The Brink of the Abyss: From Transcatheter Aortic Valve Implantation, to Impella, to Left Ventricular Assist Device Destination Therapy

Acute valvular emergencies are common causes of cardiogenic shock. Patients with critical aortic pathologies causing shock frequently undergo percutaneous interventions for valve replacement. However, in cases of persistent cardiogenic shock after valve replacement, there are limited options for further mechanical support. In this case study, we report a patient with a prior history of aortic valve replacement who presented in cardiogenic shock. After a transcatheter aortic valve-in-valve replacement, he remained in persistent shock with worsening clinical parameters requiring escalating inotropic and vasopressor support. With input from a multidisciplinary care team, an Impella 5.5 (Abiomed, Inc.) was placed through the valve for mechanical circulatory support, ultimately serving as a bridge to a durable left ventricular assist device as destination therapy. This technically challenging approach was successful, and the patient was discharged to acute rehabilitation with improved symptoms

Trends in P2Y12 Receptor Inhibitor Use and Adherence After Percutaneous Coronary Intervention, 2008-2016

Post-angioplasty, patient adherence to recommended antiplatelet therapy decreased when newer, more expensive drugs were introduced. From 2008-2016, as the use of newer agents increased, the proportion of patients not filling any antiplatelet prescription within 30 days of discharge increased from 6.4% to 19.1%. In the subsequent 12 months, the newer drugs were associated with higher patient costs and lower adherence to recommended therapy

Outcome of gastrointestinal surgery during COVID-19 lockdown in a tertiary care hospital, Nepal

Introduction: Perioperative strategies have been changing due to the COVID-19 pandemic to prevent the risk of postoperative complications and transmission of infection. This study was aimed to assess the outcome of gastrointestinal surgery and the risk of transmission by implementing COVID-19 testing criteria and surgical strategy. Method: This was a retrospective descriptive study conducted at the department of surgery at Patan Hospital, Nepal, during COVID-19 lock-down from 24 march to 15 June 2020. All patients who underwent gastrointestinal (GI) surgery were included. High-risk patients (as defined by the Hospital Incident Command System, HICS) were tested for COVID-19 preoperatively. Surgery was performed in COVID operating room with full protective gear. Low-risk patients were not tested for COVID-19 preoperatively and performed surgery in non-COVID OR. Data from patient’s case-sheets were analyzed descriptively for age, gender, comorbidities, hospital stay, RT-PCR results, surgeries, and postoperative complications. Result: There were total 44 GI surgeries performed; 31(70.5%) were emergency, 5(11.3%) semi-emergency and 8(18.2%) oncology. There were 11(25%) patients tested for COVID-19 preoperatively and were negative. Nine HCWs tested for COVID-19 randomly were negative. Severe postoperative complications developed in 3 patients, with one mortality. Conclusion: Among GI surgeries, there was no increase in postoperative complications and transmission of COVID-19 to the patients or HCWs following the implementation of standard testing criteria and surgical strategy

Statin Use and Functional Decline in Patients With and Without Peripheral Arterial Disease

ObjectivesWe determined whether statin use (vs. non-use) is associated with less annual decline in lower-extremity functioning in patients with and without lower-extremity peripheral arterial disease (PAD) over three-year follow-up.BackgroundIt is unclear whether statin use is associated with less functional decline in patients with PAD.MethodsParticipants included 332 men and women with an ankle brachial index (ABI) <0.90 and 212 with ABI 0.90 to 1.50. Functional outcomes included 6-min walk distance and usual and rapid-pace 4-m walking velocity. A summary performance score combined performance in walking speed, standing balance, and time for five repeated chair rises into an ordinal score ranging from 0 to 12 (12 = best).ResultsAdjusting for age, race, gender, comorbidities, education, health insurance, total cholesterol/high-density lipoprotein level, body mass index, pack-years of smoking, leg symptoms, immediately previous year functioning, statin use/non-use, ABI, and change in ABI, the PAD participants using statins had less annual decline in usual-pace walking velocity (0.002 vs. −0.024 m/s/year, p = 0.013), rapid-pace walking velocity (−0.006 vs. −0.042 m/s/year, p = 0.006), 6-min walk performance (−34.5 vs. −57.9 feet/year, p = 0.088), and the summary performance score (−0.152 vs. −0.376, p = 0.067) compared with non-users. These associations were attenuated slightly by additional adjustment for high-sensitivity C-reactive protein levels. Among non-PAD participants, there were no significant associations between statin use and functional decline.ConclusionsThe PAD patients on statins have less annual decline in lower-extremity performance than PAD patients who are not taking statins

Neutrophil Extracellular Trap–Derived Enzymes Oxidize High‐Density Lipoprotein: An Additional Proatherogenic Mechanism in Systemic Lupus Erythematosus

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108351/1/art38703.pd

Modelling Costs of Interventional Pulmonary Embolism Treatment: Implications of US Trends for a European Healthcare System

BACKGROUND Catheter-directed treatment (CDT) of acute pulmonary embolism (PE) is entering a growth phase in Europe following a steady increase in the United States (US) in the past decade, but the potential economic impact on European healthcare systems remains unknown. METHODS AND RESULTS We built two statistical models for the monthly trend of proportion of CDT among patients with severe (intermediate- or high-risk) PE in the US. The conservative model was based on admission data from the National Inpatient Sample (NIS) 2016-2020, and the model reflecting increasing access to advanced treatment from the PERTTM national quality assurance database registry 2018-2021. By applying these models to the forecast of annual PE-related hospitalizations in Germany, we calculated the annual number of severe PE cases and the expected increase in CDT use for the period 2025-2030. The NIS-based model yielded a slow increase, reaching 3.1% (95% CI 3.0-3.2%) among all hospitalizations with PE in 2030; in the PERT-based model, increase would be steeper, reaching 8.7% (8.3-9.2%). Based on current reimbursement rates, we estimated an increase of annual costs for PE-related hospitalizations in Germany ranging from 15.3 to 49.8 million euros by 2030. This calculation does not account for potential cost savings, including those from reduced length of hospital stay. CONCLUSION Our approach and results, which may be adapted to other European healthcare systems, provide a benchmark for healthcare costs expected to result from CDT. Data from ongoing trials on clinical benefits and cost savings are needed to determine cost-effectiveness and inform reimbursement decisions

Diagnosis, Treatment and Follow Up of Acute Pulmonary Embolism: Consensus Practice from the PERT Consortium

Pulmonary embolism (PE) is a life-threatening condition and a leading cause of morbidity and mortality. There have been many advances in the field of PE in the last few years, requiring a careful assessment of their impact on patient care. However, variations in recommendations by different clinical guidelines, as well as lack of robust clinical trials, make clinical decisions challenging. The Pulmonary Embolism Response Team Consortium is an international association created to advance the diagnosis, treatment, and outcomes of patients with PE. In this consensus practice document, we provide a comprehensive review of the diagnosis, treatment, and follow-up of acute PE, including both clinical data and consensus opinion to provide guidance for clinicians caring for these patients

COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-up

Coronavirus disease 2019 (COVID-19), a viral respiratory illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), may predispose patients to thrombotic disease, both in the venous and arterial circulations, due to excessive inflammation, platelet activation, endothelial dysfunction, and stasis. In addition, many patients receiving antithrombotic therapy for thrombotic disease may develop COVID-19, which can have implications for choice, dosing, and laboratory monitoring of antithrombotic therapy. Moreover, during a time with much focus on COVID-19, it is critical to consider how to optimize the available technology to care for patients without COVID-19 who have thrombotic disease. Herein, we review the current understanding of the pathogenesis, epidemiology, management and outcomes of patients with COVID-19 who develop venous or arterial thrombosis, and of those with preexisting thrombotic disease who develop COVID-19, or those who need prevention or care for their thrombotic disease during the COVID-19 pandemic.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155446/1/Bikdeli-2020-COVID-19 and Thrombotic or Thromb.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155446/3/DeepBluepermissions_agreement-CCBYandCCBY-NC_ORCID_Barnes.docxhttps://deepblue.lib.umich.edu/bitstream/2027.42/155446/4/license_rdf.rdfDescription of Bikdeli-2020-COVID-19 and Thrombotic or Thromb.pdf : ArticleDescription of DeepBluepermissions_agreement-CCBYandCCBY-NC_ORCID_Barnes.docx : Deep Blue sharing agreemen