Single-center Retrospective Cohort Study Research Articles

Extracorporeal membrane oxygenation (ECMO) is an infrequently utilized, resource intensive life-sustaining therapy used in critically ill children, and frequently those with congenital heart disease. However, reports on the use of ECMO pre-cardiac-surgical intervention as a bridge to an operation are limited. This study evaluated contemporary outcomes in patients supported with ECMO prior to an index cardiac surgical intervention. This is a single center retrospective cohort study from a pediatric quaternary care hospital evaluating demographic and clinical characteristics associated with mortality in a cohort of patients requiring ECMO support as a bridge to an index cardiac surgical intervention. The primary outcome was survival to hospital discharge. Over the 13-year study period there were 37 ECMO runs prior to an index cardiothoracic surgical procedure, representing 6.6% (37/547) of ECMO runs and 0.3% (37/12440) cardiac-surgical admissions in pediatric patients. No clinical covariates were statistically associated with the need for ECMO post a surgical intervention. However, the need for post-operative ECMO was associated with 2.5 times greater risk of mortality with multivariable logistic regression showing the need for post-operative ECMO to be an independent predictor of mortality. Diagnostic category was also important with specific cardiac diagnoses associated with improved survival. The need for ECMO to rescue a clinical decompensation prior to an index cardiac surgical interventions is a rare scenario with diagnosis-specific considerations, the potential for surgical correction of the underlying pathophysiology, and successful immediate post-operative decannulation being key determinants of survival in this population.

ABSTRACT Background Despite successful recanalization rates exceeding 85% with mechanical thrombectomy, approximately half of acute ischemic stroke patients with large vessel occlusion experience futile recanalization—vessel reopening without meaningful functional recovery. Better predictive frameworks are needed. Methods We conducted a retrospective cohort study of 283 consecutive patients with large vessel occlusion stroke who achieved successful recanalization (mTICI ≥2b) between December 2022 and December 2023. The primary endpoint was futile recanalization, defined as modified Rankin Scale >3 at 90 days. Multivariable logistic regression identified independent predictors, while ROC analysis determined optimal cutoff values. Results Among 283 patients (mean age 67.2 ± 12.8 years, 54.4% male), 189 (66.8%) experienced futile recanalization. Independent predictors included advanced age (adjusted OR 1.048, 95% CI 1.021–1.076, p = 0.001), higher baseline NIHSS score (adjusted OR 1.132, 95% CI 1.078–1.189, p < 0.001), and antibiotic requirement during hospitalization (adjusted OR 2.891, 95% CI 1.587–5.267, p < 0.001). Antibiotics were initiated at median 3 days [IQR 2–5] post-admission. Optimal cutoff values were age > 68.5 years and NIHSS > 21.5. The predictive model demonstrated excellent discrimination (AUC 0.883, 95% CI 0.840–0.926) and good calibration (Hosmer-Lemeshow p = 0.287). Conclusions Advanced age, severe baseline neurological deficit, and systemic infectious complications independently predict futile recanalization following mechanical thrombectomy. These findings provide a clinically applicable framework for risk stratification, treatment optimization, and prognostic counseling in acute stroke care.

Familial multiple sclerosis (MS), defined by the occurrence of MS in one or more relatives, is thought to represent a genetically influenced subtype of the disease. To compare clinical progression, cerebrospinal fluid (CSF) parameters, and treatment responses between familial and sporadic MS patients. We conducted a retrospective analysis of 1,035 patients diagnosed with MS according to the 2017 McDonald criteria (523 familial, 512 sporadic). Demographic variables, MS subtypes, expanded disability status scale (EDSS) scores, CSF oligoclonal band (OCB) status, IgG index, and treatment regimens were evaluated. Statistical tests included t tests, chi-square, and multivariable regression. Familial MS patients showed a higher incidence of secondary progressive MS (10.9%) compared to sporadic cases (7.0%, p = 0.030). Disease duration was significantly longer in familial MS (14.5 vs. 12.3years, p < 0.01) though time to diagnosis did not differ. OCB positivity rates were comparable, but the IgG index was significantly elevated in familial MS (p < 0.01). Treatment responses did not differ between groups. Familial MS is associated with more rapid disease progression and enhanced humoral immune activation, suggesting a distinct phenotype. These findings support the need for genetic and immunologic investigations to guide personalized treatment strategies.

To evaluate and compare outcomes of single- and double-fenestrated physician-modified endovascular grafts (PMEGs) for aortic arch pathologies treated in an emergent setting. All patients consecutively treated for an emergent aortic arch pathology were included in this retrospective single-center cohort study between July 2014 and March 2023. In each case, the distal smaller fenestration for the left subclavian artery (LSA) was the only 1 stented. For a double-fenestrated endograft, a proximal larger fenestration that incorporated both the brachiocephalic trunk and the left common carotid artery was added. A total of 86 patients with complicated aortic arch lesions were treated, with 74% being men and a mean age of 68 years. Of these, 63% underwent single LSA fenestration, while 37% had double-fenestrated thoracic endovascular aortic repair. The main indications for repair included acute complicated type B aortic dissection (TBAD) (54%), traumatic transection of the aorta (TTA) (19%), and other conditions such as penetrating aortic ulcer (PAU), degenerative aneurysm (DA), pseudoaneurysm (PSA), and aortic thrombus. The technical success rate was 91%, with modification times of 10 minutes for single fenestration and 23 minutes for double fenestration. Thirty-day mortality was 19%, with no significant difference between the 2 fenestration types. Neurologic events occurred in 3 patients (3%), and 3 (3%) patients had perioperative retrograde dissection. Endoleaks occurred in 5% (type 1) and 2% (type 3), with no type 2 endoleaks. Eight patients (9%) required reintervention, and all supra-aortic trunks remained patent. During a follow-up of 27.6 months, no patients experienced aortic rupture (AR), neurological events, or required conversion to open surgery. Single and double PMEGs are suitable and reproducible treatment for emergent serious aortic arch lesions, with comparable outcomes whatever the aortic landing zone and number of fenestrations.Clinical ImpactFenestrated physician-modified endovascular grafts for emergent aortic arch repair appear to be a promising treatment, offering reproducibility, rapid deployment, and limited manipulation of supra-aortic trunks. The standardized technique eliminates the need for complex sizing and benefits from consistent aortic arch anatomy in most patients. It provides clinicians with a practical and efficient option in emergency settings, achieving high technical success with acceptable complication rates.

The Dexcom G7 continuous glucose monitor is labeled for 10 days of wear. We assessed the real-world duration of Dexcom G7 sensor wear in youth with type 1 diabetes (T1D) in this single-center retrospective cohort study. Median duration of sensor wear was calculated for youth using ≥3 sensors over a 93-day period (May 13, 2024, to August 13, 2024). Overall, 643 unique individuals (15.1 years, 45.1% female, 66.3% non-Hispanic White, 60.2% privately insured, 4.9 years T1D duration) wore 5055 sensors over the 93 days. The median sensor wear time was 8.6 days (interquartile range 7.3, 9.6). Wear time was <7.0 days for 24.8% of sensors, and just 39.9% of sensors were worn for ≥10.0 days. In summary, the real-world duration of Dexcom G7 sensor wear is <10 days for most youth with T1D. Whereas people with diabetes typically receive 36 sensors per year, with a median wear time of 8.6 days, youth would require 43 sensors or more to allow for continuous use.

Aneurysm Risk Index as a Novel Method to Evaluate Abdominal Aortic Aneurysms: A Proof-of-Concept Study.

Background The Controlled Nutritional Status (CONUT) metric has demonstrated effectiveness as a prognostic indicator for acute and chronic diseases in addition to other wasting conditions. However, its association with sarcopenia in elderly hospitalized patients remains insufficiently explored. Our study objectives included the assessment of the potential of CONUT score to predict sarcopenia onset. Methods Our study was a single center retrospective cohort study. Patients from the Department of Geriatrics of the First People’s Hospital of Kunshan were recruited for this study. Multiple indicators related to nutrition and sarcopenia, including CONUT, Prognostic Nutritional Index (PNI), triglyceride–total cholesterol–body weight index (TCBI), Geriatric Nutritional Risk Index (GNRI), and handgrip strength (HGS). Spearman’s and Pearson’s correlation were calculated to assess the associations between nutritional indices and sarcopenia-related indicators. The demographic characteristics, physical examination findings and laboratory parameters were included in univariate logistic regression. Based on the results of univariate logistic regression and theoretical analysis, variables were selected for multivariate logistic regression in order to identify risk factors for sarcopenia. Results A total of 236 elderly hospitalized patients were included. Malnutrition was prevalent in patients with sarcopenia. The optimal CONUT cut-off values were defined as &amp;gt;4 for males and &amp;gt;3 for females, dividing patients into high CONUT ( n = 140, 59.32%) and low CONUT ( n = 96, 40.58%) groups. Patients in the high CONUT group had lower levels of albumin, prealbumin, hemoglobin, and total lymphocyte count. Multivariate logistic regression analysis showed that a high CONUT score was an independent risk factor for sarcopenia ( OR:1.814, 95% CI: 1.019–3.255, p = 0.044 ). Male sex and low iron level were also demonstrated to be associated with sarcopenia. Conclusion CONUT score is an independent risk factor for sarcopenia and may serve as a practical indicator for sarcopenia risk screening in elderly hospitalized patients.

Mechanical circulatory support with ventricular assist device (VAD) is a life-saving therapy in children with end-stage heart failure. Infections are a major problem in VAD-therapy and may lead to significant morbidity and mortality. The aim of the study was to evaluate possible risk factors for superficial percutaneous lead/canula infections (SI) and to determine their impact on overall outcome during VAD-therapy. Single center, retrospective analysis of infectious complications in 70 consecutive children supported on a VAD (58 Berlin Heart EXCOR Pediatric pulsatile flow pump and 12 Heartware continuous flow pump). Cox proportional hazard models with SI, bloodstream infections, and stroke as outcome, as well as a competing risk model for device weaning, death, and heart transplantation were used to identify risk factors in the study population. SI were documented in twelve out of 70 children (17%). The event rate for SI was 5.86 per 100 patient months [95%CI 3.03-10.23] with a median time to SI of 109 days [IQR 66-163]. The occurrence of SI was mostly in patients with longer support times while the underlying diagnosis and previous thoracotomies had no impact on the number of SI. Further, children older than three years of age had a higher risk for SI (HR 2.67; 95% CI 1.09-6.57, p = 0.032). SI were not associated with the risk of bloodstream infections (HR 1.27; 95%CI 0.44-3.67, p = 0.656) or death (HR 0.32; 95% CI 0.06-1.80, p = 0.194). SI occurred frequently during VAD therapy in children, without leading to a higher rate of bloodstream infections or mortality. Further, being above three years of age at VAD implantation was associated with increased risk to develop SI.

Background Patient-centered venous access is critical in breast cancer supportive care. While the tunnel-less axillary vein (AxV) approach for totally implantable venous access port (TIVAP) implantation may improve patient experience, comparative evidence on patient-reported outcomes (PROs) against the standard internal jugular vein (IJV) approach remains limited. Methods This single-center retrospective cohort study compared ultrasound-guided IJV (n = 106) versus AxV (n = 102) TIVAP implantation in breast cancer patients (September 2020–February 2025). Primary outcomes included postoperative comfort (assessed at 1 day) and cosmetic outcome and satisfaction (assessed at 6 months). Complications were monitored for 6 months. Group comparisons utilized chi-square/Fisher’s exact tests. To control for potential confounders, multivariable logistic regression analyses were performed, adjusting for age, body mass index, and implantation side. Complications were monitored for 6 months. Results The AxV approach significantly enhanced early postoperative comfort, with a higher rate of no discomfort (Grade 0: 72.5% vs. 59.4%, p = 0.032). At 6 months, the AxV approach demonstrated superior, favorable cosmetic outcomes (Grades 1–2: 93.1% vs. 67.9%, p &amp;lt; 0.001) and higher overall satisfaction (94.1% vs. 85.8%, p = 0.039). Multivariable analysis confirmed the AxV approach as an independent predictor for ideal comfort [adjusted odds ratio (aOR) = 4.48, p = 0.0002], favorable cosmetic outcome (aOR = 6.22, p &amp;lt; 0.001), and overall satisfaction (aOR = 3.07, p = 0.033). More AxV patients would choose the port again (83.3% vs. 72.6%, p = 0.045). The overall complication rates were comparable between groups [4.8%, 0.269/1,000 central line-days (CD) vs. 4.9%, 0.279/1,000 CD; p = 0.957]. Conclusion For breast cancer patients, the ultrasound-guided AxV approach for TIVAP provides superior early postoperative comfort, long-term cosmetic results, and patient satisfaction without increasing early complication risks, representing a significant patient-centered advancement in venous access.

Late preterm infants represent nearly a quarter of a million infants born in the United States annually. There is a known variation in admission location for these infants. The objective of this study was to identify the timing and reasons for transfer for late preterm infants requiring an escalation in care during the birth hospitalization. This single-center retrospective cohort study examined the birth hospitalization for late preterm infants (34 + 0 to 36 + 6weeks) born between 2019 and 2021, specifically focusing on infants requiring an escalation to a higher level of care. Infants with congenital anomalies expecting neonatal intensive care unit (NICU) admission were excluded. The analysis included descriptive and inferential statistics. Of 1022 infants, 150 symptomatic infants were admitted to the level III/IV NICU at birth. Of the remaining 872 infants, 14% (n = 124) received escalation of care (n = 77 from level I to II, 25 from level I to III/IV, 22 from level II to III/IV). The most common reasons for escalation were need for respiratory support (n = 32, 26%), cardiorespiratory monitoring (n = 31, 25%), thermoregulation (n = 29, 23%), and dextrose-containing intravenous fluids (n = 27, 22%). Infants required escalation of care at a median of 12.5hours after birth (IQR 4-40hours, range 0-133), with 50% (n = 62) occurring within the first 12hours and 67% (n = 83) within 24hours. Escalation of care for late preterm infants most frequently occurs in the first 24hours after birth. The most frequent reasons for escalation were the need for respiratory support, followed by cardiorespiratory monitoring and thermoregulation.

Despite dosing protocols and tight therapeutic drug monitoring (TDM), tacrolimus concentrations remain highly variable in pediatric liver transplant (LTx) recipients during the first month post-transplantation. The objective of this study was to describe weight-adjusted tacrolimus concentration-to-dose (C/D/kg) ratios and to identify physical, clinical, and laboratory parameters associated with interpatient pharmacokinetic (PK) variability in hospitalized children during the first month post-LTx. In this single-center retrospective cohort study (January 2018-October 2021), we calculated C/D/kg ratios for 36 LTx recipients aged 0-2years. Descriptive statistics and linear mixed models characterized changes in tacrolimus C/D/kg ratios over time, and we determined the percentage of concentrations within six predefined ranges (0-4, 4-6, 6-8, 8-10, 10-15, and >15μg/L). In total, 524 trough concentrations of orally administered tacrolimus were analyzed. Tacrolimus C/D/kg ratios ranged from 0.19 to 0.75, demonstrating substantial interpatient variability. Time post-transplantation, alanine aminotransferase, aspartate aminotransferase, total bilirubin, coadministration of corticosteroids, spironolactone, fluconazole, fentanyl, amlodipine, flucloxacillin, and ciprofloxacin were significantly associated with interpatient variability (P<0.05 for all). In the first week, 40.0% tacrolimus trough concentrations were below 4μg/L, and using TDM the distribution shifted towards the therapeutic mid-range (6-10μg/L). TDM of tacrolimus is often not enough to obtain the concentrations in the therapeutic range. Identifying cofounders for variability a priori is essential for guiding efficient and accurate dosing, shifting the focus from reactive TDM towards better dosing strategies that improve PK predictions and ultimately improve therapy for pediatric LTx recipients.

To delineate gestational age (GA)-dependent pathophysiology of necrotizing enterocolitis-associated intestinal perforation (NEC-IP) and establish precision management protocols. A single-center retrospective cohort study (2013-2023) included 66 preterm (< 37weeks) and 38 term (≥ 37weeks) neonates with NEC-associated perforations. Outcomes included anatomical distribution, microbiological profiles, management disparities, and prognoses. Preterm infants exhibited significantly higher rates of twin gestation (43.9% vs 7.9%, p = 0.003), antenatal steroid exposure (43.9% vs 2.6%, p < 0.001), and preoperative fasting rate (33.3% vs 7.9%, p = 0.009) compared to term infants. Preterm infants demonstrated Gram-positive bacteremia (83.3%) with Gram-negative peritoneal predominance (83.9%), alongside significantly lower leukocyte counts (Stage 2:12.6 vs 14.9 × 10⁹/L, Stage 3: 9.1 vs 11.1 × 10⁹/L, both p < 0.05), platelet levels (all stage), and hemoglobin levels (Stage 1:125.1 vs 141.6 × 1012/L, p = 0.004). Term infants showed Gram-positive peritoneal dominance (76.2%) with classic peritonitis signs (hematochezia 68.4%, abdominal tenderness 55.3%). Lleal perforations predominated in preterms (69.7% vs 21.1%, p < 0.001), whereas colonic involvement was prevalent in terms (63.1%). Prolonged parenteral nutrition in preterms (27.0 vs 20.0days, p = 0.009) correlating with prolonged hospitalization (38.4 ± 9.7 vs 23.5 ± 8.1days; p < 0.001), achieved higher enteral tolerance (151.7 vs 134.2ml/kg/d, p = 0.009). There was no case dead in initial admission. Rehospitalization and mortality rates in readmission were comparable (term 73.7 vs preterm 60.6%, p = 0.177;1% vs 2%; p = 0.653). Although weight at discharge in term group was higher compared to preterm infants (2.5 ± 0.4 vs 3.5 ± 0.6kg; p < 0.001), while weight velocity was similar between two groups (18.3 ± 7.5 vs 16.6 ± 9.6g.kg⁻1·d⁻1; p = 0.312). GA-specific NEC-IP mechanisms mandate: (1) preterm-focused ileal exploration & Gram-negative coverage, (2) term-focused retroperitoneal debridement & Gram-positive control, and (3) GA-stratified diagnostic framework integrating clinical signs and imaging. This precision approach reduces missed perforations and surgical delays.

The incompetence of the tricuspid valve (TV) may predispose to unfavorable results of Fontan palliation in patients with single right ventricle (RV). This study aims to reveal the effect of TV intervention in patients with single RV on long-term outcomes after Fontan completion. A single-center retrospective cohort study was conducted with patients who underwent Fontan completion from 1985 to 2017. There was a total of 678 patients with single RV. A total of 128 patients (18.8%) underwent TV intervention at any stage (TVI group); 30 of them (23.4%) underwent repeat TV surgery (repeat TVI subgroup). The control group comprises 550 patients (81.2%) who had no TV surgery regardless of the degree of TR (non TVI group). The median follow-up was 8.8 (± 7.6) years. Overall transplant- and Fontan takedown-free survival was 62.5% (95% CI 59.2%-64.9%) at 20 years. The repeat TVI group had significantly lower transplant and takedown-free survival rates (Non TVI 76.5% vs. Single TVI 75.3% vs. repeat TVI 56.0% at 15 years, P = 0.02). The younger age at Fontan (1.12 [95% CI 1.02-1.22], p = 0.019), repeat TVI (3.33 [95% CI 1.57-7.04], p = 0.002), TV intervention after Fontan (6.14 [95% CI 2.60-14.50], p < 0.001), significant ventricular dysfunction before Fontan (3.12 [95% CI 1.12-8.30], p = 0.028) and any concomitant procedure at Fontan (1.98 [95% CI 1.16-3.37], p = 0.013) were the significant risk factors for transplant and takedown free- survival. Repeat TV intervention during the Fontan was associated with inferior outcomesin patients with morphologic systemic RV. Successful TV intervention could provide comparable long-term survival outcomes to non-TV intervention patients.

Introduction Acute respiratory distress syndrome (ARDS) requiring veno-venous extracorporeal membrane oxygenation (vvECMO) remains associated with high mortality. Whether etiology-based differentiation within infectious ARDS improves prognostic and therapeutic precision remains unclear. This study compared vvECMO-treated ARDS patients with different pulmonary infections to identify clinically relevant etiology-specific differences. Methods The retrospective single-center cohort study included adult patients who received vvECMO for severe infectious pulmonary ARDS between 2014 and 2021. Patients were categorized into Covid-19 ( n = 48) and Non-Covid ( n = 44). Clinical parameters, disease progression, treatment, and outcomes were compared. Cox and modified Poisson regression analyses identified predictors of ICU mortality. Results Non-Covid ARDS patients had greater disease severity at ECMO initiation, although mortality was lower: SOFA score (15.7 vs. 13.7; p = 0.003); PRESERVE score (3.73 vs. 2.73; p = 0.004). In Covid-19 ARDS, age ≥60 years (RR 1.62), early SOFA score worsening (RR 1.17), new renal replacement therapy (RR 1.60), and septic shock (RR 3.33) were associated with increased mortality, whereas these factors were not predictive in Non-Covid ARDS. Red blood cell transfusion was associated with reduced mortality in both groups (HR 0.96 and 0.95), while fresh frozen plasma transfusion increased mortality exclusively in Covid-19 ARDS (HR 1.09). A rising SOFA score within 5 days after ECMO initiation predicted mortality only in the Covid-19 cohort (RR 1.17). Conclusion Even within primary infectious pulmonary ARDS, substantial heterogeneity exists. The underlying infection critically affects the prognostic value of clinical parameters, organ dysfunctions, and scoring systems in vvECMO-treated patients. Considering ARDS etiology may improve risk stratification and guide individualized therapy. Trial registration German Clinical Trials Register (DRKS00027856), https://drks.de/search/en/trial/DRKS00027856 .

To assess safety and feasibility of intrathecal chemotherapy (IC) and disease monitoring via Ommaya reservoir (OR) in routine clinical practice in patients with leptomeningeal disease (LMD). Leptomeningeal disease carries poor prognosis with an average survival of 3-6 months after diagnosis. OR are an accessible alternative to serial lumbar punctures for delivery of IC and disease monitoring in these patients but are not widely used, partially due to safety concerns. This single-center retrospective cohort study enrolled patients who received at least one administration of IC via OR for LMD between 2017 and 2022 at a tertiary academic center. Demographics, primary malignancy, treatment type, complications, adverse events and outcomes were recorded for each enrolled patient. We identified 22 patients (17 females, 5 males) with mean age 50.9 ± 14.8 years. The primary cancers were breast (12), leukemia (3), ovarian carcinoma (3), CNS lymphoma (1), urothelial carcinoma (1), spinal melanocytoma (1), and high-grade glioma (1). A total of 208 IC injections via OR were performed [median 9 OR injections per patient (interquartile range (IQR) 5-13)]. Five patients (23%) experienced mild adverse events of grade 2 or lower by Common Terminology Criteria for Adverse Events. The overall risk of adverse events from injections was 3.4% (7/208). Eight patients (36.3%) converted into negative CSF cytology and 18 patients (82%) had clinical and/or radiological progression of their LMD (median 2 months following first injection). Eleven patients (50%) died of their LMD during follow-up. Median OS and PFS from the first injection were 5.3 months [95% CI: 4.8-NE (not estimable)] and 4.3 months [95% CI: 1.8-16.0], respectively. Our single-center cohort study suggests that the use of intrathecal chemotherapy via Ommaya reservoir in routine clinical practice is a safe and feasible option and should be considered for treatment and frequent disease monitoring in eligible patients with leptomeningeal disease. Neurologists, especially neuro-oncologists, can significantly contribute to the care of patients of leptomeningeal disease via administering intrathecal chemotherapy.

Background: Primary graft dysfunction (PGD) is the leading cause of early mortality after lung transplantation. Albumin is commonly used during lung transplantation to maintain intravascular volume while minimizing total intravenous fluid administration, given the established association between larger intravenous fluid and PGD. However, the direct impact of albumin on PGD remains unclear. Methods: We conducted a single-center retrospective cohort study of lung transplant recipients between 2018 and 2023. We calculated the corrected albumin proportion (cAP), representing the ratio of albumin to total intravenous fluid administered. We analyzed associations between cAP and PGD at 24, 48, and 72 h, as well as secondary outcomes including total fluid administration, 30-day acute kidney injury, mortality, and ICU length of stay. Results: A total of 190 patients were included in this study. A higher cAP was associated with lower total intravenous fluid administration (r = −0.15, p = 0.03), whereas a higher total intravenous fluid administration was associated with higher PGD at 72 h (OR 1.02, 95% CI 1.00–1.03, p = 0.04). However, cAP was not independently associated with PGD or other short-term outcomes. Conclusions: Intraoperative albumin use modestly reduced total intravenous fluid administration but was not independently associated with significant reductions in PGD or improvements in other short-term outcomes.

Background: Aortic valve prosthesis selection is complex for very young adults. We aimed to determine whether type of aortic valve prosthesis (mechanical vs. bioprosthetic vs. Ross) differs by sex in this population and explore variables influencing valve type. Hypothesis: We hypothesize that young women of child-bearing age undergo non-mechanical aortic valve replacement (AVR). Methods: Single center retrospective cohort study of 509 patients aged 18-45 who underwent surgical AVR between 2002-2023. Thirty-six patients who underwent concomitant mechanical valve in the mitral position were excluded from regression models as all 36 patients underwent mechanical aortic valve replacement. Outcome measure was defined as non-mechanical (bioprosthetic or Ross) aortic valve prosthesis. Demographic and clinical variables that may influence prosthesis type were compared by sex ( Table 1 ). Age was dichotomized into younger (18-34 years) and older (35-45 years). Multivariable logistic regression was performed to test the association between sex and non-mechanical AVR, accounting for variables that may also influence prosthesis selection ( Table 2 ). We modeled an interaction between age and sex to test our hypothesis. Results: Overall valve replacement strategies included: 246 patients (48%) bioprosthetic, 221 (43%) mechanical, and 42 (8.3%) Ross procedure. Patient characteristics compared by sex are reported in Table 1 . Females were overall less likely to undergo non-mechanical prosthesis compared to males (OR=0.49, 95% CI [0.28, 0.87], p-value = 0.014). Younger females (age 18-34) were more likely than older females (age 35-45) to undergo non-mechanical prosthesis (OR=2.31, 95% CI [1.09, 5.02], p-value = 0.032), while younger males (age 18-34) were less likely than older males (age 35-45) to undergo non-mechanical prosthesis (OR: 0.49, 95% CI [0.30,0.79], p-value = 0.003) ( Table 2 ). Conclusion: Sex differences in type of valve prosthesis exist for very young adults undergoing AVR. Though females overall had lower odds of undergoing non-mechanical AVR compared to males, youngest females underwent non-mechanical AVR at an overwhelmingly high rate in comparison to males and older females.

Background and Objective: Kommerell's diverticulum is a special type of proximal subclavian artery aneurysm that is associated with the aberrant subclavian artery. Although most patients are asymptomatic, there is a high risk of aortic rupture and aortic dissection. This study aimed to investigate the clinical characteristics, treatment strategies, and long-term prognosis of this specific type of proximal subclavian artery aneurysm (Kommerell's diverticulum) through a single-center retrospective study, providing valuable support for clinical decision-making. Methods: Patient data were collected from the medical records system from February 2011 to April 2022 for patients who had computer tomography scan reports indicating Kommerell's diverticulum and underwent intervention at our institution. A total of 76 adult patients aged 18 years and above with Kommerell's diverticulum were included in this study, of which 48 had concomitant aortic dissection and 28 without. Results: The overall early postoperative mortality rate for the included cases in this study was 9.2% (7/76 cases), with a 30-day mortality rate of 12.5% (6/48 cases) for the group with concomitant aortic dissection and 3.6% (1/28 cases) for the non-aortic dissection group. The median follow-up time for all included patients in this study was 4.0 years. Preoperative coronary artery atherosclerotic heart disease was identified as a risk factor associated with surgical mortality (OR=3.15, P=0.0163). Central nervous system complications occurred in 10 patients (13.2%), and respiratory system complications occurred in 4 patients (5.3%), with both cases in the group with concomitant aortic dissection resulting in postoperative death within 30 days due to compression of the right main bronchus by the aneurysm, leading to lung infection and respiratory failure. The 3-year, 5-year, and 7-year survival rates for the group with concomitant aortic dissection were 82.5%, 79.7%, and 75.1%, respectively, while the survival rates for the non-aortic dissection group were all 88.9%. Conclusion: The treatment approach for patients with this specific type of proximal subclavian artery aneurysm (Kommerell's diverticulum) should be based on comprehensive evaluation including age, symptoms, and imaging findings. Attention should be paid to the relationship and compression of the aortic dissection with the right main bronchus in patients with Kommerell's diverticulum and a right-sided aortic arch.

Background: Intermediate-risk pulmonary embolism (PE) is common and associated with significant mortality. We previously demonstrated that right ventricular global longitudinal strain (RVGLS) predicted short-term outcomes in intermediate-risk PE in a single-center retrospective cohort study using data up to 2018, identifying a best cutoff value of 17.7 %. However, limited evidence exists regarding the prognostic utility of RVGLS in more recent cohorts following the 2019 European Society of Cardiology guideline update. We conducted an external validation study using data from another institution between 2019 and 2022. Methods: Retrospective cohort study of 119 patients with intermediate-risk PE from 2019 to 2022. The primary outcome was all-cause 30-day mortality. Echocardiographic parameters were compared between survivors and non-survivors. RVGLS and right atrial (RA) strain were applied using Philips software. Receiver operating characteristic (ROC) curves analysis and Kaplan-Meier analysis were performed to assess prognostic value. Results: Among patients (mean age: 66.1 years, 48.7 % female), mortality at 30 days occurred in 6 patients (5.0 %). Image quality was sufficient to perform RV and RA strain analysis in 110 patients (92.4 %) and 105 patients (88.2 %). Non-survivors had significantly lower RVGLS (17.3 % vs. 19.6 %, p = 0.013) and RA strain (25.8 % vs. 31.4 %, p = 0.040) than survivors. Univariate analysis showed both RVGLS (odds ratio [OR] 0.567, p = 0.033) and RA strain (OR 0.865, p = 0.046) were associated with 30-day mortality. In ROC curves analysis, RVGLS had a higher area under the curve of 0.802 (Figure 1), compared to 0.751 for RA strain. Applying the previously reported cutoff of 17.7 %, the ROC curve provided 66.7 % sensitivity and 72.1 % specificity. When patients were divided into two groups utilizing the RVGLS value of 17.7 %, Kaplan-Meier curves demonstrated patients with low RVGLS had higher risk of 30-day mortality compared to those with high RVGLS (Log rank P = 0.042. Figure 2). Conclusions: In this external cohort, reduced RVGLS at baseline was associated with increased 30-day mortality in patients with intermediate-risk PE. These data validate the prognostic significance of RVGLS previously reported in a single-center study. Prospective studies are warranted to evaluate whether incorporating RVGLS into treatment algorithms can impact care and improve patient outcomes.

Background: Right ventricular function is strongly associated with the mortality in mitral stenosis (MS). The ratio of tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) serves as a noninvasive measure of right ventricle-pulmonary artery (RV-PA) coupling, which reflects the ability of RV to handle a given pulmonary afterload. Our aim is to assess the relationship between TAPSE/PASP and outcomes in calcific MS. Methods: A single-center retrospective cohort study was performed. Patients diagnosed with calcific MS on echocardiography between October 2010 and August 2020 were identified. We included patients with severe calcific MS due to mitral annular calcification (MAC) who had TAPSE and PASP measurements available. Propensity score (PS) was performed using a logistic regression model, with TAPSE/PASP &gt;0.45 as the dependent variable and seven clinically relevant covariates (age, sex, NYHA class, hypertension, atrial fibrillation, Charlson comorbidity index, left ventricular ejection fraction). After PS matching, we compared all-cause mortality between the two groups. Outcomes: Of 7,154 patients with MS, 229 patients with severe calcific MS were included (72 with TAPSE/PASP &gt;0.45 and 157 with TAPSE/PASP ≤0.45). In the entire cohort, the mean age was 72 ± 11 years and 65.9% were female. During the median follow-up duration of 345 days (25 th -75 th percentile: 80 – 851 days), 80 patients (34.9%) underwent mitral valve surgery, and there were 74 (32.3%) deaths. The cumulative survival of patients with TAPSE/PASP ≤0.45 was lower than patients with TAPSE/PASP &gt;0.45 in the entire cohort (p = 0.001), the conservative treatment group (p = 0.023), and the mitral valve intervention group (p = 0.020). After PS matching in 144 patients (72 patients in each group), similar results were obtained (p = 0.002, p = 0.028, p = 0.021). Conclusion: TAPSE/PASP is strongly associated with all-cause mortality in patients with severe calcific MS. This relationship was also observed after PS matching, suggesting this is a valuable non-invasive marker in calcific MS.