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Potential impact of aortic stenosis diagnosis on mortality and other in-hospital complications in patients with pancreatic cancer undergoing pancreaticoduodenectomy
No full textBACKGROUND: Patients with aortic stenosis undergoing noncardiac surgery pose a dilemma to physicians as they are at an increased risk for complications. This study aims to investigate the effect of aortic stenosis on mortality and other complications in patients with pancreatic cancer undergoing pancreaticoduodenectomy.
METHODS: We investigated patients with pancreatic cancer undergoing pancreaticoduodenectomy between 2016 and 2019 using the National Inpatient Sample database. The study population was divided based on the presence or absence of aortic stenosis. Multivariate logistic regression analyses were performed to determine factors associated with in-hospital mortality and other complications.
RESULTS: Of the 16,150 patients with pancreatic cancer who underwent pancreaticoduodenectomy, 165 patients were diagnosed with aortic stenosis. The mean age of patients with aortic stenosis was significantly higher. Patients with aortic stenosis had a significantly higher in-hospital mortality, occurrence of cardiac arrest, and ICU admission compared with patients without aortic stenosis. There was no difference in mechanical ventilation, hospital charges, and length of stay between the two groups.
CONCLUSIONS: Aortic stenosis was found to be associated with higher in-hospital mortality and worse outcomes in patients with pancreatic cancer undergoing pancreaticoduodenectomy. Preoperative risk stratification and a multidisciplinary approach to perioperative management, among other measures, should be considered to improve outcomes
Association Between Frailty, Use of Advanced Therapies, In-Hospital Outcomes, and 30-Day Readmission in Elderly Patients Admitted With Acute Pulmonary Embolism
No full textBackground: Clinical decision-making when assessing elderly patients with acute PE often involves an assessment of frailty that may impact the use of advanced therapies. We sought to evaluate the use of advanced therapies and associated in-hospital outcomes by frailty status in such patients. Methods: We utilized the National Readmission Database (NRD) to identify acute PE admissions in older patients ( \u3e 75 years) from 2016 to 2020. We defined high-risk PE by the presence of one or more of the following: shock, progressive hypoxia, vasopressor use, or ECMO requirement. Frailty was determined using a previously validated hospital frailty risk score (HFRS). Results: Overall, 233,091 nationally representative patients with acute PE met the study inclusion criteria; 50.9% of patients with no frailty risk (score \u3e 5), while 49.1% of patients with increased frailty risk (score 5-30). A total of 7.4% (17,277) of patients with high-risk features were identified, of whom 79.9% (13,810) patients were frail. Receipt of catheter-directed thrombolysis (CDT) and embolectomy (CDE) were comparable among high-risk frail and non-frail patients. Compared to non-frail patients, increased frailty was associated with higher in-hospital mortality. This increase was 2.3-fold in those without high-risk features and 1.2-fold in those with high-risk features. There is a similar increase in intracranial hemorrhage, gastrointestinal bleeding, and hematuria. Similarly, frailty and high-risk PE were associated with higher length of stay (LOS), increased resource utilization and cost, and fewer home discharges. Conclusion: Catheter-based therapies were utilized at similar rates in frail individuals compared to non-frail elderly individuals with high-risk PE. Increased frailty conferred an increased risk of in-hospital adverse events in elderly patients with PE
71982 | Peri-procedural Imaging and Procedural Characteristics of TTVR With Alternative Access
No full textBackground: Transcatheter tricuspid valve replacement (TTVR) with Evoque (Edwards, USA) is a relatively novel therapy in management of patients with severe tricuspid regurgitation (TR) at high risk for surgical intervention. As its commercial availability has expanded its access, patients with broader and more challenging right-sided anatomy are undergoing treatment. Although the device delivery system (DDS) was designed for transfemoral (TF) access, transjugular access has recently shown feasibility in a select group of patients. With expanding usage of alternative access, defined as non-right-femoral vein, familiarity with these patient characteristics is of utmost importance. Methods: Retrospective analysis of all patients who underwent TTVR at a single center between February 2024 and March 2025 was performed. All patients had pre-procedural CCT analyzed for right atrial height, superior vena cava offset, inferior vena cava offset, tricuspid annular angle, and papillary distance. Results: A total of 93 patients were analyzed, of whom 61 had right femoral vein (FV) access, 13 had left FV, 10 had right transjugular (RIJ), and 9 had left transjugular (LIJ) access. Results are demonstrated in Table 1. [Formula presented] Conclusion: Alternative access, with utilization of left FV, RIJ, and LIJ has demonstrated feasibility and safety in TTVR with Evoque. Particularly, in patients with short RA heights alternative access is recommended, and depending on patient characteristics one may select from LFV or transjugular access. Familiarity with these techniques will aid in greater procedural success across a broader spectrum of patient anatomies
CT Based Planimetry Of Tricuspid Regurgitation Anatomic Regurgitant Orifice Area Correlation With Echo Metrics Of Severity And Utilizing CT Metrics To Augment Echo-based Quantification Techniques
No full textIntroduction: Tricuspid regurgitation (TR) is a cause of significant morbidity and mortality. Due to the complex anatomy of the tricuspid valve, the echo assessment of the regurgitation severity can be challenging to grade reproducibility. Effective regurgitant orifice area (EROA) has demonstrated a direct link to clinical outcomes. ECG gated CT angiography (CCTA) offers high temporal resolution of tricuspid valve anatomy, allowing for accurate measurement of the true anatomic AROA. This measurement may be challenging, even on transesophageal echocardiogram due to limitations in available acquisition windows. Data comparing these measurements is scarce and our aim was to better assess their correlation and subsequent clinical utility Methods: Retrospective analysis was performed on 42 patients who underwent TTVR using the EVOQUE tricuspid valve between August 2024 and February 2025. All patients had pre-procedural imaging with CT and TEE. AROA on structural CT (TV coaptation gap by planimetry) was compared with CT derived volumetric systolic IVC contrast reflux volume, as well as TEE derived TR vena contracta, calculated EROA regurgitant volume and preprocedural integrative TR severity on expert-adjudicated TEE We assessed the correlation between our variables using adjusted R2 model Results: Data of 42 patients was analyzed; Superior correlation was found between CT TR EROA and EROA on TEE (AdjR2 = 0.7) and CT IVC contrast reflux volume (AdjR2 = 0.4). A strong correlation was also demonstrated between TR EROA on TEE and TR Vena contracta and regurgitant volume on TEE (AdjR2 = 0.7and 0.4 respectively). There was no significant correlation between CT EROA and TR pre-procedure grading, TR VC on TEE and TR Regurgitant volume (AdjR2 = 0.04, 0.2 and 0.07 respectively). Conclusions: CT imaging plays a crucial role in the preprocedural planning of transcatheter tricuspid interventions, but its utility in assessing traditional echocardiographic severity metrics remains underexplored. We found a strong correlation between CT-based AROA and TEE-based tricuspid regurgitation EROA, suggesting that CT TR AROA could serve as a reliable reference standard for grading TR and guiding treatment decisions. Additionally, our study supports the use of CT-derived IVC contrast reflux volume as a valuable adjunct in assessing TR severity. The weaker correlation with expert TR grading further suggests that CT-based quantitative metrics may offer advantages over conventional echocardiographic integrative grading. [Formula presented
TCT-660 Percutaneous Retrieval of Large Mitral Valve Vegetation Using the FlowTriever System with Cerebral Embolic Protection: A Novel Approach in a High-Risk Patient Presenting with Stroke
No full textMethods: An 83-year-old female with a history of Atrial fibrillation and prior Mitral and Tricuspid valve repair presented with an acute stroke. MRI confirmed new embolic infarcts. TEE revealed a large mobile mitral valve vegetation despite a negative infectious workup. Given the high surgical risk, percutaneous retrieval was pursued. Knowing the hypermobility of this mass, we elected to use a novel method for full-body protection using the ŌNŌCOR device. Results: Under moderate sedation, Access was obtained via the right femoral artery. A TruSteer sheath was advanced over an Amplatz Super Stiff guidewire into the ascending aorta. The ŌNŌCOR retrieval device was deployed at the aortic root through this sheath for embolic protection. Under intracardiac echocardiography guidance, transseptal access was achieved. Following septal balloon dilation, a 24F FlowTriever aspiration catheter was advanced into the left atrium. The vegetation was successfully retrieved via multiple aspiration passes. The ŌNŌCOR retrieval device was retrieved; small debris was captured. The procedure was technically successful, with complete vegetation retrieval. Specimen analysis was negative for endocarditis. Conclusion: Percutaneous transseptal aspiration thrombectomy using the FlowTriever system, combined with the ŌNŌCOR device for full body protection, is a feasible and novel approach for managing large, mitral valve vegetations in high-risk surgical patients. This case demonstrates the potential for catheter-based interventions in complex structural heart disease. Categories: STRUCTURAL: Valvular Disease and Intervention: Mitra
TCT-182 Impact of Lesion Preparation Strategy on the Efficacy of Paclitaxel Coated Balloon for Coronary In-stent Restenosis: A Subgroup Analysis of the AGENT IDE Randomized Trial
No full textBackground: Prior evidence suggests that complex lesion preparation (CLP) with scoring balloon and atherectomy before treatment with a drug-coated balloon (DCB) may offer potential clinical benefits. AGENT IDE trial demonstrated superiority of AGENT paclitaxel-coated balloon over balloon angioplasty (BA) for treating in-stent restenosis (ISR). This post-hoc analysis evaluates whether pre-treatment with CLP vs. typical balloons (TB) modified the ISR treatment effect. Methods: The study randomized 600 ISR patients in a 2:1 allocation to AGENT DCB or BA. Entry into the trial required successful lesion preparation defined angiographically as TIMI grade flow \u3e2, with no greater than 50% residual stenosis and no dissection greater than National Heart, Lung, Blood Institute type C. Primary endpoint was 12-month target lesion failure (TLF) rate (composite of target lesion revascularization [TLR], myocardial infarction [MI], or cardiac death). Results: A total of 326 patients (54.3%) achieved successful lesion preparation using CLP (specialty balloon, atherectomy, or combination therapy) prior to randomization; 274 (45.7%) underwent pre-treatment with TB. Patient demographics, comorbidities and lesion characteristics were similar between CLP and TB groups. One-year outcomes are shown in the Table. The reduction in TLF with DCB vs. BA was consistent for patients treated with CLP tools (18.3% vs 32.6%, HR 0.53, 95% CI [0.33-0.84]) and those treated with TB (17.5% vs 24.3%, HR 0.68, 95% CI [0.39-1.18], interaction P = 0.48), driven by reduced TLR and target vessel MI. [Formula presented] Conclusion: Lesion optimization is critically important when treating patients with ISR. AGENT DCB is a more effective therapeutic option than conventional BA, irrespective of ISR lesion preparation strategies. Categories: CORONARY: Drug-Coated Balloons and Local Drug Deliver
Go the Distance: Student Workers and Repository Impact
No full textHave you often dreamed of a fully staffed scholarly communications team? If you\u27re like me—the only full-time employee managing the institutional repository (IR) and research information management system (RIMS)—this great, warm place is just a dream. This lightning talk shares how strategic hiring and training of undergraduate student workers can help bridge the gap. At Loyola Marymount University, students support scholarly communications services by assisting in the management of our RIMS, Scholars @ LMU, and IR, Digital Commons @ LMU. During the hiring process, students complete an attention-to-detail assessment, helping both the librarian and the student understand the expectations and training needs. Beyond technical skills, students are rigorously and repeatedly taught how to communicate their work to faculty, becoming ambassadors for the IR and RIMS, and for future employers. They gain experience in metadata, research visibility, and usage analytics, but are taught how to translate these experiences directly in their resumes and interviews. Transparent communication about faculty requests, gratitude, and impact data helps students see the real-world value of their contributions in professional settings. This lightning talk provides examples of how our scholarly communications student assistants graduate with the ability to articulate their transferable skills and resume-ready experience
Lessons Learned from Showcasing Repository Usage Statistics to Inform and Inspire
No full textAfter one year of going live with our repository, researchers are capitalizing on the repository\u27s benefits to enhance the impact of their work. One key set of data that has driven more inspiration and inquiry from our internal stakeholders is the repository statistics. We know that data dashboards are a common leverage point in our organization, so we decided to bring the repository statistics into the internal environment in which our stakeholders are already investing their time and resources. Our challenge was to create a dashboard of repository usage statistics to inform, inspire, and motivate uploads to our digital repository. In this presentation, we unpack the choices we made regarding which repository statistics to share via an internal dashboard, the technical approaches we have taken to access and store the data internally, and the feedback we have received so far. We will share lessons learned through the technical approaches we attempted within the Microsoft environment; skillsets needed to embark on a project of this nature; learning how to use API documentation; and remaining challenges. This presentation will be of interest to repository managers in health-related settings who conduct data-informed outreach to their internal stakeholders with the goal of sharing mission-critical research findings with the public in a timely manner. From the perspective of a non-profit, independent research organization, we offer a unique perspective on approaches to leverage usage statistics from a digital repository to both incentivize use and bring awareness to the benefits of repositories for increased impact
Expanding our IR after health system combination: Nurses lead the way
No full textIn 2022, Advocate Aurora Health in Wisconsin and Illinois combined with Atrium Health in North Carolina and Georgia with Wake Forest School of Medicine as our academic core. The combined organization called Advocate Health includes multiple legacy libraries with one library serving the Advocate Health Midwest region (legacy Advocate Aurora Health) and four libraries serving different markets and educational schools in the Advocate Health Southeast region. The Midwest region has an institutional repository (SHARE) that collects scholarly activity for all Midwest teammates. No libraries in the Southeast region had an institutional repository at the time of combination. Nursing as a service line prioritized collaboration across the enterprise and their leadership values showcasing scholarship from nurses. Nursing research leaders approached the library in the Midwest to expand the scope of SHARE to include nurses in the Southeast region. We are currently in the process of securing an amendment of our agreement with Digital Commons to make this possible. In this presentation, we will discuss: • Value nursing research has found in disseminating their scholarly activity through SHARE • Increased awareness of SHARE via author readership reports • Service line integration will drive institutional repository expansion/library integration • Strategies to fund the expansion • Upcoming opportunities and challenges due to partial expansion of SHAR
Rees-Jones Center for Foster Care Excellence Collection: Resources for providers, caregivers, child welfare professionals and others
No full textThe Rees-Jones Center for Foster Care Excellence, a primary integrated care program for children who have experienced the child welfare system, regularly provides trainings on topics related to understanding and navigating the effects of trauma on children and families. Utilizing our collection on the Children Health Scholarly Collection, the experts at the Rees-Jones Center share recorded trainings and resources, using the platform in a unique way to make information easily accessible to those working with and caring for children and youth who have experienced trauma (e.g. caregivers, child welfare professionals, health care professionals). The Rees-Jones Center repository offers information on child development, behavior management, trauma-informed care, and more; many resources are available in Spanish and some offer free Social Work or Nursing Continued Educations Units (CEUs). The caregivers who have visited the site have stated that they find the variety of materials “user-friendly” and “readily available, valuable information for when they have time to focus”, while caseworkers and partners who have used the platform have stated appreciation for having “important resources consolidated to one place”, making it “easier [for them] to find quality and trustworthy information to use and share with families”. For those interested, the repository includes information about the Rees-Jones Center’s research and policy publications, highlighting the advocacy work of the team. Our repository also features other recommended sites for families to get further information and training from trusted organizations such as the National Child Traumatic Stress Network (NCTSN), Sesame Street Workshop, and HealthyChildren.org