/2023] Open
Abstract
Background The COVID-19 pandemic presented patients with barriers to receiving healthcare. We sought to determine whether changes in healthcare access and practice during the pandemic affected perioperative outcomes after robotic-assisted pulmonary lobectomy (RAPL). Methods We retrospectively analyzed 721 consecutive patients who underwent RAPL. With March 1st, 2020, defining the start of the COVID-19 pandemic, we grouped 638 patients as "PreCOVID-19" and 83 patients as "COVID-19-Era" based on surgical date. Demographics, comorbidities, tumor characteristics, intraoperative complications, morbidity, and mortality were analyzed. Variables were compared utilizing Student's t-test, Wilcoxon rank-sum test, and Chi-square (or Fisher's exact) test, with significance at p ≤ 0.05 . Multivariable generalized linear regression was used to investigate predictors of postoperative complication. Results COVID-19-Era patients had significantly higher preoperative FEV1%, lower cumulative smoking history and higher incidences of preoperative atrial fibrillation, peripheral vascular disease (PVD), and bleeding disorders compared to PreCOVID-19 patients. COVID-19-Era patients had lower intraoperative estimated blood loss (EBL), reduced incidence of new-onset postoperative atrial fibrillation (POAF), but higher incidence of effusion or empyema postoperatively. Overall postoperative complication rates between the groups were similar. Older age, increased EBL, lower preoperative FEV1%, and preoperative COPD are all predictive of an increased risk for postoperative complication. Conclusions COVID-19-Era patients having lower EBL and less new-onset POAF, despite greater incidences of multiple preoperative comorbidities, demonstrates that RAPL is safe during the COVID-19 era. Risk factors for development of postoperative effusion should be determined to minimize risk of empyema in COVID-19-Era patients. Age, preoperative FEV1%, COPD, and EBL should all be considered when planning for complication risk.
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Affiliation(s)
- William N Doyle
- Department of Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
| | - Diep Nguyen
- Department of Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
| | - William J West
- Department of Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
| | - Cole R Fiedler
- Department of Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
| | - Kristie M Labib
- Department of Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
| | - Lauren Ladehoff
- Department of Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
| | - Allison O Dumitriu Carcoana
- Department of Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
| | - Jenna C Marek
- Department of Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
| | - Jose A Malavet
- Department of Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
| | - Carla C Moodie
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Joseph R Garrett
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Jenna R Tew
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Jobelle J A R Baldonado
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
- Department of Surgery, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
| | - Jacques P Fontaine
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
- Department of Surgery, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
| | - Eric M Toloza
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
- Department of Surgery, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
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Norton N, Bruno KA, Di Florio DN, Whelan ER, Hill AR, Morales-Lara AC, Mease AA, Sousou JM, Malavet JA, Dorn LE, Salomon GR, Macomb LP, Khatib S, Anastasiadis ZP, Necela BM, McGuire MM, Giresi PG, Kotha A, Beetler DJ, Weil RM, Landolfo CK, Fairweather D. Trpc6 Promotes Doxorubicin-Induced Cardiomyopathy in Male Mice With Pleiotropic Differences Between Males and Females. Front Cardiovasc Med 2022; 8:757784. [PMID: 35096991 PMCID: PMC8792457 DOI: 10.3389/fcvm.2021.757784] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Doxorubicin is a widely used and effective chemotherapy, but the major limiting side effect is cardiomyopathy which in some patients leads to congestive heart failure. Genetic variants in TRPC6 have been associated with the development of doxorubicin-induced cardiotoxicity, suggesting that TRPC6 may be a therapeutic target for cardioprotection in cancer patients. Methods: Assessment of Trpc6 deficiency to prevent doxorubicin-induced cardiac damage and function was conducted in male and female B6.129 and Trpc6 knock-out mice. Mice were treated with doxorubicin intraperitoneally every other day for a total of 6 injections (4 mg/kg/dose, cumulative dose 24 mg/kg). Cardiac damage was measured in heart sections by quantification of vacuolation and fibrosis, and in heart tissue by gene expression of Tnni3 and Myh7. Cardiac function was determined by echocardiography. Results: When treated with doxorubicin, male Trpc6-deficient mice showed improvement in markers of cardiac damage with significantly reduced vacuolation, fibrosis and Myh7 expression and increased Tnni3 expression in the heart compared to wild-type controls. Similarly, male Trpc6-deficient mice treated with doxorubicin had improved LVEF, fractional shortening, cardiac output and stroke volume. Female mice were less susceptible to doxorubicin-induced cardiac damage and functional changes than males, but Trpc6-deficient females had improved vacuolation with doxorubicin treatment. Sex differences were observed in wild-type and Trpc6-deficient mice in body-weight and expression of Trpc1, Trpc3 and Rcan1 in response to doxorubicin. Conclusions: Trpc6 promotes cardiac damage following treatment with doxorubicin resulting in cardiomyopathy in male mice. Female mice are less susceptible to cardiotoxicity with more robust ability to modulate other Trpc channels and Rcan1 expression.
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Affiliation(s)
- Nadine Norton
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, United States
| | - Katelyn A. Bruno
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
- Center of Clinical and Translational Science, Mayo Clinic, Jacksonville, FL, United States
| | - Damian N. Di Florio
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
- Center of Clinical and Translational Science, Mayo Clinic, Jacksonville, FL, United States
| | - Emily R. Whelan
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Anneliese R. Hill
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | | | - Anna A. Mease
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - John M. Sousou
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Jose A. Malavet
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Lauren E. Dorn
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Gary R. Salomon
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Logan P. Macomb
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Sami Khatib
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | | | - Brian M. Necela
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, United States
| | - Molly M. McGuire
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Presley G. Giresi
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Archana Kotha
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
- Center of Clinical and Translational Science, Mayo Clinic, Jacksonville, FL, United States
| | - Danielle J. Beetler
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
- Center of Clinical and Translational Science, Mayo Clinic, Jacksonville, FL, United States
| | - Raegan M. Weil
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, United States
| | - Carolyn K. Landolfo
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - DeLisa Fairweather
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
- Center of Clinical and Translational Science, Mayo Clinic, Jacksonville, FL, United States
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