Longer Length Research Articles

Multistage closure of a congenital extrahepatic portosystemic shunt

BackgroundCongenital extrahepatic portosystemic shunts (CEPS) are rare shunts connecting the extrahepatic portal system with the inferior vena cava. Shunt dimensions and the risk of portal hypertension determines the closure strategy. Endovascular treatment is indicated for single stage occlusion of longer length shunts, whereas the remaining shunt types are preferentially surgically occluded. Herein we describe the technical details of a novel endovascular treatment for short length CEPS.Case presentationA 15-years-old male with a short length CEPS complicated with multinodular liver disease was submitted to a multistage closure, as indicated by the high portal pressure values during shunt balloon occlusion venography. Initially a transjugular intrahepatic portosystemic shunt (TIPS) was created and the CEPS occluded with an atrial septal defect occluder. In a second procedure the TIPS was embolized with a flow reductor stent and an amplatzer vascular plug II. At a 1 year follow up the liver nodules size reduced, the patient remains asymptomatic, and the shunt adequately closed.ConclusionThis paper outlines the potential use of a TIPS and an atrial septal defect occluder combination in complex CEPS, supporting its usage as an alternative to the standard surgical treatment.Level of Evidence: Level 4, Case report.

The cognitive level does not interfere with recovery after robot-assisted gait training in traumatic brain injury: A 10-year cohort study

BACKGROUND: There is still no clear evidence available on the role of robot-assisted gait training (RAGT) in severe traumatic brain injury (TBI) and on the relationship between this intervention and cognitive impairment. OBJECTIVE: This study investigates the impact of the cognitive level at admission on functional recovery in a cohort of patients with severe TBI who received RAGT training within a multidisciplinary rehabilitation setting. METHODS: We included patients with gait disturbance due to a severe TBI. Patients were grouped into three classes according to their level of cognitive functioning (LCF) at admission (LCF 2-3; LCF 4-5-6; LCF 7-8). We collected demographics (sex, age), clinical data, and a set of outcome measures at admission and discharge. RESULTS: We registered 80 patients, 19 females and 61 males, 35.3 ± 14.85 years. Patients with a low cognitive level at admission were mostly subacute (p= 0.001). Cognitive impairment despite longer length stay in the hospital (LOS) (p= 0.001) did not preclude recovery after RAGT in terms of cognition (R2= 0.68; p< 0.0001), functional independence (R2= 0.30; p< 0.0001) and overall disability (R2= 0.32; p< 0.0001). CONCLUSION: Irrespective of their level of cognition, patients with severe TBI might benefit from RAGT during a multidisciplinary program.

Abstract 11234: The Impact of Median Yearly Income on Structural Heart Disease Procedural Outcomes

Introduction: The association of socioeconomic status with health outcomes is well known. This study used zip codes as a surrogate for income and compared outcomes post-procedure and at 6 and 12 months following TAVR at an urban hospital. Methods: We performed a retrospective study on patients undergoing TAVR at the University of Illinois-Chicago(UIC) in Chicago, Illinois between March 2018 and June 2020. Using income data from the US Census Bureau, patients were placed into 2 groups: zip codes with a median income less than the national urban mean income of $54,296 (LMI) and greater than the average urban mean yearly income (GMI).Primary outcomes included composite MACE (CV death, MI and/or CVA), length of stay, and all-cause death. Secondary outcomes included CHF exacerbation, and repeat revascularization. Outcomes were analyzed at hospital discharge, 6 months and 12 months. T and Chi square tests were used to analyze continuous/categorical variables, respectively. Results: We analyzed 114 patients, 84 patients were categorized as LMI and 30 patients were categorized as GMI. 94.3% of the LMI group was Black, while only 62% of the GMI group was Black. Age and gender distributions were similar between groups. Initial post procedural outcomes showed no statistical difference between the LMI and GMI. The LMI group trended towards a longer length of stay than the GMI group (p=0.1). A history of heart failure was greater in the LMI group (p = 0.025). At 6 months there was a lower repeat revascularization rate in the LMI group compared to the GMI group (0% vs. 1.8%, p = 0.017). However, other outcomes including composite MACE (9.6% vs. 1.8%, p=0.3) and all cause death (6.1% vs. 0.9%p=0.4) were statistically similar. At 12 months only 112 patients had recorded outcomes. At this time, repeat revascularization was still significantly different (0% vs. 2.6%, p = 0.005) but all other outcomes remained nonsignificant. Results: Post TAVR, patients in the GMI group experienced a higher rate of repeat coronary revascularization as compared to the LMI group, although, the composite event rate was similar. Further investigation into this observation is warranted; however, overall outcomes between patients from poorer communities seems to be similar to wealthier communities.

Abstract 14036: Post Transcatheter Aortic Valve Replacement (TAVR) Electrophysiologic (EP) Study Trends and Its Implication on Permanent Pacemaker (PPM) Implantation Rate: Insights From National Inpatient Sample Database

Introduction: High-risk conduction (HRC) disorders are frequently encountered post transcatheter aortic valve replacement (TAVR). There is a robust expert consensus statement about the management of such patients (e.g.performance of an electrophysiology (EP) study). Yet, it is unclear what the real-world practices are and how they might be influencing outcomes. Hypothesis: Accordingly, we sought to study the trends and implications of EP study post TAVR on the PPM implantation rate. Methods: The National Inpatient Sample (2011-2018) database was queried, using ICD-9 and ICD-10 codes, for individuals who underwent a TAVR procedure. Patients with a history of PPM were excluded. Outcomes of interest were postprocedural EP study, PPM implantation, mortality, and other non-cardiac complications. Logistic and linear regression models were employed to study hospital outcomes. Results: A total of 1,95162 (median age 82 yrs, 47.9% female) underwent TAVR. HRC abnormality and CHB were seen in 19.5% and 11 % of patients, respectively. A total of 12.1% had PPM implantation post-procedure, and 0.77% had an EP study during the same hospitalization. Of all PPM implantations, 2% underwent a prior EP study. Among patients with HRC features (N=33,381), the odds of receiving a PPM were ~3 higher (OR [95% CI] =2.74 [1.92, 3.90], p<0.0001) in those who underwent an EP study (vs. no EP study). Among patients with CHB (N=21,324), there was a 60% (OR [95% CI] =0.39 [0.23, 0.67], p=0.001) decrease in PPM implantation rate in those who underwent an EP study (vs. no EP study). EP study was associated with a longer length of stay (p<0.001) and higher hospital charges (p=0.001) with no difference in mortality rates (p=0.16). The yearly trend of EP study and PPM implantation is shown in figure 1. Conclusions: Depending on the type of conduction disorder, EP study has a significant and variable influence on the rate of PPM implantation post TAVR. The clinical implication of such impact needs further studies.

Abstract 13609: Impact of Frailty on Hospital-Related Outcomes of Elective Left Atrial Appendage Closure

Introduction: Atrial fibrillation as the most common arrhythmia worldwide results in a significantly elevated risk of cardioembolic stroke. Left atrial appendage (LAA) closure has been advocated and supported by randomized clinical trials as an alternative treatment in patients with atrial fibrillation who have contraindications for anticoagulation. The safety of this procedure in patients who are considered frail remains unknown since they have been underrepresented in most clinical studies. Our study aims to investigate the impact of frailty on hospital-related outcomes in patients undergoing elective LAA closure. Methods: We reviewed the National Inpatient Sample database from January 2016 to December 2017 to identify patients that underwent elective percutaneous LAA closure using the ICD-10 code 02L73DK for the procedure. Frailty was defined using the Johns Hopkins Adjusted Clinical Groups (ACG) frailty-defining diagnoses indicator. An individual is considered frail if they present >=1 diagnosis within the indicator. The outcomes include in-hospital mortality, hemorrhage requiring blood transfusion, respiratory failure, sepsis, length of stay, and total hospitalization cost. Multivariate logistic or linear regression was adopted to determine the impact of frailty on the outcomes while reducing the effect of possible confounding baseline characteristics. Results: From the period of January 2016 to December 2017, a total of 14795 patients underwent elective LAA closure. Of those patients, 830 were determined to meet the criteria for frailty, while 13965 were considered non-frail. The frail group is older than the non-frail group with a mean age of 78.77 years old than 75.53 years old. Frailty was associated with an increased risk of hemorrhage requiring transfusion (odds ratio 2.82, p=0.030) and a longer length of stay (2.10 vs 1.30 days, p=0.003). The frail group appears to have higher hospitalization costs, but the result was not statistically significant ($122668.2 vs $114295.3, p=0.091). Conclusions: The presence of frailty was associated with an increased risk of hemorrhage requiring transfusion and a longer length of hospital stay after elective left atrial appendage closure.

Abstract 13415: Initial Diuretic Dosing and Length of Stay in Patients Hospitalized for Congestive Heart Failure

Background: Among patients hospitalized for heart failure, a prior randomized trial suggests the initial dose of diuretics may have implications on time to decongestion and length of hospital stay. Little is known about the dosing of intravenous loop diuretics in routine clinical practice and the association between diuretic dosing and hospital length of stay. Methods: We identified 12,209 patients admitted with heart failure at 12 Allina Health hospitals in central Minnesota and western Wisconsin between January 1, 2017 and December 31, 2020. We excluded patients on observational status, no or unknown home loop diuretic dosing, no intravenous loop diuretic within 24 hours of admission, and patients who received inotropes or dialysis within 24 hours of admission. Initial diuretic dose was compared to home dose in furosemide equivalents using the Diuretic Strategies in Patients with Acute Decompensated Heart Failure trial logic and categorized into below home dose, equivalent to home dose, or above home dose. We describe patient characteristics and length of stay by category of initial diuretic dose. Results: Among 3,580 admitted for heart failure, initial diuretic dose was below home dose in 555 (15%) patients, equivalent to home dose in 756 (21%) patients, and above home dose in 2269 (64%) patients. Baseline characteristics by category of initial diuretic dose are presented in the Table. Mean length of stay was longest in patients receiving a diuretic dose that was below home dose (6.4 days) and shortest in patients receiving a dose above home equivalent (5.0 days) (Table). Conclusions: In a cohort of patients admitted for heart failure, more than 1 in 3 patients received an initial dose of intravenous loop diuretics that was equivalent to or below their home diuretic dose and this was associated with a longer length of hospital stay. These findings may represent a quality improvement opportunity in the care of patients hospitalized for heart failure.

Abstract 11740: Outcomes of Durable Left Ventricular Assist Device Implantation in Patients With End Stage Renal Diseases- Latest Outcomes From Nationwide Inpatient Sample (2015-2018)

Introduction: Left ventricular assist devices (LVAD) improve survival in patients with advanced heart failure however their use in patients with concomitant end stage renal disease (ESRD) is limited. Previous studies demonstrate higher mortality and morbidity in this subset of patients. Our aim was to assess in-hospital outcomes in patients who undergo LVAD implantation with and without ESRD in a national cohort. Methods: Using Nationwide Inpatient Sample (NIS) for years 2015-2018, all patients who underwent LVAD implantation during the hospitalization were identified. Cohort was divided into two groups, with and without ESRD. Baseline characteristics, comorbidities, in-hospital outcomes were compared between both the groups. Statistical significance was assigned at p<0.05. Analysis was performed using STATA. Results: A total of 7185 patients underwent LVAD implantation between 2015-2018. 150 patients (2.09%) had ESRD at baseline. Despite having similar baseline characteristics and comorbidities in both groups (Table 1), the in-hospital mortality was significantly higher in patients with ESRD (43.33% vs 7.46% p-value: 0.001). Similarly, patients in ESRD group had longer length of stay (92.56 ±11.6 days vs a 33.72±0.73 days, p=0.001) and their cost of stay was also significantly higher ($2,179,827 vs $915,699, p=0.001). After multivariable analysis, ESRD remained an independent predictor of inpatient mortality (OR: 3.68, 95% CI (1.06-12.6), p=0.03). The bleeding, infectious and thromboembolic outcomes (Table 2) were also significantly higher in patients with ESRD undergoing LVAD implantation. Conclusions: Patients who are ESRD and receive LVAD during their admission are at higher risk of mortality, bleeding, infectious and thromboembolic events. More studies are required to improve management strategies and identify specific subgroup of patients who would benefit from LVAD implantation in this subset.

Abstract 12973: Intra-Procedural Change in Platelet Occlusion Time to Predict Hemodynamic and Clinical Outcomes Following Transcatheter Aortic Valve Replacement

Background and Objectives: Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement for the therapeutic treatment of severe aortic stenosis. However, intraprocedural hemodynamic assessment by echocardiography is not always optimal and new tools are needed. A new approach using the blood biomarker measuring platelet occlusion time (CT-ADP) and more specifically its change between the pre-intervention and post-intervention (ΔCT-ADP) could be useful to overcome the lack of accuracy of echocardiography, but also to prevent adverse clinical events following TAVI. The objective of this study is to examine the association between ΔCT-ADP and i) intraprocedural valve hemodynamic performance; and ii) occurrence of all-cause death and rehospitalization for heart failure (HF) in TAVI patients. Methods: Three hundred and thirty-eight patients who underwent TAVI at our institute were recruited. Clinical and echocardiographic data were collected before and after the procedure. Two blood samples were collected prior to- and at the end of- TAVI to assess the immediate changes (Δ: pre minus post) in CT-ADP following TAVI. A percentage (Δ/pre-intervention value) was determined for CT-ADP and mean gradient (MG) for each patient. Results: Prior to TAVI, 135(40.0%) patients had a prolonged CT-ADP (>180 s). There was a significant but modest correlation between ΔCT-ADP and the change in mean transvalvular gradient immediately after TAVI (r=0.15, p=0.007). A ΔCT-ADP (i.e. decrease) >10% (i.e. median of cohort) was associated with a higher rate of transcatheter valve regurgitation ≥ moderate (0.0% vs 3.0%, p=0.030) following TAVI, and a longer length of hospital stay (7.8±8.3 vs. 9.7±9.0 days, p=0.002). During a median follow-up of 1.2 (1.0-2.4) years, there were 87 clinical events (30 rehospitalizations and 57 deaths). A ΔCT-ADP >10% tended toward higher risk of events in univariable analysis (HR[95%CI]: 1.49[0.94-2.37], p=0.090), but not after adjustment for other risk factors (HR[95%CI]: 1.10[0.53-2.28], p=0.79). Conclusion: A >10% decrease in CT-ADP immediately after TAVI is associated with worse hemodynamic outcomes. This association is not independent and appears to be related to other risk factors.

Abstract 13638: Protein Calorie Malnutrition is an Adverse Prognostic Marker in Atrial Fibrillation Patients: An Analysis of the National Inpatient Sample Registry

Introduction: Protein Calorie Malnutrition (PCM) is not thought to be associated with atrial fibrillation (AF). Some research has stipulated that overweight AF patients may have a better prognosis than those with normal weight, however, the interaction between poor nutritional status and AF has not been well explored. Dyselectrolytemias secondary to malnutrition could confer a poor prognosis in AF patients. We aimed to assess the impact of PCM on outcomes in patients admitted with AF. Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample from 2017. About 412,159 hospitalizations who had AF as their primary diagnosis were identified and stratified based on the presence of PCM using ICD-10 codes. Multivariate regression analysis was used to adjust for confounders and to analyze the variables. The selection of covariates was done with a univariate screen and literature review. Results: Out of the 412,159 hospitalized patients with AF, 11,590 individuals had PCM. In-hospital mortality in AF patients with PCM were significantly higher than those without (4.62% vs 0.77%); p<0.0001. When adjusted for patient demographics, comorbidities, and hospital characteristics, AF patients with PCM had a higher risk of mortality (aOR=3.45, p<0.0001), cardiac arrest (aOR=2.41, p<0.0001), PE (aOR=2.06, p<0.0001), sepsis (aOR=4.72, p<0.0001), pneumonia (aOR=2.25, p<0.0001), AKI (aOR=1.41, p<0.0001), acute respiratory failure (ARF) (aOR=1.81, p=0.011), and being intubated (aOR=1.45, p=0.019). When adjusted similarly, AF patients with PCM had longer length of stay (LOS) by 2.76 days (mean LOS: 6.61 vs 3.25 days) (p<0.0001) and an additional hospital cost (HC) of $18,373 (mean HC: $62,093 vs $39,934) (p<0.0001). However, there was no difference in the risk of developing stroke (aOR=1.23, p=0.26) in AF patients with PCM. Conclusions: AF patients with PCM had worse outcomes in terms of in-hospital mortality, LOS, HC, cardiac arrest, PE, sepsis, pneumonia, AKI, ARF, and being intubated compared to those without PCM. This suggests that PCM is an adverse prognostic marker in this population. Current limitations include the underrepresentation of metabolic derangements due to inadequate coding within this administrative database.

Tracheostomy decannulation outcomes in 131 consecutive neurosurgical patients

Objectives This study was a retrospective study to investigate factors related to difficult tracheostomy decannulation, and to evaluate outcomes of tracheostomized neurosurgical patients. Methods All consecutive tracheostomized neurosurgical patients in the Prince of Wales Hospital between 1st September 2016 and 31st August 2019 were reviewed retrospectively. Patients were grouped into easy decannulation and difficult decannulation groups using 3 months as cut-off time. Risk factors were analysed and outcomes were compared. Results One hundred thirty-one patients were included. In univariate analyses, male gender, GCS less than or equal to 8 on admission, the presence of vocal cord palsy at 3 months, and pneumonia within 1-month post-tracheostomy were associated with difficult decannulation. In multivariable logistic regression for difficult decannulation, GCS on admission, the presence of vocal cord palsy at 3 months, and the presence of pneumonia within 1-month post-tracheostomy remained statistically significant. The easy decannulation group had a shorter length of in-patient stay, higher survival rate, and more favourable neurological outcome (GOS 4–5) than the difficult decannulation group at both 6 months and 1 year. The majority of easy decannulation group patients (54%) were discharged to home, while the majority of the difficult decannulation group (42%) of patients were discharged to the infirmary. Conclusion GCS less than or equal to 8 on admission, the presence of vocal cord palsy, and the presence of pneumonia were associated with difficult tracheostomy decannulation in neurosurgical patients. Difficult decannulation is associated with a longer length of in-patient stay and poor neurological outcomes.

Spatiotemporal Dynamic Assembly/Disassembly of Organelle-Mimics Based on Intrinsically Disordered Protein-Polymer Conjugates.

Design of reversible organelle‐like microcompartments formed by liquid–liquid phase separation in cell‐mimicking entities has significantly advanced the bottom‐up construction of artificial eukaryotic cells. However, organizing the formation of artificial organelle architectures in a spatiotemporal manner within complex primitive compartments remains scarcely explored. In this work, thermoresponsive hybrid polypeptide‐polymer conjugates are rationally engineered and synthesized, resulting from the conjugation of an intrinsically disordered synthetic protein (IDP), namely elastin‐like polypeptide, and synthetic polymers (poly(ethylene glycol) and dextran) that are widely used as macromolecular crowding agents. Cell‐like constructs are built using droplet‐based microfluidics that are filled with such bioconjugates and an artificial cytoplasm system that is composed of specific polymers conjugated to the IDP. The distinct spatial organizations of two polypeptide‐polymer conjugates and the dynamic assembly and disassembly of polypeptide‐polymer coacervate droplets in response to temperature are studied in the cytomimetic protocells. Furthermore, a monoblock IDP with longer length is concurrently included with bioconjugates individually inside cytomimetic compartments. Both bioconjugates exhibit an identical surfactant‐like property, compartmentalizing the monoblock IDP coacervates via temperature control. These findings lay the foundation for developing hierarchically structured synthetic cells with interior organelle‐like structures which could be designed to localize in desired phase‐separated subcompartments.

Bridging Recovery Initiative Despite Gaps in Entry (BRIDGE): study protocol for a randomized controlled trial of a bridge clinic compared with usual care for patients with opioid use disorder

BackgroundPatients with substance use disorders are overrepresented among general hospital inpatients, and their admissions are associated with longer lengths of stay and increased readmission rates. Amid the national opioid crisis, increased attention has been given to the integration of addiction with routine medical care in order to better engage such patients and minimize fragmentation of care. General hospital addiction consultation services and transitional, hospital-based “bridge” clinics have emerged as potential solutions. We designed the Bridging Recovery Initiative Despite Gaps in Entry (BRIDGE) trial to determine if these clinics are superior to usual care for these patients.MethodsThis single-center, pragmatic, randomized controlled clinical trial is enrolling hospitalized patients with opioid use disorder (OUD) who are initiating medication for OUD (MOUD) in consultation with the addiction consult service. Patients are randomized for referral to a co-located, transitional, multidisciplinary bridge clinic or to usual care, with the assignment probability being determined by clinic capacity. The primary endpoint is hospital length of stay. Secondary endpoints include quality of life, linkage to care, self-reported buprenorphine or naltrexone fills, rate of known recurrent opioid use, readmission rates, and costs. Implementation endpoints include willingness to be referred to the bridge clinic, attendance rates among those referred, and reasons why patients were not eligible for referral. The main analysis will use an intent-to-treat approach with full covariate adjustment.DiscussionThis ongoing pragmatic trial will provide evidence on the effectiveness of proactive linkage to a bridge clinic intervention for hospitalized patients with OUD initiating evidence-based pharmacotherapy in consultation with the addiction consult service.Trial registrationClinicalTrials.govNCT04084392. Registered on 10 September 2019. The study has been approved by the Vanderbilt Institutional Review Board. The current approved protocol is dated version May 12, 2021.

Predictors of Short-Term Mortality Following First Episode of Spontaneous Bacterial Peritonitis in Hospitalized Cirrhotic Patients.

Background and aimsSpontaneous bacterial peritonitis (SBP) is an important cause of morbidity and mortality in patients with cirrhosis. This study aimed to identify the factors impacting morbidity and short-term mortality in a cohort of patients with cirrhosis following an index episode of SBP.MethodsIn a retrospective study of hospitalized cirrhotic cohort, 333 patient records were reviewed. Demographic, clinical, and laboratory, as well as radiological characteristics of the patient population were analyzed on day 1 of admission. The diagnosis of cirrhosis was based on the combination of laboratory, clinical, and radiological features. The diagnosis of SBP was established by abdominal paracentesis in the presence of cellular, biochemical, and microbiological features consistent with SBP. All independent variables were analyzed to generate a predictive model of mortality by using the Cox proportional hazards regression analysis (adjusted for age and gender).ResultsA total of 61 cirrhotic patients with ascites and a first episode of SBP were identified. The overall mortality among hospitalized patients was 19.7% and was associated with longer length of stay (12.6 vs. 7.6 days; p=0.01). Patient cohorts with multiple antibiotic resistant bacteria as a cause of SBP had a significantly higher mortality compared to those with other bacterial phenotypes (p=0.03). Multivariate analyses showed that a model for end-stage liver disease (MELD) score (hazard ratio [HR]=1.29; 95% CI: 1.10 to 1.92; p=0.023), Child-Turcotte-Pugh score (HR=1.23; 95% CI: 1.05 to 1.82; p=0.027), and acute kidney injury (HR=2.09; 95% CI: 1.41 to 3.47; p=0.01) were the predictors of mortality from SBP.ConclusionSBP predicts in-hospital mortality in cirrhotic patients. In addition to multiple antibiotic resistant bacteria, thresholds of both hepatic and renal injury independently predict adverse outcomes.

Lung ultrasound can predict heart failure developing and mortality during hospitalization in ST-segment elevation myocardial infarction

Abstract Introduction About 10% of patients admitted for ST-segment elevation myocardial infarction (STEMI) present with signs of heart failure at admission. Heart failure developed during hospitalization and mortality are uncommon complications in patients admitted for STEMI with no signs of heart failure at admission (Killip-Kimball class I, KKI). Most of these patients have a good prognosis during hospitalization. B-lines in lung ultrasound (LUS) provide useful diagnostic and prognostic information in heart failure patients with the potential to stratify the risk of complications in patients presenting with STEMI KKI. Purpose To evaluate the predictive value of the LUS to develop heart failure and death during hospitalization in patients admitted with STEMI KKI. Methods This is a prospective observational multicenter study. Consecutive patients admitted for STEMI KKI in two tertiary hospitals were included. Exclusion criteria were patients with cardiac arrest at presentation, severe lung disease or hemodialysis. The LUS was carried out by an independent operator blinded to clinical data in the first 24 hours after admission. We counted B-lines using 8-scan site LUS protocol and divided patients in two groups: wet lung group (3 or more B-lines in at least one zone) and dry lung (no positive zone). The primary endpoint was a composite of clinical congestive heart failure, cardiogenic shock or mortality during the index hospitalization. Results From June 2020 to February 2021, 135 patients STEMI KKI patients were included. Twenty-nine patients (21,5%) had a wet lung according to the LUS. Ten patients (7,4%) presented the primary outcome (all of them developed heart failure, 1 of them cardiogenic shock and 2 of them died during hospitalization). Eight in 29 wet-lung patients (27,6%) presented the primary outcome whereas only 2 in 106 (1,9%) of the dry-lung patients [relative risk of 14,6 (IC 95% 3,3–65,1)]. Patients who develop the primary outcome had no differences in NTproBNP at admission but had higher NTproBNP peak, higher troponin T peak, lower left ventricular ejection fraction and longer length of stay (Figure 1). Conclusions In patients admitted with STEMI KKI, presenting 3 or more B-lines at least at one lung zone in the LUS at first 24 hours after admission was strongly associated with worse prognosis during hospitalization. LUS allows a better risk classification of patients and may potentially discriminate those with potential risk of complications during hospitalization from those with an excellent prognosis who can benefit from early discharge. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): 2020 grant for training and research of the Association of Ischemic Heart Disease and Critical Cardiological Care, Spanish Society of Cardiology Figure 1. Baseline data in event/no event groupsFigure 2. Wet lung/dry lung groups events graphic

Racial disparities in renal outcomes of pulmonary hypertension hospitalizations: analysis of 2016 to 2018 National Inpatient Sample

Abstract Background Although the prevalence of pulmonary hypertension among black and white individuals are similar, black individuals have been reported to have worse prognosis. However, data on renal outcomes and racial disparities in pulmonary hypertension patients are extremely limited. Purpose To investigate the racial differences in acute renal failure outcome of pulmonary hypertension hospitalizations. Methods We queried 2016–2018 National Inpatient Sample (NIS) database to identify pulmonary hypertension patients using appropriate ICD-10 codes. Race variable in the database was used to categorize pulmonary hypertension patients into Blacks and Others groups (Whites, Hispanics, Asian or Pacific Islanders). We used Chi-square test to evaluate the difference between binary variable, and Student's t- test for differences between continuous variables. Multivariate logistic regression was used in outcomes analysis to adjust for potential hospital and patient level confounders. Results Among the total 1,362,765 pulmonary hypertension patients across three years, 68% (906,994) were Whites, 18.9% (251,530) were Blacks, 7.8% (104,169) Hispanics and 2% (30,139) Asian or Pacific Islanders. Blacks with pulmonary hypertension were younger (mean age, 64.1 vs. 73.1 years; p<0.01), more females (57.4% vs. 42.5%; p<0.01), higher prevalence of diabetes (47.2% vs. 39.9%; p<0.01), systolic heart failure (31.2% vs. 25.1%; p<0.01), chronic kidney disease (43.2% vs. 36.4%; p<0.01), end-stage renal disease (17.1% vs. 6.8%; p<0.01), obesity, obstructive sleep apnea and anemia compared to Other races. After adjusting for hospital and patient level confounders including above mentioned comorbidities, Blacks had higher odds of acute renal failure compared to Others [Adjusted Odds ratio: 1.15 (1.11 – 1.18); p<0.01]. Blacks with pulmonary hypertension were also associated with unadjusted longer length of stay (7.0 vs. 6.4 days; p<0.01) and similar total hospitalization charges (USD: $78,408 vs. $80,076; p=0.18) compared to Others. Conclusions Racial minorities are underrepresented among patients with pulmonary hypertension. Blacks with pulmonary hypertension have higher co-morbidity and are associated with worse in-hospital renal outcomes compared to other races. They are also associated with longer length of stay. Vigilant renal functions monitoring, and early nephrologists involvement are needed during hospitalization to prevent worse renal outcomes in this patient population. Funding Acknowledgement Type of funding sources: None.

Short- and intermediate-term mortality in women and men after surgical versus interventional revascularization and aortic valve replacement

Abstract Background Patients with isolated aortic valve stenosis (AS) at intermediate and even low-risk benefit from an interventional treatment with TAVI as compared to surgical aortic valve replacement. Whether patients with concomitant coronary artery disease have a better outcome with an interventional (PCI plus TAVI) or surgical (CABG plus SAVR) treatment strategy is still unclear. Purpose To evaluate the differences in 30-days (short-term) and one-year (intermediate term) mortality in women and men with CAD and AS undergoing a surgical or catheter-based treatment. Methods All patients were treated in Heart and Diabetes Center Bad Oeynhausen during 2016–2019. The surgical group contained 932 patients, the interventional cohort 360 patients as a result of setting a maximum time interval of 3 months between PCI and TAVR. CABG+SAVR and PCI+TAVR cohorts were compared by using a propensity score analysis including age, left ventricular function, EuroSCORE II and degree of CAD as matching parameters. After matching the total cohort, 406 patients could be obtained. The matched female cohort consisted of 114 patients, the matched male cohort of 284 patients. As a primary endpoint all-cause mortality was analyzed at 30 days and one year after the procedure. Furthermore, procedural and post-procedural outcome were analyzed. Results The studied TAVI cohort was a low to intermediate risk population (EuroScore II of the total cohort: 3.82 [2.49–6.64] in CABG+SAVR vs 4.36 [2.59–7.12] in PCI+TAVR, p=0.38; women: 6.18 [3.43–8.6], p=0.279; men: 4.39 [2.83–8.82], p=0.279). There was no significant difference in 30-days mortality between the surgical and interventional group, regarding the total cohort (3.9% vs 2.5%; p=0.398). Whereas in the male cohort 30-days mortality was comparable between interventional and surgical treatment (2.1% vs 2.1%; p=1), in the female group the surgical treatment showed a trend towards higher mortality without reaching statistical significance (8.8% vs 3.5%; p=0.242). Additionally, one-year mortality did not differ in the three cohorts between CABG+SAVR and PCI+TAVR (total cohort: 11.3% vs 12.8%; p=0.648 women: 14% vs 10.5%; p=0.568; men: 11.3% vs 14.8%; p=0.378). The number of postprocedural permanent pacemaker implantations was statistically higher after TAVR plus PCI (total cohort: 7.4% vs 15.3%; p=0.012; women: 7% vs 19.3%; p=0.052; men: 8.5% vs 19%; p=0.01). Furthermore, a significantly longer length of hospital stay was reported for the surgical cohort (total cohort: 13 [11–17] vs 11 [9–15]; p=0; women: 14 [12–18] vs 12 [10.5–15.5]; p=0.019; men: 13 [11–15] vs 11 [9–15]; p=0). Conclusion In patients with AS and CAD there is no significant difference in short and intermediate term mortality when comparing surgical or interventional treatment. Subsequently, an interventional approach might be a legitimate alternative to CABG+SAVR in these patients. Funding Acknowledgement Type of funding sources: None.

Simulation of melting and solidification of graphene nanoparticles-PCM inside a dual tube heat exchanger with extended surface

In this research, the charging and discharging processes of nano-phase change material (nano-PCM) CaCl2.6H2O containing Graphene nanoparticles in a two-dimensional circular enclosure are simulated. The enclosure consists of two concentric circles so that the inner circle has a high temperature (charging mode) and low temperature (discharging mode), and the outer one is insulated. Twelve rectangular blades are placed on the walls of the inner circle with the same temperature as the wall temperature. By changing the length from 0 to 1.5 mm in the process of charging and discharging of nano-PCM, the values ​​of Nusselt number, percentage of changed phase, melting and freezing contours, etc., are studied. COMSOL Multiphysics 5.5 software and finite element method were employed for the simulations and the melting front was simulated using the enthalpy method. The results demonstrate that using a blade with a longer length causes the enclosure temperature to be higher in the charging mode and lower in the freezing state than the case without blades mode at the same time. Adding a blade with a length of 1.5 to the enclosure causes the Nusselt number to enhance by 252% in 100 s and to decrease by 87% in 1000 s in charging mode, while the Nusselt number is reduced by 94% and is enhanced by 115% at the same times, respectively, in the discharging process. An increase in the blade length causes the amount of molten nano-PCM to enhance in the charging mode and the amount of frozen nano-PCM to increase in the discharging state. Also, using an enclosure with a longer blade length makes the charging and discharging processes take place faster.

Delirium and Long-Term Outcomes among Survivors of Extracorporeal Membrane Oxygenation Therapy: A Nationwide Cohort Study in South Korea

Background: The prevalence of delirium and its association with long-term outcomes of extracorporeal membrane oxygenation (ECMO) therapy have not yet been identified. We aimed to investigate the prevalence of delirium and its associated factors during hospitalization among ECMO survivors. We also examined whether the occurrence of delirium was associated with 1-year all-cause mortality among ECMO survivors. Methods: As a population-based cohort study, data were obtained from the National Health Insurance Service database in South Korea. Adults older than 18 years who received ECMO therapy between 2005 and 2018 were included in this study. ECMO survivors were defined as patients who were discharged from the hospital. Results: The analysis included a total of 8153 ECMO survivors, of whom 551 (6.8%) experienced delirium during hospitalization. Older age (odds ratio [OR]: 1.01, 95% confidence interval [CI]: 1.00-1.02; P = 0.004), male sex (OR: 1.38, 95% CI: 1.13-1.68; P = 0.002), underlying depression (OR: 1.90, 95% CI: 1.49-2.41; P < 0.001), and longer length of hospital stay (OR: 1.02, 95% CI: 1.02-1.03; P < 0.001) were associated with a higher incidence of delirium. In multivariable Cox regression modeling, the occurrence of delirium was not significantly associated with the risk of 1-year all-cause mortality (hazard ratio: 0.90, 95% CI: 0.76-1.07; P = 0.229). Conclusion: The prevalence of delirium among ECMO survivors during hospitalization was 6.8% in South Korea, and old age, male sex, longer duration of hospital stay, and underlying depression were associated with it. However, there was no significant association between delirium and 1-year all-cause mortality among ECMO survivors.

Effect of the Base-Pair Sequence on B-DNA Thermal Conductivity.

The thermal conductivity of double-stranded (ds) B-DNA was systematically investigated using classical molecular dynamics (MD) simulations. The effect of changing the base pair (bp) on the thermal conductivity of dsDNA needed investigation at a molecular level. Hence, four sequences, viz., poly(A), poly(G), poly(CG), and poly(AT), were initially analyzed in this work. First, the length of these sequences was varied from 4 to 40 bp at 300 K, and the respective thermal conductivity (κ) was computed. Second, the temperature-dependent thermal conductivities between 100 and 400 K were obtained in 50 K steps at 28 bp length. The Müller-Plathe reverse nonequilibrium molecular dynamics (RNEMD) was employed to set a thermal gradient and obtain all thermal conductivities in this work. Moreover, mixed sequences using AT and CG sequences, namely, A(CG)nT (n = 3-7), ACGC(AT)mGCGT (m = 0-5), and ACGC(AT)nAGCGT (n = 1-4), were investigated based on the hypothesis that these sequences could be better thermoelectrics. One-dimensional lattices are said to have diverging thermal conductivities at longer lengths, which violate the Fourier law. These follow the power law, where κ ∝ Lβ. At longer lengths, the exponent β needs to satisfy the condition β > 1/3 for divergent thermal conductivity. We find no such significant Fourier law violation through divergence of thermal conductivities at 80 bp lengths or 40 bp lengths. Also, in the case of the second study, the presence of short (m ≤ 2) encapsulated AT sequences within CG sequences shows an increasing trend. These results are important for engineering DNA-based thermal devices.

672 OESOPHAGOGASTRIC ANASTOMOTIC LEAK IN THE THORAX TREATED WITH COVERED METAL STENTS: SAFE AND HIGHLY SUCCESSFUL

Abstract Anastomotic leak (AL) develops in 5–22% of cases following oesophagectomy, and results in additional morbidity, and reduction in overall survival. The management of AL has evolved significantly with advances in endoscopic therapies. Covered cylindrical metal stents have been increasingly used, and insertion techniques have improved over time. We aimed to investigate the effectiveness and safety of modern metal stents in the management of AL. Methods All patients who underwent oesophagectomy with thoracic anastomosis between 2006–2020, and subsequently developed AL were retrospectively identified. Initially, treatment details and patient outcomes were assessed for the subgroup of patients where the AL was initially managed using a stent. In all cases, these were cylindrical covered metal stents. Those patients that progressed to surgery after treatment with a stent were then excluded, with the remainder compared to the subgroup of patients that underwent conservative (i.e., non-interventional) treatment for AL. Results Of 63 patients with AL, primary management was with stents in 32 (57%). Technical success was achieved in all stenting procedures, although three patients (9%) developed complications (stent migration). After stenting, six cases (19%) subsequently required escalation to operative management (thoracotomy). The remainder (N = 23) were then compared to those managed conservatively (N = 26) and were found to have a significantly longer length of hospital stay (median: 37 vs. 20 days, p = 0.003). The AL healing rate was 96% in both groups (p = 1.000); one conservatively managed patient died before healing, and one stented patient refused further treatment. Conclusion Endoscopic treatment of oesophageal AL with cylindrical covered metal stents is safe, with a high technical success rate, and low rates of stent-related morbidity. Treatment with stents also avoids the need for operative management including oesophageal disconnection in the majority of cases, whilst leading to successful healing of the AL. However, treatment with stents does significantly increase hospital stay over conservative management, particularly where multiple procedures are required.