Faculty Bibliography

OBJECTIVE/UNASSIGNED:Endoaortic balloon occlusion facilitates cardioplegic arrest during minimally invasive surgery (MIS). Studies have shown endoclamping to be as safe as traditional aortic clamping. We compared outcomes and hospital costs of endoclamping versus external aortic occlusion in a large administrative database. METHODS/UNASSIGNED:= 1,244). Generalized linear modeling measured differences in in-hospital complications (major adverse renal and cardiac events, including mortality, new-onset atrial fibrillation, acute kidney injury [AKI], myocardial infarction [MI], postcardiotomy syndrome, stroke/transient ischemic attack [TIA], and aortic dissection) and length of stay (LOS). RESULTS/UNASSIGNED:= 0.005). There were no aortic dissections in the endoclamp group. CONCLUSIONS/UNASSIGNED:Aortic endoclamping in MIS was associated with similar costs, shorter LOS, no dissections, and comparably low mortality and stroke rates when compared with external clamping in this hospital billing dataset. These results demonstrate the clinical safety and efficacy of endoaortic balloon clamping in a real-world setting. Further studies are warranted.

BACKGROUND/UNASSIGNED:Evidence suggests that patients critically ill with COVID-19 have a dysregulated host immune response that contributes to end-organ damage. Extracorporeal membrane oxygenation (ECMO) has been used in this population with varying degrees of success. This study was performed to evaluate the impact of ECMO on the host immunotranscriptomic response in these patients. METHODS/UNASSIGNED:Eleven patients critically ill with COVID-19 requiring ECMO underwent an analysis of cytokines and immunotranscriptomic pathways before ECMO (T1), after ECMO for 24 hours (T2), and 2 hours after ECMO decannulation (T3). A Multiplex Human Cytokine panel was used to identify cytokine changes, and immunotranscriptomic changes in peripheral leukocytes were evaluated by PAXgene and NanoString nCounter. RESULTS/UNASSIGNED:, which code for binding ligands for the activation of toll-like receptors 2 and 4. Reactome analyses of differential gene expression demonstrated an impact on many of the body's most important immune inflammatory pathways. CONCLUSIONS/UNASSIGNED:These findings suggest a temporal impact of ECMO on the host immunotranscriptomic response in patients critically ill with COVID-19.

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:Our objective was to report the incidence, management, and outcomes of patients who developed a secondary pneumothorax while admitted for coronavirus disease 2019 (COVID-19). METHODS:A single-institution, retrospective review of patients admitted for COVID-19 with a diagnosis of pneumothorax between March 1, 2020, and April 30, 2020, was performed. The primary assessment was the incidence of pneumothorax. Secondarily, we analyzed clinical outcomes of patients requiring tube thoracostomy, including those requiring operative intervention. RESULTS:From March 1, 2020, to April 30, 2020, 118 of 1595 patients (7.4%) admitted for COVID-19 developed a pneumothorax. Of these, 92 (5.8%) required tube thoracostomy drainage for a median of 12 days (interquartile range 5-25 days). The majority of patients (95 of 118, 80.5%) were on mechanical ventilation at the time of pneumothorax, 17 (14.4%) were iatrogenic, and 25 patients (21.2%) demonstrated tension physiology. Placement of a large-bore chest tube (20 F or greater) was associated with fewer tube-related complications than a small-bore tube (14 F or less) (14 vs 26 events, P = .011). Six patients with pneumothorax (5.1%) required operative management for a persistent alveolar-pleural fistula. In patients with pneumothorax, median hospital stay was 36 days (interquartile range 20-63 days) and in-hospital mortality was significantly higher than for those without pneumothorax (58% vs 13%, P < .001). CONCLUSIONS:The incidence of secondary pneumothorax in patients admitted for COVID-19 is 7.4%, most commonly occurring in patients requiring mechanical ventilation, and is associated with an in-hospital mortality rate of 58%. Placement of large-bore chest tubes is associated with fewer complications than small-bore tubes.