Trends Over Time in Incidence of Bicuspid Aortic Valve Patients with Thoracic Aortic Aneurysms in New York

Aim: Bicuspid aortic valve (BAV) is one of the most common congenital cardiac malformations, with increased risk for early onset thoracic aortic aneurysms (TAA). This study aims to examine the trends over time in incidence of BAV patients with TAA, given imaging advancements and increased frequency of imaging. Methods: Using administrative billing codes, this retrospective cohort study analyzed New York Statewide Planning and Research Cooperative System records from January 2007- December 2018, evaluating BAV+TAA incidence trends. Subgroups based on index admission were evaluated with a pre-identified 2014 inflection time point using an interrupted time series (ITS) analysis. Results: Using a New York State-wide billing database, 3,294 BAV and TAA first-time encounters were classified into three diagnosis-related patient sub-groups, as patients with: historical BAV + new TAA diagnoses (24.74%); new BAV + historical TAA diagnoses (27.57%); and new BAV + new TAA diagnoses (47.69%). Total BAV and TAA diagnostic incidence increased from 7.93/1,000,000 residents in 2007, to 24.75/1,000,000 residents in 2018 (overall annual rate of 17.91/1,000,000, p\u3c .001). With a pre-established 2014 inflection point, the incidence rate dramatically changed for new BAV+ new TAA patients (slope = 0.7592, 95% CI 0.2332-1.2851)

Thoracic Aortic Aneurysm Patients’ Diagnosis, Treatments, and Outcomes: The New York Experience

IMPORTANCE: Traditionally, thoracic aortic aneurysms (TAA) were diagnosed upon complications arising or post-mortem examination. Following 2014, asymptomatic new TAA diagnoses noticeably rose at increasing rates. In parallel, reductions in the rates of urgent/emergent TAA-related treatments and adverse risk-adjusted short-term outcomes were observed. OBJECTIVES: For New York State adult residents, the trends from 2005 to 2018 in new thoracic aortic aneurysm (TAA) diagnoses, surgical treatments, percutaneous treatments, and risk-adjusted outcomes were examined. DESIGN: This retrospective cohort study documented the quality of TAA care provided to New York adult residents. SETTING: Using the 2005 to 2018 New York Statewide Planning and Research Cooperative System (SPARCS) database, billing codes detected 74,118 newly diagnosed TAA patients; of these, 84.06% (n = 62,307) were non-ruptured diagnoses. PARTICIPANTS: Overall, TAA patients’ mean age was 71.00 years + 19.00 years; 62.47% were male. EXPOSURES: TAA patients’ baseline characteristics, TAA-related interventions, and adverse outcomes were reported. MAIN OUTCOMES: Trends over time were evaluated for TAA diagnosis rates, TAA surgical and percutaneous treatment rates, and adverse clinical outcomes (e.g., 30-day mortality, and 30-day readmission). RESULTS: Overall, new TAA diagnoses increased from 19.8/100,000 residents (2005) to 75.73/100,000 residents (2018); starting in 2014, a dramatic rise in detection of new non-ruptured TAA diagnoses was observed. In contrast, treatment rates decreased for surgical (19.33% in 2005 to 6.54% in 2018) and percutaneous (4.17% in 2006 to 1.53% in 2018) procedures. Comparing pre-2014 versus post-2014, TAA patients had greater chances of having an open surgery (odds ratio [OR] = 1.77; p \u3c 0.0001) or percutaneous procedure (OR = 1.79; p \u3c 0.0001). Over time, 30-day operative mortality decreased (OR = 0.94; p-value \u3c 0.0001). As an “at risk” patient sub-group, however, elderly women had very high 30-day mortality risk (OR: 1.87; p \u3c 0.0001). CONCLUSIONS: Post-2014, the New York State rates of new non-rupture TAA diagnoses radically increased; serendipitously, the TAA-related treatment and short-term adverse outcome rates decreased. Given expanded chest imaging due (in part) to new lung cancer guidelines and transcatheter aortic valve procedures, the enhanced TAA diagnosis rates post-2014 appear to have resulted in overall TAA patients’ quality of care improvements

Single Versus Multi-Center Surgeons\u27 Risk-Adjusted Mitral Valve Repair Procedural Outcomes

The purpose of this study is to explore strategies to improve mitral valve repair (MVr) outcomes. This research explores postoperative outcomes of patients undergoing MVr surgery by single center surgeons versus patients of multicenter surgeons. Specific outcomes of interest include 30-day operative mortality, major operative complications (e.g., deep sternal wound infection, permanent stroke, renal dysfunction requiring dialysis, reoperation, and prolonged ventilation), length of stay, and 30-day readmissions. In brief, the serisk-adjusted outcome rates for surgeons that perform mitral valve repair procedures will be compared for surgeons that operate at a single center [i.e. SC surgeons] versus multiple centers [i.e. MC surgeons]. The overarching study hypothesis is: H(0) There will be no difference in the risk-adjusted outcome rates between surgeons that operate at a single center [i.e. SC surgeons] versus multiple centers [i.e. MC surgeons]. Based on prior research, however, it is anticipated that single center surgeons may have superior outcomes compared to multi-center surgeons

End-Stage Acute Thoracic Aortic Care Patients’ Interventions and Two-Year Survival: the New York State Experience

BACKGROUND: Scarce US-based regional or State-specific reports exist recording the incidence, prevalence, or post-diagnosis clinical outcomes for end-stage thoracic aortic aneurysmal (TAA) disease. This retrospective cohort study of New York State (NYS) patients with newly diagnosed ruptured or dissected thoracic aortic aneurysms (TAA-RD) documents two-year follow-up after elective and emergent procedures. METHODS: Using hospital billing codes, NYS first-time TAA-RD encounters were extracted. As the primary study endpoint, the two-year composite included all-cause death, subsequent rupture or dissection, or non-elective intervention; individual composite sub-components were secondary study endpoints. Multivariable logistic regression models estimated two-year intervention and composite outcome risks. Using multivariable regression models created for the composite endpoints, post-discharge elective TAA procedural impact was evaluated. RESULTS: Of the 5,789 NYS residents identified, 49.92% reached the two-year composite endpoint with 23.98% two-year deaths. Only 1902 (32.86%) of TAA-RD patients had an index intervention. Post-discharge elective TAA interventions dramatically reduced adverse outcome risk (odds ratio [O.R.] = 0.36; 95% confidence interval [C.I.] = 0.26 - 0.51). Multivariable regression models identified patient characteristics associated with the two-year adverse composite outcome including urgent/emergent status, increased Elixhauser comorbidity score, non-rheumatic aortic regurgitation, and carotid disease. CONCLUSIONS: Nearly 50% of NYS TAA-RD patients reached the two-year adverse endpoint. Post-2014, the TAA-RD diagnosis rates increased but emergent thoracic aortic surgery rates decreased. Surprisingly, under 50% of NYS TAA-RD patients received an index admission procedure; this rate is lower than anticipated. Beyond traditional morphologic metrics, “at risk” TAA patient-characteristics were identified. Post-discharge survivors had excellent post-procedural two-year durability rates

Atrial fibrillation in mechanical circulatory support patients

Atrial fibrillation (AF) is known to be one of the most common arrhythmias noted in cardiac procedures and is frequently associated with heart failure. As frequent interventions for patients with heart failure involve implantation of mechanical circulatory assist devices (e.g., left ventricular assist devices), it is timely to review the role this arrhythmia has on adverse clinical outcomes. A comprehensive literature search was conducted for PubMed. Relevant medical subject heading (MeSH) terms used in the initial literature search include “Heart-Assist Devices”, “Extracorporeal Membrane Oxygenation”, “Atrial Fibrillation”, “Heart Failure”, “Mortality”, “Hospital Readmission”, “stroke”, “Postoperative Complications”. In this review, the relevant literature was highlighted to identify the incidence, clinical impacts, and management of AF surrounding mechanical circulatory support implantation. The incidence of AF in this mechanical circulatory support device population was similar to that of patients with other cardiac procedures (10%-40%). Moreover, in most studies, preoperative AF was not significantly associated with adverse outcomes. In contrast, however, it appears that postoperative atrial fibrillation may predispose patients to increased risk for thromboembolic events and adverse long-term outcomes

A literature review: pre-/post-operative atrial fibrillation for thoracic aortic aneurysm procedures

Atrial fibrillation (AF) is among the most frequent cardiac surgical arrhythmias documented. The global AF prevalence is estimated at over 33 million cases, with estimates ranging up to 6.1 million cases in the United States. Among cardiac surgical patients, the risk factors for new-onset post-operative AF (POAF) include Caucasian race with increased prevalence documented in older men. Due to trends of earlier thoracic aortic aneurysm (TAA) detection and treatment, it is timely to review the AF association with adverse TAA clinical outcomes. Towards this goal, a comprehensive PubMed literature review was performed. For this initial Medline literature search, the MeSH search strategy included “thoracic aortic aneurysm” and “atrial fibrillation”. Based on the pertinent articles identified, the limited literature available for preoperative TAA AF and the predictors of POAF following TAA procedures were reviewed. Given only a handful of publications addressing these pre-/post-operative AF topics were identified using this very broad initial search approach, a knowledge chasm exists–as very little is known about TAA patients with pre-operative or new-onset post-operative AF. Given the paucity of evidence-based information available, clinically relevant TAA-specific research questions have been raised to guide future TAA AF-related investigations

Morphologic Severity of Atypia Is Predictive of Lung Cancer Diagnosis

In cytologic analysis of lung nodules, specimens classified as atypia cannot be definitively diagnosed as benign or malignant. Atypia patients are typically subject to additional procedures to obtain repeat samples, thus delaying diagnosis. We evaluate morphologic categories predictive of lung cancer in atypia patients. This retrospective study stratified patients evaluated for primary lung nodules based on cytologic diagnoses. Atypia patients were further stratified based on the most severe verbiage used to describe the atypical cytology. Logistic regressions and receiver operator characteristic curves were performed. Of 129 patients with cytologic atypia, 62.8% later had cytologically or histologically confirmed lung cancer and 37.2% had benign respiratory processes. Atypia severity significantly predicted final diagnosis even while controlling for pack years and modified Herder score (p = 0.012). Pack years, atypia severity, and modified Herder score predicted final diagnosis independently and while adjusting for covariates (all p p < 0.001) alone. Patients with severe atypia may benefit from repeat sampling for cytologic confirmation within one month due to high likelihood of malignancy, while those with milder atypia may be followed clinically