Faculty Bibliography

BACKGROUND:Transcatheter aortic valve replacement (TAVR) has become a cornerstone in the management of aortic valve disease. However, delayed complications after hospital discharge and readmission remain in an issue following TAVR. We aimed to evaluate the impact of remote monitoring systems on clinical outcomes after TAVR. METHODS:All patients who underwent TAVR from September 2014 through January 2019 were included retrospectively. Additionally, all patients, clinically indicated for TAVR from 9/1/2018 through 8/30/2021, were screened, and patients who agreed were prospectively enrolled. Medtronic Care Management Service (MCMS) was used to monitor patients following TAVR after discharge (Medtronic, Minneapolis, MN). RESULTS:A total of 1078 patients were included. Among them, 843 (78.2 %) patients were discharged with MCMS (MCMS group) and 235 (21.8 %) patients were discharged without (non-MCMS group). Overall, the mean age was 81.5 years, and mean STS-PROM was 5.53 %. Baseline conduction defect was observed in 427 (39.6 %). Peripheral artery disease was more common in the MCMS group while a history of myocardial infarction was more likely seen in the non-MCMS group. After propensity-score matching, length of hospital stays was significantly shorter in the MCMS group (1.42 days vs. 1.82 days in the non-MCMS group, p < 0.001). Readmission rates and new permanent pacemaker insertion rates were similar between the two groups. All-cause mortality, 30-day and 90-day mortality were comparable between the groups. CONCLUSIONS:MCMS was easily applicable to a clinical practice and may reduce length of hospital stays in patients undergoing TAVR without increasing readmission or mortality.

BACKGROUND AND AIMS/OBJECTIVE:Systemic inflammation in cardiogenic shock is associated with increased disease severity and mortality. C-reactive protein (CRP) is a widely accessible inflammatory biomarker that may aid phenotyping and risk stratification. We evaluated the association between admission CRP and in-hospital mortality in patients with cardiogenic shock. METHODS:Using a multicentre, nationally representative database, we identified adults with a discharge diagnosis of cardiogenic shock from 2015-2023 who had CRP measured within two days of hospital admission; patients with sepsis were excluded. CRP was analysed in tertiles. Inverse probability weighting (IPW) was used to assess associations with in-hospital mortality. Secondary outcomes included ICU and hospital length of stay and total cost. RESULTS:We identified 26,525 patients; median (IQR) CRP was 18.4 mg/L (5.0-67.0 mg/L). In-hospital mortality was 28.7%, 32.7%, and 42.3% across tertiles 1-3. In-hospital mortality increased by 19% for each 50-unit increase in CRP (OR 1.19; 95% CI: 1.16-1.21, p<0.001). After IPW, tertiles 2 and 3 had higher absolute mortality risks compared with tertile 1 by 3.9% (95% CI: 2.4%-5.3%) and 12.4% (95% CI: 10.9%-13.9%), respectively (both, p<0.001). Findings were consistent in sensitivity analyses restricted to day-1 CRP measurement, primary diagnoses of heart failure or myocardial infarction, and among patients requiring early mechanical circulatory support (all, p<0.05). Median ICU and hospital stay increased significantly across tertiles (all, p<0.001), total cost was not statistically different. CONCLUSIONS:In patients with cardiogenic shock, a readily available biomarker, elevated CRP was associated with higher in-hospital mortality.

BACKGROUND:Crisis Standards of Care (CSC) may require rationing of life-sustaining resources, such as mechanical ventilation, during public health emergencies. Simulation modeling offers a scalable, transparent method to evaluate triage frameworks before implementation. While ventilator triage frameworks vary in their use of exclusion criteria, comorbidity adjustments, and reassessment frequency, few have been rigorously compared using real-world data under realistic surge conditions. Robust platforms that simulate both front-end (initiation) and back-end (reassessment or reallocation) triage are critical for evaluating clinical, operational, and ethical performance. METHODS:We developed a computational simulation platform using retrospective real-world data from intubated adults during the Spring 2020 COVID-19 surge across a large New York City health system. The simulated surge cohort included all patients mechanically ventilated between March 1 and June 30, 2020. A crisis cohort was defined as those patients receiving ventilation once 95% of the health system's pre-pandemic ventilator supply was in use. Eight CSC strategies were evaluated, including policies from New York, Pennsylvania, Maryland, Canada, two academic frameworks, a lottery-based system, and first-come first-served. Strategies varied in their use of exclusion criteria, comorbidity modifiers, reassessment intervals, and prioritization for special populations. Daily ICU census and ventilator availability were used to simulate resource strain and drive triage decision-making. Patients simulated for ventilator rationing were simulated to expire. Manual abstraction of comorbidities and structured rules for imputing missing SOFA subscores were applied uniformly. RESULTS:The platform simulated 10,000 iterations per strategy and included 2,365 intubated patients. Final analyses will be published separately. CONCLUSION:This platform provides a scalable, reproducible framework for evaluating ventilator triage strategies under pandemic-like conditions. By integrating both initial triage and serial reassessment (front- and back-end) logic, operational constraints, and clinical trajectories, it enables detailed comparisons of survival, resource utilization, and prognostic accuracy. The simulation also supports ethical evaluation by testing the practical impact of exclusion and comorbidity-based criteria. Such models can assist governments, health systems, and public health agencies in designing triage protocols that are evidence-informed, ethically defensible, and operationally feasible. This work demonstrates how computational modeling can strengthen health system preparedness and support public trust.

BACKGROUND:Chronic kidney disease (CKD) is associated with cardiovascular disease (CVD). Exceptional parental longevity protects against CVD. We examined whether exceptional parental longevity modified the associations of kidney function and kidney aging with CVD in older adults. METHODS:We used data from LonGenity (2008-2023), a cohort of Ashkenazi Jewish adults aged 65-95, comparing the offspring of parents with exceptional longevity to the offspring of parents with usual survival. Exceptional longevity was defined as living beyond 95 years. Kidney function was estimated using glomerular filtration rate (eGFR); CKD was defined as eGFR < 60 mL/min/1.73m2. Kidney aging was assessed using kidney age gap-the difference between proteomic kidney age and chronological age. Logistic and Cox regression tested associations between eGFR and kidney aging with prevalent and incident CVD, respectively. Effect modification was tested using interaction terms and stratified analyses. RESULTS:Among 1180 participants (mean age 76 ± 7 years), 23% had CKD; median kidney age gap was -0.04 years (IQR: -0.67, 0.66); 15% had baseline CVD. eGFR and kidney aging were associated with prevalent CVD, but not incident CVD. Exceptional parental longevity did not modify the association of eGFR with prevalent or incident CVD. However, it did modify the association of kidney age gap with incident, but not prevalent, CVD. In the offspring of parents with exceptional longevity, higher kidney age gap was associated with increased incident CVD hazard (HR: 1.90; 95% CI: 1.23, 2.94), but not in the offspring of parents with usual survival (HR: 0.79 95% CI: 0.59, 1.05). CONCLUSIONS:Kidney age gap may reflect early CVD risk in biologically resilient populations, thus warranting prospective studies.

This multinational cone-beam computed tomography (CBCT) study evaluated the root canal morphology of mandibular first premolars (M1Ps) from 21 countries and compared how well the Ahmed and Vertucci classification systems represented these patterns. A total of bilateral mandibular first premolars from eligible CBCT scans were assessed using both systems, and the data were analyzed with a hierarchical probabilistic approach to account for population and imaging-related variation. Across the overall dataset, a simple single-canal configuration was the dominant pattern, and this remained the most common finding in all populations despite limited but structured variation in less frequent subclasses. The Ahmed system classified all observed configurations, whereas the Vertucci system left approximately 10.2% of cases without an equivalent category. In addition, Ahmed preserved more anatomical detail, while Vertucci compressed several distinct configurations into broader groups. Demographic and imaging-related factors had modest effects, with voxel size showing the clearest technical influence on the detection of more complex patterns. Overall, M1P morphology showed a stable global pattern with secondary heterogeneity, and the Ahmed system provided a more complete and informative representation for CBCT-based morphology assessment across diverse populations.

BACKGROUND/UNASSIGNED:Recent observational studies have suggested that early treatment (<12 hours from diagnosis) of intermediate risk pulmonary embolism (PE) with catheter-based therapies may reduce morbidity and mortality. However, the effect of early versus late mechanical thrombectomy on acute pulmonary hemodynamics and right ventricular mechanics is less well defined. METHODS/UNASSIGNED:Patients enrolled in SYMPHONY-PE were divided into one of 2 groups based on the time from baseline CT pulmonary angiography to mechanical thrombectomy: Early <12 hours versus late ≥12 hours. The primary safety end point was the rate of major adverse events within 48 hours, as adjudicated by an academic independent safety board. The primary efficacy end point was the core-lab assessed mean change in right ventricle-to-left ventricle ratio from baseline to 48 hours. RESULTS/UNASSIGNED:=0.431) between groups, and there were no mortalities. The differences in efficacy outcomes were greatest in higher-risk patients per the Composite Pulmonary Embolism Shock score. CONCLUSIONS/UNASSIGNED:Early mechanical thrombectomy was associated with larger reductions in right ventricle-to-left ventricle ratio and mean pulmonary artery pressure, with no significant differences in safety event rates compared with patients who underwent late thrombectomy. Randomized trials are needed to test these associations. REGISTRATION/UNASSIGNED:URL: https://www.clinicaltrials.gov; Unique identifier: NCT06062329.

The American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Evidence-based methodology is used, with a MEDLINE literature search to identify pertinent clinical studies on the topic and a MAUDE (U.S. Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported adverse events of a given technology. Both are supplemented by accessing the "related articles" feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but in many cases, data from randomized, controlled trials are lacking. In such cases, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. Technology Status Evaluation Reports are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the committee as a whole, and approved by the Governing Board of the ASGE. When financial guidance is indicated, the most recent coding data and list prices at the time of publication are provided. For this review, the MEDLINE database was searched through August 2024 for articles related to endoscopic submucosal dissection. Technology Status Evaluation Reports are scientific reviews provided solely for educational and informational purposes. Technology Status Evaluation Reports are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment.