Faculty Bibliography

Objective: Endoaortic balloon occlusion, or endoclamping, facilitates cardioplegic arrest during minimally invasive surgery (MIS). Limited research has shown endoclamping to be as safe as traditional aortic clamping. This study compares outcomes after cardiac surgery utilizing endoclamping as compared with traditional methods of aortic occlusion in a broader, real-world setting.
Method(s): 52,882 adults undergoing eligible cardiac surgery (10/2015-3/2020) were identified by administrative data from the Premier Hospital Dataset. Endoclamp MIS procedures (n=419) were 1:3 propensity score matched to similar procedures performed using traditional aortic occlusion methods (primarily external clamping, n=1244). Comparison procedures were selected by procedure type, and absence of: known sternotomy (a proxy for MIS), CABG, or concomitant aortic surgery. Generalized linear modeling measured differences in in-hospital complications [major adverse renal and cardiac events (MARCE, including mortality, new onset atrial fibrillation, acute kidney injury, myocardial infarction, postcardiotomy syndrome, stroke/TIA) and aortic dissection], and length of stay.
Result(s): Mean age was 63 years, and 53% were male (n=882). The majority (93%, n=1543) were mitral valve procedures and the remainder were atrial septal defect, left atrial appendage occlusion and/or tricuspid valve procedures. 1 in 6 (17%, n=285) procedures were robotic-assisted and 1% (n=20) were re-operations at the same index hospital. The endoclamp group exhibited lower MARCE rates as compared to the comparison external clamping group, with borderline difference at P<0.10: 22% vs. 26% (odds ratio (OR)=0.78, P=0.0611). Lower MARCE rates appeared to be driven largely by myocardial infarction (OR=0.14, P=0.0061) and postcardiotomy syndrome (OR=0.27, P=0.0051). No endoclamp patients experienced aortic dissection. Rates of mortality, atrial fibrillation, acute kidney injury and stroke/TIA were not significantly different between the 2 groups. Median length of stay was significantly shorter with endoclamping vs. external clamping methods (incident rate ratio=0.87, P=<0.0001).
Conclusion(s): Endoclamping was associated with shorter hospital stays, no dissections and comparable low mortality and stroke rates when compared to traditional external clamping techniques in this hospital billing dataset. These results demonstrate the clinical safety and efficacy of endoclamping in a real-world setting. Further studies are warranted. (Table Presented)

Background: Sarcoidosis is a granulomatous disease involving intrathoracic and extrathoracic organs. Genetic and environmental factors, such as exposure to World-Trade Center (WTC) dust after 9/11, may play a role in clinical presentation. Characterization of sarcoidosis in community members with exposure to the WTC dust can provide further insight into the relationship between environmental exposure and sarcoidosis. Methods: Patients with documented sarcoidosis were identified in the WTC Environmental Health Center (EHC), a treatment program for community members. Demographic and clinical data were collected from standardized questionnaires and chart review. Organ involvement was assessed with a standard instrument. Results: Among patients in the WTC EHC, 87 were identified with sarcoidosis after 9/11. Sarcoidosis cases were more likely African-American, local workers, and had more respiratory symptoms, compared with non-sarcoidosis WTC EHC patients. Many (46%) had ≥ Scadding stage 3 on chest imaging, and had reduced lung function measures. Extrathoracic involvement was identified in 33/87 (38%) with a diversity of organs involved. Conclusions: WTC-exposed sarcoidosis in community members is often characterized by severe pulmonary disease and a high rate of diverse extrathoracic involvement. Further analysis is required to characterize the course of disease progression or resolution.

Antithrombotic therapy for stroke prevention in patients with atrial fibrillation (AF) has dramatically shifted from warfarin, a vitamin K antagonist, to the direct oral anticoagulants (DOACs) such as dabigatran, apixaban, and rivaroxaban. In patients with contraindications to oral anticoagulation, left atrial appendage occlusion (LAAO) devices, such as the Watchmanâ„¢ device, may be considered; however, temporary postimplantation antithrombotic therapy is still a recommended practice. We present a case of complex antithrombotic management, post LAAO device implantation, designed to avoid drug interactions with concomitant rifampin use and remained necessary secondary to subsequent device leak. This case highlights the challenges of antithrombotic therapy post LAAO device placement in a complex, but representative, patient.