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TCT-977 Acute Effects of Transcatheter Tricuspid Valve Replacement on Right Heart Hemodynamics
No full textBackground: Current literature describes an increase in RV systolic volume following TTVI. We aimed to characterize the acute hemodynamic changes after TTVR using invasive measurements. Methods: This retrospective, single-center, descriptive study included 112 patients who underwent TTVR for severe TR between March 2023 and March 2025. Invasive hemodynamic measurements and echocardiogram were recorded before and after valve implantation. RV dysfunction was visually estimated using a four-point scale (none, mild, moderate, severe). Results: Significant increases were observed in RVSP (p\u3c0.01), mean PA pressure (p\u3c0.01), and PCWP (p\u3c0.01) following TTVR. RV function declined significantly following TTVR (p\u3c0.01), but improved at 30-day follow up (p=0.03). RV function was reduced at 30-days compared to baseline (p=0.02). PAPI showed a nonsignificant trend toward an increase while PVR (p=0.37), CO (p=0.59), and CI (p=0.78) remained unchanged. [Formula presented] Conclusion: TTVR is associated with an acute increase in right-sided filling pressures and a transient decline in RV function. By 30-days, RV function improves relative to the immediate post-TTVR period but remains reduced compared to baseline. A longer follow up will further describe RV recovery following TTVR. These findings highlight the value of invasive hemodynamic assessment in characterizing early physiological responses to TTVR and may inform future preprocedural preparation and risk stratification strategies, especially in those with advanced RV dysfunction. Categories: STRUCTURAL: Valvular Disease and Intervention: Tricuspi
TCT-719 Alternative Access in transcatheter aortic valve replacement: Insight from Michigan Structural Heart Consortium
No full textBackground: Transfemoral access (TF) has emerged as the predominant default method for TAVR procedures, driven by notable advancements in technology and technique over recent years. However, around 5% of patients in the U.S. necessitate alternative access routes due to unfavorable iliofemoral vascular anatomy, particularly severe calcification or inadequate vessel size. The most frequently utilized alternative approaches include transfemoral TF, transaxillary (TAX), transcarotid (TC), and transcaval (TCV) access, while older methods such as transapical and direct transthoracic techniques have declined in use. Methods: We conducted a retrospective cohort study using data from the Michigan Structural Heart Consortium (MISHC), a statewide, multicenter quality improvement collaborative collecting detailed clinical data on structural heart procedures. Outcomes assessed included all-cause mortality, stroke, major bleeding, and length of hospital stay (LOS). Kaplan-Meier analyses assessed survival differences. Bayesian generalized linear mixed models adjusted for baseline demographics, clinical comorbidities, and hospital-level variability. Results: Among 18,405 consecutive TAVR procedures analyzed, access sites included transfemoral TF (97.5%), transcarotid (1.3%), transaxillary (0.6%), and transcaval (0.6%). Baseline Society of Thoracic Surgeon score was highest in transcaval TCV patients (p \u3c 0.001). In-hospital mortality was highest among transcaval patients (p \u3c 0.001). At 1 year, transaxillary access (odds ratio [OR]: 2.05, 95% Credible Interval [CI]: 1.19-3.40) and transcarotid access (OR: 1.90, 95% CI: 1.27-2.80), but not transcaval access, showed significantly increased odds of mortality compared to transfemoral TF access. TCV was not associated with higher mortality compared to TF. Kaplan-Meier analysis revealed significantly lower survival rates for non-transfemoral TF access than for transfemoral TF access (log-rank p\u3c 0.001). Conclusion: Alternative access routes for TAVR, particularly transcaval and transaxillary T approaches, are associated with significantly higher risks than transfemoral TF access. These findings highlight the importance of careful patient selection and vigilant follow-up. Categories: STRUCTURAL: Valvular Disease and Intervention: Aorti
FDG-PET For Myocardial Viability Assessment: Does it Guide Decision Making For Revascularization In Real World Practice? A Single Center Experience
No full textIntroduction: The incidence of heart failure driven by ischemic heart disease is increasing. Intuitively it makes sense that identification of ischemic viable myocardium could drive revascularization decisions and survival, but recent study evidence has not favored it. We sought to evaluate if FDG PET guides real world decision making for revascularization in ischemic cardiomyopathy and if it makes a difference Methods: This is a retrospective chart review study of PET ischemia and viability testing performed between 2020-2024 at our institution; Patients’ baseline characteristics including comorbidities, ejection fraction and PET study results were evaluated. We compared baseline characteristics between positive viability and negative viability groups. Revascularization and changes in ejection fraction outcomes were assessed Results: Data of 111 patients who underwent PET ischemia and viability testing were analyzed; mean patients age is 69 yr old, M:F ratio 4:1, 64% white and 29% African American, all patients had HTN and HLD, 51 % diabetics and 53% were smoker. 78% of patients had a history of MI and 95% of patients have ischemic cardiomyopathy with a mean EF of 34%. The average SRS, SSS, SDS were 14, 13, 7 respectively. 99 patients received FDG for viability assessment. We found the following; First; 65 patients (67%) were positive for ischemic viable myocardium and 31 patients (31%) with non-viable myocardium. Second, there was no statistically significant difference in baseline characteristics of patients with positive viability and negative viability groups. Third, in the positive viability group (n=65); 37 patients (56%) had revascularization with PCI/CABG and 31 patients (43%) were treated medically and in the negative viability group, 19 patients (61%) were treated medically and only 11 patients (35%) received revascularization. Fourth, there is a significant improvement of the ejection fraction in the positive viability patients who underwent revascularization (mean baseline EF of 32%, mean post revascularization EF of 38% with P value =0.0004) and significant improvement in EF in the positive viability patient who were treated medically (mean baseline EF of 34%, mean EF post 3 months of medical therapy 37% with P value =0.005). Fifth, there is no significant improvement in the ejection fraction in the negative viability patients who underwent revascularization (mean baseline EF of 32%, mean post revascularization EF of 23% with P value =0.39). Finally, symptoms were reported to be improved in 36 patients (52%) in the viability positive group. Conclusion: - Our single center experience shows that clinicians continue to believe in viability assessment and refer patients for FDG-PET testing.-FDG-PET viability studies can be utilized to guide management and decision making of revascularization which can predict functional recovery and symptoms improvemen
A Trauma-Informed Approach to Video Review in Medical Institutional Repositories
No full textSince the 1970s, the University of Virginia School of Medicine’s Medical Center Hour has hosted speakers who explore the relationship between medicine and society. When patrons request access to recordings that have not been digitized, staff must carefully review the footage to identify sensitive material such as PHI and apply redactions before making the video accessible. While this process ensures compliance with privacy and confidentiality requirements, it can surface deeper emotional and ethical concerns. Staff may be exposed to distressing content during review, and patrons may be confronted with emotionally challenging material with little preparation. This presentation discusses how trauma-informed practices can strengthen workflows for video review, redaction, and access in medical institutional repositories. Using the Medical Center Hour lecture series as a case study, the speaker will highlight strategies for supporting staff engaged in sensitive review work, developing redaction protocols that balance transparency with confidentiality, and incorporating content warnings and metadata that ethically contextualizes materials. By acknowledging both the compliance requirements and the emotional labor of video review, trauma-informed approaches help medical institutional repositories safeguard the integrity of their collections while also supporting the well-being of staff and users who engage with them
Clearing the Hurdles: Strategies for Accessibility Remediation in a Digital Repository
No full textIn July 2024, a new accessibility law in Colorado took effect, which requires state and government agencies—including libraries—to make their digital content accessible to users with disabilities. Recognizing that digital accessibility is both a legal obligation and a fundamental part of equitable access to information, the Strauss Library at the University of Colorado Anschutz Medical Campus developed a step-by-step remediation plan to bring its institutional repository into compliance. The project began by rewriting outdated accessibility policies, then transitioned towards assessing collections, setting priorities, and developing workflows to remediate inaccessible files. This presentation will outline the strategic approach the library adopted despite limited staff time and expertise. It will also share the challenges encountered and successes achieved as well as highlight lessons learned. Attendees will take away practical strategies that can be adapted by other organizations seeking to strengthen accessibility in their own digital repositories, regardless of size or resources
Solitary Cutaneous Xanthogranuloma With DNMT3A Mutation Arising Postallogenic Transplant in a Patient With T-Cell Acute Lymphoblastic Leukemia
No full textThe development of a mature histiocytic neoplasm after an immature lymphoproliferative disorder is rare but well documented. Previous studies have demonstrated clonal relationships between these entities-often through T- and B-cell receptor clonality analyses-supporting the concept of transdifferentiation. We report a unique case of a solitary, subtle xanthogranuloma identified during routine comprehensive skin examination in a patient with a history of T-cell acute lymphoblastic lymphoma, postallogeneic stem cell transplant. Next-generation sequencing of the skin lesion revealed the presence of a DNMT3A mutation identical to that found in the patient\u27s prior lymphoma, despite the patient being in both morphologic and molecular remission in the peripheral blood and bone marrow. This case underscores the importance of vigilant surveillance and highlights a potential mechanistic link through clonal evolution or transdifferentiation
Sex- and Race/Ethnicity-Specific Associations Between Food Insecurity and Metabolic Dysfunction-Associated Steatotic Liver Disease in American Adults
No full textObjectives: The study aimed to examine the association between food insecurity and metabolic dysfunction-associated steatotic liver disease (MASLD) across different race ethnicity or gender using the 2017-March 2020 National Health and Nutrition Examination Survey (NHANES). Methods: The current study included 6618 participants aged ≥19 years. Steatotic liver disease was determined through transient elastography examination. Odds ratios (ORs) and 95% confidence intervals (CIs) for MASLD associated with food insecurity were estimated using logistic regression. Results: Compared to full food security, very low adult food security was associated with increased odds of MASLD (OR=1.35, 95% CI, 1.05-1.73). There were associations of very low adult food security with higher odds of MASLD in women (OR= 1.82, 95% CI, 1.08-3.09) but not in men, with statistically significant interaction between adult food insecurity and gender (p interaction = 0.038). Similarly, the positive association of adult food insecurity with MASLD was mainly found in non-Hispanic Whites and other race, but not in non-Hispanic Black, Hispanic, and non-Hispanic Asian groups. Furthermore, mediation analyses suggested that added sugar intake and intake of whole fruits and vegetables excluding potatoes partially mediated the associations of adult food insecurity with MASLD. Conclusions: The positive association between food insecurity and MASLD might be dependent on race ethnicity and gender. Increases in whole fruits and vegetables intake and reduction added sugar consumption may partially reduce the impact of food insecurity on MASLD development. Funding Sources: No
Glecaprevir/pibrentasvir in chronic HCV: an integrated analysis of patients on concomitant opioids, antipsychotics and cardiovascular medications
No full textBackground and aims: Although glecaprevir pibrentasavir (G P) is highly effective and has a well-documented safety profile, co_administration of G P with concomitant medications that are substrates of P-glycoprotein (P-gp), breast cancer resistance protein (BCRP), and organic anion transporting polypeptide (OATP) 1B1 3 may result in an increased plasma concentration of these drugs. While the effect of G P on the exposures of these concomitant medications is expected to be small, herein we analyze the safety and tolerability of a subset of concomitant medications including antipsychotics (aripiprazole, quetiapine, risperidone, paliperidone, lurasidone, clozapine), cardiovascular agents (statins, beta-blockers, calcium-channel blockers, hypertensives) and opioids (fentanyl, oxycodone and hydrocodone). Method: An integrated pooled analysis was carried out across 21 randomized controlled clinical trials in patients with chronic HCV genotype 1–6 infection with or without compensated cirrhosis receiving G P for 8, 12 or 16 weeks. Results: Among 6547 patients in this analysis, 136 patients were on antipsychotic medications, 219 received statins, 226 hypertensives, 94 beta-blockers and 44 calcium-channel blockers that had potential interactions with G P; however, none of the patients experienced a treatment-related serious adverse event (SAE). Of the 133 patients on opioids with potential interactions, 1 patient experienced a treat_ment-related SAE. Treatment discontinuations due to any AEs were rare with only 1 discontinuation in the antipsychotics class, 3 in the cardiovascular class and 3 in the opioid class. High adherence (\u3e94%, as defined by percentage of tablets taken versus expected) was observed across these specific concomitant medication classes. Sustained virologic response at 12 weeks post-treatment (SVR12) by modified intent-to-treat (ITT; excluding patients who failed to achieve SVR12 due to reasons other than virologic failure) was 99.2% when used concomitantly with antipsychotics, 99.5% with statins, 100% with beta-blockers, calcium channel blockers and antihyper_tensive agents and 96.9% with opioids. Conclusion: This integrated pooled analysis demonstrated that G P when concomitantly administered with medications such as those belonging to the antipsychotic (aripiprazole, quetiapine, risperidone, paliperidone, lurasidone, clozapine), cardiovascular (statins, beta_blockers, calcium-channel blockers, hypertensives) and opioid class, was safe, well tolerated, and demonstrated high efficacy and adherence
Everolimus Does Not Alter Non-Hepatic Malignancy Following Liver Transplant
No full textPurpose: Malignancy after solid organ transplant especially skin cancers is common phenomenon and remains a major etiology of post-transplant mortality. Some case reports and small single center studies highlight various antioncogenic effects of mammalian target of rapamycin (mTOR) inhibitor class of immunosuppressants especially everolimus. This study aims to assess the effect of everolimus on the incidence of post-transplant skin malignancy and outcomes among liver transplant recipients. Methods: A retrospective chart review of post liver transplant patients at a large tertiary center in the midwest who received a liver transplant between 1 2015-12 2019 was conducted. Patients were split into 3 groups: not on everolimus post-transplant (group 1), started on everolimus within 1 year of transplant and discontinued before 3 years (group 2) and on everolimus for at least 3 consecutive years post-transplant (group 3). Demographic data including age, gender and etiology of cirrhosis was collected with primary outcomes assessing incidence of skin cancer. Secondary outcomes included other malignancy, transplant rejection, and death. Linear regression model used to compare these groups (group 1 vs. 3 and 2 vs. 3). Results: Among 381 liver transplant recipients, 59 patients were started on everolimus within 1 year of transplant and discontinued before 3 years (15.4%, group 2) and 65 patients were on everolimus for 3 consecutive years (17.1%, group 3). 25 patients in group 1 (9.7%), 6 in group 2 (6.8%) and 6 (9.2%) developed some skin malignancy with squamous cell carcinoma the most common among all three groups. 26 patients in group 1 (10.1%), 6 in group 2 (6.8%) and 5 (7.7%) developed some other type of malignancy with hematologic (23%) most common in group 1 and GI (67%) in group 2 and 3 (80%). There was no significant difference in incidence of skin malignancy (group 1 vs 3, p = 0.835; group 2 vs 3, p =0.513) or other malignancy across the groups. Similarly no significant difference in death (group 1 vs 3, p = 0.502; group 2 vs 3, p =0.611) or transplant rejection (group 1 vs 3, p = 0.30; group 2 vs 3, p =0.066). Conclusions: Our data demonstrates everolimus did not have a protective effect against skin malignancy, other malignancy, rejection or death among liver transplant patients. Whether these findings were related to a small sample size or time frame is unclear. Further investigations are warranted with a larger sample size and over a longer period to evaluate the long term benefit this immunosuppressant may have. CITATION INFORMATION: Rehman S., Garg N., Rahman T., Abusuliman M., Saleem A., Jafri S. Everolimus Does Not Alter Non-Hepatic Malignancy Following Liver Transplant AJT, Volume 25, Issue 8 Supplement 1 DISCLOSURES: M. Abusuliman: None
