20966 research outputs found
Sort by
TCT-318 Stroke after TAVR - Impact on Clinical Outcome and Patient Reported Quality of Life (QoL): The Michigan Structural Heart Consortium (MISHC) Experience
No full textBackground: We evaluated the incidence, risk factors, and comparative outcomes of patients who experienced a stroke following TAVR versus those who did not, using a large cohort from MISHC. Methods: MISHC collects data on all TAVRs performed at 31 hospitals in Michigan. Demographic, clinical, and procedural characteristics—including QoL as measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ)—were summarized. Comparisons between stroke and non-stroke groups were performed. Inverse Probability of Treatment Weighting was applied to adjust for confounding variables. Results: Among 18,633 patients who underwent TAVR between 1/2016-1/2024, 332 (1.78%) experienced a stroke prior to discharge. Patients who suffered a stroke had significantly higher in-hospital, 30-day, and one-year mortality rates compared with those who did not (p \u3c 0.001). Adjusted outcomes are shown (key figure). KCCQ scores at 30 days remained significantly lower in stroke patients and one-year scores trended lower. Other adjusted outcomes were significantly worse in the stroke cohort. [Formula presented] Conclusion: Stroke following TAVR is associated with significantly worse clinical outcomes, including increased short- and long-term mortality, prolonged hospitalization, greater healthcare utilization, and diminished QoL. Even after adjustment, stroke patients demonstrated persistently lower 30-day QoL scores, with a non-significant trend toward lower scores at one year. Further research is needed to refine stroke prevention strategies and develop targeted rehabilitation approaches to optimize post-stroke recovery and long-term QoL in this high-risk population. Categories: STRUCTURAL: Valvular Disease and Intervention: Aorti
TCT-728 Evolving Strategies to Prevent Coronary and Left Ventricular Outflow Tract Obstruction: The UNICORN and BATMAN Techniques – A Multicenter Study
No full textBackground: Strategies for preventing coronary or left ventricular outflow tract (LVOT) obstruction during TAVR and TMVR are becoming more prevalent. This study describes efficacy and safety of Undermining Coronary Obstruction with Radiofrequency Needle Ablation (UNICORN) and Balloon-Assisted Translocation of the Anterior Mitral Leaflet (BATMAN) procedures. Methods: This study was a retrospective, multicenter study of patients who underwent UNICORN during TAVR and BATMAN during TMVR between March 2024 and May 2025. Primary success was UNICORN or BATMAN without periprocedural coronary or LVOT obstruction, reintervention or death. The primary safety endpoint was freedom from major adverse cardiovascular events and major vascular complications at 30 days. Results: A total of 52 UNICORN and 25 BATMAN patients were treated at 11 different sites. UNICORN patients primarily underwent valve-in-surgical valve procedure (55.8%) and BATMAN patients primarily underwent valve-in-mitral annular calcification (40%). Procedural success was 96.2% in UNICORN patients (2 patients with coronary obstruction). Primary safety at 30 days was 86.5% (4 strokes, 3 major vascular complications and 1 myocardial infarction). In the BATMAN group, procedural success was 64%. There were 5 periprocedural deaths, 3 cases of LVOT obstruction, and 3 reinterventions. Of the deaths, 2 died following intestinal ischemic events presumed embolic; 1 died of cardiogenic shock in the procedure; 1 patient died secondary to valve embolization; 1 patient sustained an intraprocedural left ventricular injury and died during repair. Primary safety at 30 days was 76%, with 1 post-discharge myocardial infarction. [Formula presented] Conclusion: UNICORN and BATMAN procedures are feasible in a high-risk population. Further experience is needed to optimize patient selection and improve short term outcomes. Categories: STRUCTURAL: Valvular Disease and Intervention: Aorti
TCT-260 Multivessel Versus Culprit-Vessel Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction with Cardiogenic Shock
No full textBackground: Culprit-shock established the benefit of culprit-only revascularization in acute myocardial infarction and cardiogenic shock (AMICS). Whether the use of percutaneous left ventricular assist devices (pLVAD) changes this paradigm remains unclear. Methods: This patient-level pooled analysis of RECOVER III (NCT04136392) and the National Cardiogenic Shock Initiative (NCT03677180)-both single-arm, multicenter, observational studies-enrolled patients with AMICS who underwent percutaneous coronary intervention (PCI) with pLVAD. Outcomes were compared between patients with multi-vessel (MV) disease undergoing MV PCI vs. culprit-vessel (CV) PCI. Patients who underwent left main PCI were excluded. Results: Among 369 patients with MV disease, 191 (51.8%) underwent MVPCI and 178 (48.2%) underwent CVPCI, with no significant differences in baseline characteristics. In-hospital survival was higher in patients undergoing MVPCI (63.4% vs. 52.2%, RR: 0.77 [0.60, 0.98], p=0.03). Thirty-day and 1-year survival favored MVPCI (57.7% vs. 48.2%, p=0.08, and 45.5% vs. 34.5%, p=0.059, respectively). In stage E shock, MVPCI improved in-hospital survival (54.8% vs. 39.4%, p=0.03). Notably, stage C/D had similar in-hospital survival irrespective of revascularization strategy (71.4% vs. 69.2%, p=0.75) (Table). [Formula presented] Conclusion: In patients with AMICS and MV disease treated with early pLVAD, MVPCI was associated with improved survival, especially in patients in Stage E shock. Randomized trials are needed to confirm the benefit of MVPCI in this population. Categories: CORONARY: Hemodynamic Support, Cardiogenic Shock and Cardiac Arres
TCT-1021 Incidence and Outcomes of Hospitalized Acute Ischemic Stroke Patients with subsequent ST-Segment-Elevation Myocardial Infarction
No full textBackground: Acute ischemic stroke (AIS) and ST-segment elevation myocardial infarction (STEMI) are two life-threatening, atherothrombotic conditions with overlapping risk profiles. While their individual pathophysiology is well described, the occurrence of STEMI during AIS hospitalization and its clinical impact remain underexplored. Methods: We analyzed 2,804,819 adult patients hospitalized with AIS from 2016-2021 using the National Inpatient Sample, a nationally representative database. Patients with concomitant STEMI were identified using ICD-10 Diagnostic codes; those with NSTEMI were excluded. The primary outcome was in-hospital mortality. Secondary outcomes included cardiogenic shock, cardiac arrest, acute kidney injury (AKI), procedural interventions, and resource utilization. Multivariable logistic regression adjusted for demographics, comorbidities, and hospital-level variables. Temporal trends were assessed over the 6-year period. Results: Among 2,804,819 AIS admissions, 6,550 (0.23%) had a STEMI during hospitalization. Patients with STEMI had significantly higher in-hospital mortality (24.96% vs 3.10%, p\u3c0.001). STEMI was independently associated with increased odds of mortality (OR 7.43, 95% CI 6.44-8.57), cardiogenic shock (OR 9.64, 95% CI 7.21-12.89), cardiac arrest (OR 7.76, 95% CI 6.01-10.03), and AKI (OR 1.96, 95% CI 1.72-2.23), among other complications. STEMI patients mroe frequently required PCI, mechanical circulatory support, intubation, and had longer hospital stays. From 2016 to 2021, STEMI incidence among AIS patients declined (∼30% to ∼20%), yet mortality in this subgroup remained disproportionately high. Conclusion: STEMI in patients hospitalized with AIS is associated with a seven-fold increased risk of in-hospital mortality and a dramatically worse secondary complications including cardiac arrest, cardiogenic shock, AKI, and need for further medical interventions. Despite a decreasing incidence over time, this overlap syndrome demands urgent clinical recognition and integrated neurologic-cardiac care pathways to improve recognition, management protocols, and interdisciplinary care strategies to mitigate morbidity and mortality in this high-risk population. Categories: ENDOVASCULAR: Stroke, Stroke Prevention, Carotid Interventio
Keynote Panel: Different Views of Irs in the Medical Landscape: A Panel Reflects on 2025
No full textMIRL 2025 featured a keynote panel of library leaders who discussed topics relevant to a medical IR community
Orthopedic Surgery in Liver Transplant Recipients: Does Surgical Urgency Influence Post Operative Morbidity
No full textPurpose: Despite chronic immunosuppression, liver transplant recipients often require surgical interventions, with a growing demand for orthopedic procedures in this population. These surgeries present significant perioperative challenges, requiring a balance between maintaining immunosuppression and minimizing post-operative complications. However, the impact of surgical urgency on post-operative outcomes remains unclear. This study evaluates post-operative complications in liver transplant recipients undergoing elective versus emergent orthopedic surgeries and examines whether immunosuppressive regimens influence outcomes. Methods: A retrospective cohort study was conducted using SlicerDicer to identify liver transplant recipients who underwent orthopedic surgeries between 2013 and 2022. Patients were categorized based on surgical urgency as either elective or emergent. Collected data included demographics, type of surgery, and immunosuppressive regimen. Outcomes assessed included infection, transaminitis, acute kidney injury (AKI), and hospital readmission within one year post-operatively. Differences in outcomes among various immunosuppressive regimens were also examined. A descriptive analysis was performed to identify trends in post-operative complications based on surgical urgency and immunosuppressive regimen. Results: A total of 87 patients were included, with a mean age of 67.5 years and a mean transplant-to-surgery interval of 87 months. The majority were male (59%, n=51) and White (82%, n=71), with smaller proportions of African American (16%, n=14) and other racial backgrounds (2%, n=2). Of these, 69 patients (79.3%) underwent elective orthopedic procedures, while 18 patients (20.7%) underwent emergent surgeries. Post-operatively, infection occurred in 7.2% of elective cases and 16.7% of emergent cases, transaminitis in 7.2% of elective cases and 11.1% of emergent cases, and AKI in 17.4% of elective cases and 16.7% of emergent cases. Hospital readmission within one year was observed in 36.2% of elective cases and 50.0% of emergent cases. These findings suggest a trend toward increased post-operative complications in patients undergoing emergent orthopedic surgery, particularly infections and transaminitis. Additionally, no significant differences in complication trends were observed among different immunosuppressive regimens. Conclusions: Orthopedic surgery in liver transplant recipients carries a risk of post-operative complications, with emergent procedures showing a trend toward systemic complications. While no differences were observed between immunosuppressive regimens, these findings highlight the need for careful perioperative management, particularly in emergent cases. Further studies with larger sample sizes are warranted to better define perioperative risks and guide clinical decision-making in this patient population. CITATION INFORMATION: Saleem A., Alomari A., Samad M., Ilyas O., Khaliq I., Abusuliman M., Chaudhary A., Omeish H., Faisal M., Dababneh Y., Affas S., Jafri S. Orthopedic Surgery in Liver Transplant Recipients: Does Surgical Urgency Influence Post Operative Morbidity AJT, Volume 25, Issue 8 Supplement 1 DISCLOSURES: A. Saleem: None
The Effects of Demographic Factors Upon Intestinal Transplant Outcomes
No full textPurpose: Demographic factors are increasingly recognized as potential influences on transplant outcomes. Limited data exist on the impact of demographic factors on intestinal transplantation (IT) and multivisceral transplantation (MVT) outcomes. This study aims to evaluate the impact of both sex and age on IT and MVT post-transplant outcomes. Methods: Retrospective chart review of all patients who underwent IT or MVT at an academic transplant center from 2010 to 2023. Patients were stratified by sex (male vs. female) and age (\u3c50 vs. ≥50 years). The primary outcome was patient survival, analyzed using Kaplan-Meier analysis. Secondary outcomes included graft failure (GF), reoperation rates, moderate-to-severe rejection, and the development of chronic kidney disease (CKD). Results: Among 50 IT recipients, there were 20 men and 30 women. When stratified by age, 21 were \u3c50 years old, while 29 were ≥50 years old. IT alone accounted for 58% of transplants, while 42% were MVT. Survival analysis revealed no significant mortality difference between the groups when analyzed by sex (p=0.28) or when comparing IT alone to MVT (p=\u3e0.05 in all subgroups). Male IT recipients showed a higher need for reoperation within 1 month (p=0.01), though this difference did not persist at 3 months (p=0.44). No significant differences were observed between the sexes for GF, rejection rates, or CKD. In contrast, age was a significant predictor of survival, with recipients ≥50 years old demonstrating significantly lower survival rates than younger recipients (p\u3c0.01). Older recipients had a trend towards higher incidence of reoperation within 3 months and an increased risk of developing CKD. No significant differences were found between age groups in terms of GF or rejection rate. Conclusions: While transplant recipient sex did not significantly impact survival or transplant-related outcomes, age ≥50 years was associated with significantly lower survival rates following IT. Further studies are needed to explore immunosuppression modifications and infectious surveillance strategies that may help reduce the incidence of CKD and improve mortality outcomes in these populations. CITATION INFORMATION: Toiv A., O\u27Brien H., Andrews T., Jafri S. The Effects of Demographic Factors Upon Intestinal Transplant Outcomes AJT, Volume 25, Issue 8 Supplement 1 DISCLOSURES: A. Toiv: None
Liver Transplant Outcomes and Complications for Metabolic- Dysfunction Associated Alcohol Related Liver Disease (MetALD)
No full textPurpose: Metabolic alcohol-associated liver disease (MetALD) describes the coexistence of alcohol-associated liver disease (ALD) and metabolic dysfunction-associated steatotic liver disease (MASLD), two leading indications for liver transplantation (LT). However, the impact of this increasingly recognized dual pathology on LT recipient outcomes has not been thoroughly investigated. Our aim was to determine whether LT recipients with MetALD had less favorable postoperative outcomes than those with isolated ALD. Methods: A retrospective cross-sectional study of all patients who underwent LT for the primary indication of ALD at a high-volume academic transplant center between January 1, 2014, and September 26, 2023. Patients were stratified into 2 groups: LT recipients with isolated ALD and those with MetALD based on the presence of metabolic comorbidities. Kaplan-Meier analysis was used to compare mortality and graft survival rates between groups. Results: Of 381 LT recipients with ALD, 159 (42%) had isolated ALD, and 222 (58%) had MetALD. The MetALD group had a significantly higher median age (58 vs 50 years; p\u3c0.001) and was predominantly female (77% vs. 45%). Comorbidities in the MetALD group included diabetes (37% vs. 0%), hyperlipidemia (23% vs 0%), hypertension (77% vs. 0%), and coronary artery disease (27% vs. 0%) (all p\u3c0.001). Despite the greater prevalence of baseline metabolic comorbidities in the MetALD group, no significant differences in postoperative mortality was observed between groups at 1 (94% vs 96%), 3 (91% vs. 90%), or 5 years (90% vs. 88%) after LT. Furthermore, no significant differences in graft failure were observed between groups at 1 (91% vs 95%), 3 (88% vs 89%), or 5 years (99% vs 87%) after LT. Rejection rates and surgical complications were also comparable between groups. Conclusions: Despite being older and having a significantly higher prevalence of metabolic and cardiovascular comorbidities including diabetes, hyperlipidemia, hypertension, and coronary artery disease, LT recipients with MetALD demonstrated positive patient and graft survival outcomes comparable to those in patients with isolated ALD. These results highlight the value of LT as a treatment option in this complex patient population and suggest that the presence of MetALD should not preclude consideration for LT. CITATION INFORMATION: Toiv A., O\u27Brien H., Sarowar A., Andrews T., Jafri S. Liver Transplant Outcomes and Complications for Metabolic- Dysfunction Associated Alcohol Related Liver Disease (MetALD) AJT, Volume 25, Issue 8 Supplement 1 DISCLOSURES: A. Toiv: None
Best Practices for Addressing Differences in Antimicrobial Resistance Through Quality Improvement Projects in Antimicrobial Stewardship in Low-Resource Settings
No full textOutcomes of Iatrogenic Atrial Septal Defect Closure After Transseptal Transcatheter Mitral Valve Replacement in the Mitral Implantation of Transcatheter Valves (MITRAL) Trial
No full textBACKGROUND: The long-term hemodynamic consequences of iatrogenic atrial septum defect (iASD) after transseptal (TS) transcatheter mitral valve replacement (TMVR) are unknown. The objective of this study was to compare the clinical outcomes of patients who underwent iASD closure after TS TMVR in the MITRAL (Mitral Implantation of TRAnscatheter vaLves) trial.
METHODS: The MITRAL trial enrolled high-surgical-risk patients with severe mitral annular calcification treated with valve-in-mitral annular calcification (ViMAC), failed surgical repair with annuloplasty ring treated with mitral valve-in-ring (MViR), or failed surgical mitral bioprosthesis treated with mitral valve-in-valve (MViV).
RESULTS: Ninety-one patients were prospectively enrolled between February 2015 and December 2017, at 13 US sites (MViV = 30, MViR = 30, ViMAC = 31). Seventy-five of them were treated with TS access (MViV = 30, MViR = 30, and ViMAC = 15), of which 16 patients underwent iASD closure during or after the index procedure (MViV = 3, MViR = 7, ViMAC = 6). Closure of the iASDs was left to the operator\u27s discretion, and the reason in most patients was the presence of large left-to-right shunt. Patients who underwent closure of iASD were a sicker population at baseline with more severe symptoms (87.5% with New York Heart Association functional class III-IV, compared to 81.4% in non-iASD closure group, p = 0.02), higher rate of recent heart failure hospitalization (68.8% vs. 30.5%; p = 0.01) and lower 6-minute walk test distance (110 m vs. 214 m; p = 0.002). These patients also had longer length of stay after TMVR compared with patients who did not undergo iASD closure (8 vs. 4 days, p \u3c 0.001). Despite these differences at baseline and requiring longer hospital stays, there was no significant difference in mortality, New York Heart Association class, 6-minute walk test distance, or heart failure hospitalization at 5 years.
CONCLUSIONS: Patients who underwent iASD closure were more symptomatic at baseline, had decreased functional exercise capacity and required longer length of stay after TMVR. Despite these differences at baseline, 5-year outcomes were similar between groups