Downeykaufman2934

There are no criteria to estimate the risk of early discharge after anatomic lung resection (ALR). We hypothesized that demographic, clinical, and surgical variables could be used to predict successful post-operative day 1 (POD1) discharge after ALR.

Patients with POD1 discharge after ALR were identified in the STS database from 2012-2018. Discharges were categorized as "successful" based on freedom from complications, readmission, or death. A multivariable model identified variables from univariate analysis and was further optimized using stepwise selection. This model was used to create a risk-score of success.

Among 62,785 patients who underwent ALR, 2,480 (3.9%) were discharged on POD1. 2,129/2,480 (85.8%) had successful discharge and 351/2,480 patients (14.2%) had failed discharge, due to postoperative complication (282/2,480 (11.3%)), readmission (151/2,480 (6.1%)), or death (9/2,489 (0.4%)). In univariable analysis, successful POD1 discharge was associated with younger age, female sex, VATS, highnt to facilitate decisions regarding appropriateness of POD1 discharge.

Malnourishment is associated with poor outcomes following Lung Transplant (LTx). Validated screening tools for patients awaiting lung transplants are needed. We assessed the association of Nutritional Risk Index (NRI) with outcomes following LTx.

We categorized adult patients (age>18) undergoing incident LTx in the Scientific Registry of Transplant Recipients between 2005-2018 (N=13,392) according to NRI categories of malnutrition none≥100, mild97.5 -<100, moderate83.5-<97.5, or severe<83.5. We used Cox models to characterize the association of NRI categories with all-cause mortality within 5 years, graft failure within 1 year, and length of stay. In a subset (N=11,634), we used logistic regression to assess the association of NRI with airway dehiscence, re-intubation, and chest tube placement.

Of the 13,392 LTx recipients (mean age 55.0, 58.6% male) in the study, the most common indication for transplant was idiopathic pulmonary fibrosis (36.2%), followed by COPD (27.3%) and cystic fibrosisished, 12.4% mildly, 25.9% moderately, and 7.2% severely malnourished. 5-year mortality was higher among those with severe malnutrition (44.6%) compared to those who were non-malnourished (38.9%). Severe malnourishment remained significantly associated with higher mortality risk, with adjustment for covariates (HR 1.47, 95% CI 1.26, 1.58). The length of stay was significantly longer among patients with severe malnutrition (median 15 days) compared to non-malnourished recipients (median 18 days). This persisted after adjustment for covariates (severe malnutrition HR 0.85, 95% CI 0.79, 0.91) CONCLUSIONS NRI prior to transplant is an independent predictor of post-operative mortality and morbidity in lung transplant patients.

This study evaluated hepatic stiffness by shear wave elastography (SWE) to investigate subclinical hepatic changes in a cohort of congenital biventricular heart disease (BHD).

BHD patients and age-matched healthy controls were prospectively recruited for hepatic US and SWE. Real-time B-mode imaging with Doppler was performed for celiac axis, superior mesenteric artery (SMA), and main portal vein (MPV) and hepatic SWE was assessed. Vascular Doppler indices included peak velocities, velocity time integral, resistive, pulsatility, acceleration indices (RI, PI, AI), and portal vein volumetric flow. One-way ANOVA was used for comparisons between controls, BHD, and a cohort of Glenn and Fontan patients.

In all, 66 subjects were included. Thirty-six subjects were in BHD group (male - 25; female - 11; mean age 27.4 ± 4.6 years; mean weight 76.8 ± 18.5 kg), and 30 were normal controls (male - 11; female - 23, mean age 27.4 + 3.8 years; mean weight 70.0 + 17.2 kg). SWE was increased in BHD (8.11 ± 2.07 kPa) compared to controls (5.44 ± 1.18 kPa; P < 0.0001). Hepatic stiffness in BHD was significantly different from that in the Fontan cohort but not the Glenn cohort.

Increased hepatic stiffness was observed in young adults with repaired BHD. Although cause is not established, possibilities include hepatic congestion early in life and/or elevated central venous pressures due to right heart burden. Further research is required to determine if these patients will ultimately suffer from clinically relevant liver disease.

Increased hepatic stiffness was observed in young adults with repaired BHD. Although cause is not established, possibilities include hepatic congestion early in life and/or elevated central venous pressures due to right heart burden. Bufalin Further research is required to determine if these patients will ultimately suffer from clinically relevant liver disease.

Advancements in technology have changed the treatment of aortic arch pathologies. Specifically, the introduction of the frozen elephant trunk technique has allowed one-stage treatment of pathologies that would have otherwise required a two-stage procedure. We present the early outcomes of a novel frozen elephant hybrid stent-graft.

Between August 2015 and July 2019, 39 patients (56% male, mean age= 67±11years) underwent an arch reconstruction with a novel hybrid stent-graft in 4 different Canadian centers. The most common indication for surgery was arch aneurysm (31%) followed by acute dissection (28%). All patients were prospectively followed with clinical and imaging assessments.

The device was successfully implanted in all patients. There were 3 perioperative deaths (8%). Transient spinal cord injury occurred in 5 patients (13%); all had complete neurologic recovery before discharge. Seven patients had a perioperative stroke/TIA; 3 of them initially presented with cerebral malperfusion caused by acute dissection. One patient died during the study follow-up. Survival at 30 days, 1 and 3 years was 92±5%, 89±5% and 89±5%, respectively. At a median follow-up of 16 months, three patients required a reintervention to address a type I distal endoleak and 1 patient was treated for a type II endoleak. There was no arch anastomosis complications.

The Cook hybrid stent-graft device provides encouraging mid-term results in a high-risk cohort. This novel graft is simple to deploy, may be customized to patients' anatomy in elective cases, eases arch reconstruction and allows versatility in the choice of arch grafts.

The Cook hybrid stent-graft device provides encouraging mid-term results in a high-risk cohort. This novel graft is simple to deploy, may be customized to patients' anatomy in elective cases, eases arch reconstruction and allows versatility in the choice of arch grafts.