Acute myocardial infarction complicated by cardiogenic shock: an algorithm based ECMO program can improve clinical outcomes.

Objective: Extracorporeal membrane oxygenation (ECMO) in our institution resulted in near total mortality prior to the establishment of an algorithm-based program in July 2010. We hypothesized that an algorithm based ECMO program improves the outcome of patients with acute myocardial infarction complicated with cardiogenic shock. Methods: Between March 2003 and July 2013, 29 patients underwent emergent catheterization for acute myocardial infarction due to left main or proximal left anterior descending artery occlusion complicated with cardiogenic shock (defined as systolic blood pressure \u3c 90mmHg despite multiple inotropes, +- balloon pump, lactic acidosis). Of 29 patients, 15 patients were before July 2010 (Group 1, old program), 14 patients were after July 2010 (Group 2, new program). Results: There were no significant differences in the baseline characteristics, including age, sex, coronary risk factors and left ventricular ejection fraction, between the two groups. Cardiopulmonary resuscitation prior to ECMO was performed in 2 cases (13%) in Group 1 and 4 cases (29%) in Group 2. ECMO support was performed in 1 case (6.7%) in Group 1 and 6 cases (43%) in Group 2. The 30-day survival of Group 1 vs. Group 2 was 40% vs. 79% (p = 0.03), and one-year survival rate was 20% vs. 56% (p=0.01). The survival rate for patients who underwent ECMO was 0% in Group 1 vs. 83% in Group 2 (p = 0.09). In Group 2, the mean duration on ECMO was 9.8 ± 5.9 days. Of the 6 patients who required ECMO in Group 2, 100% were successfully weaned off ECMO or were bridged to ventricular assist device implantation. Conclusions: Initiation of an algorithm based ECMO program improved the outcomes in patients with acute myocardial infarction complicated by cardiogenic shock

The impact of a new ECMO program on clinical outcomes of patients with acute myocardial infarction complicated by cardiogenic shock.

Objective: To investigate if a new ECMO program will improve the outcome of patients who had acute myocardial infarction complicated with cardiogenic shock. Presented 24th Annual ELSO Conference. Philadelphia, PA. Sep 19-21, 2013

Racial Disparities in Transcatheter and Surgical Aortic Valve Replacement

Background Transcatheter and surgical aortic valve replacement (TAVR, SAVR) is disproportionately distributed across racial and ethnicity groups.1, 2 Nationally, 87-91% of individuals undergoing AVR are White, despite making up approximately 60% of the US population.1-4 Jefferson’s AVR demographic data is consistent with national trends. Further studies have found that zip codes associated with lower socioeconomic status (SES) have lower rates of TAVR.5 Although this disparity is widely recognized, there lacks understanding of contributing factors and potential interventions. Project Aim: Investigate additional demographic data of Thomas Jefferson University Hospital (TJUH) patients undergoing TAVR to isolate targets for future intervention

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Appropriateness of TAVR in the Chronic Liver Patient Undergoing Liver Transplant Evaluation

As the indications for Transcatheter Aortic Valve Replacement (TAVR) continue to expand, understanding appropriate patient selection is becoming an area of growing interest. The presence of Liver cirrhosis has been previously proven to increase perioperative morbidity and mortality in patients undergoing general surgical procedures. However, there is limited research articulating clinical outcomes in TAVR patients with known liver disease who are actively undergoing orthotopic liver transplant evaluation (OLT).https://jdc.jefferson.edu/cardiologyposters/1001/thumbnail.jp

Seeing Is Believing: Optical Computed Tomography (OCT) and Histologic Analysis To Define Pathophysiology Of “Very”, Very Late Stent Thrombosis Occurring More Than 7 Years After Drug Eluting Stent Implantation

Case Presentation 58-year-old male with prior non-ST elevation MI with PCI performed using a sirolimus eluting stent placed in a large OM1 branch 86 months prior presented with five hours chest pain similar to prior MI \u3e7 years earlier. Additional history of hypertension, hyperlipidemia, non-compliance with antiplatelet therapy and active tobacco abuse at time of presentation. Patient reported self-discontinuation of medications (aspirin (time unknown), statin, beta blocker) and resumed smoking. Clopidogrel was discontinued by his primary physician 97 days prior to presentation Initial electrocardiogram revealed a lateral ST elevation MI and the patient was taken to the cardiac catheterization lab for urgent coronary angiography

Underutilization of Statins and Aspirin Following Coronary Artery Bypass Graft Surgery

Introduction Coronary artery bypass graft (CABG) surgery continues to be an important procedure for the treatment of coronary artery disease. However, clinically significant stenoses and complete bypass graft occlusion rates remain high, especially among saphenous vein grafts1. This is associated with significant morbidity and mortality. Both statin medications and aspirin have been shown in numerous clinical trials to play an important role in the medical management of coronary artery disease following CABG surgery. As per the ACC/AHA guidelines, both statin medications and aspirin have class I indications to support their use indefinitely following CABG, unless contraindication exists2. Long term studies evaluating statin and aspirin usage rates following CABG procedures are lacking. Purpose The goal of this study was to assess the usage rates of statins and aspirin in post-CABG patients undergoing coronary angiograms. Further analysis was done to assess the clinical and laboratory differences among the populations based on medication usage group

Genetic analysis of over 1 million people identifies 535 new loci associated with blood pressure traits

High blood pressure is a highly heritable and modifiable risk factor for cardiovascular disease. We report the largest genetic association study of blood pressure traits (systolic, diastolic and pulse pressure) to date in over 1 million people of European ancestry. We identify 535 novel blood pressure loci that not only offer new biological insights into blood pressure regulation but also highlight shared genetic architecture between blood pressure and lifestyle exposures. Our findings identify new biological pathways for blood pressure regulation with potential for improved cardiovascular disease prevention in the future

Hard color-singlet exchange in dijet events in proton-proton collisions at s=\sqrt{s} = 13 TeV

International audienceEvents where the two leading jets are separated by a pseudorapidity interval devoid of particle activity, known as jet-gap-jet events, are studied in proton-proton collisions at $\sqrt{s} =$ 13 TeV. The signature is expected from hard color-singlet exchange. Each of the highest transverse momentum ($p_\mathrm{T}$) jets must have $p_\mathrm{T}^\text{jet}$$\gt$ 40 GeV and pseudorapidity 1.4 $\lt$$|\eta^\text{jet}|$$\lt$ 4.7, with $\eta^\text{jet1} \eta^\text{jet2}$$\lt$ 0, where $\text{jet1}$ and $\text{jet2}$ are the leading and subleading jets in $p_\mathrm{T}$, respectively. The analysis is based on data collected by the CMS and TOTEM experiments during a low luminosity, high-$\beta^*$ run at the CERN LHC in 2015, with an integrated luminosity of 0.66 pb$^{-1}$. Events with a low number of charged particles with $p_\mathrm{T}$$\gt$ 0.2 GeV in the interval $|\eta|$$\lt$ 1 between the jets are observed in excess of calculations that assume only color-exchange. The fraction of events produced via color-singlet exchange, $f_\text{CSE}$, is measured as a function of $p_\mathrm{T}^\text{jet2}$, the pseudorapidity difference between the two leading jets, and the azimuthal angular separation between the two leading jets. The fraction $f_\text{CSE}$ has values of 0.4-1.0%. The results are compared with previous measurements and with predictions from perturbative quantum chromodynamics. In addition, the first study of jet-gap-jet events detected in association with an intact proton using a subsample of events with an integrated luminosity of 0.40 pb$^{-1}$ is presented. The intact protons are detected with the Roman pot detectors of the TOTEM experiment. The $f_\text{CSE}$ in this sample is 2.91 $\pm$ 0.70 (stat) $^{+1.08}_{-1.01}$ (syst) times larger than that for inclusive dijet production in dijets with similar kinematics