University Of Minnesota Medical Center Research Articles

Extracorporeal Membrane Oxygenation Patient Outcomes Following Restrictive Blood Transfusion Protocol.

To investigate the effect of a restrictive blood product utilization protocol on blood product utilization and clinical outcomes. We retrospectively reviewed all adult extracorporeal membrane oxygenation (ECMO) patients from January 2019 to December 2021. The restrictive protocol, implemented in March 2020, was defined as transfusion of blood products for a hemoglobin level less than 7, platelet levels less than 50, and/or fibrinogen levels less than 100. Subgroup analysis was performed based on the mode of ECMO received: venoarterial ECMO, venovenous ECMO, and ECMO support following extracorporeal cardiopulmonary resuscitation (ECPR). M Health Fairview University of Minnesota Medical Center. The study included 507 patients. One hundred fifty-one patients (29.9%) were placed on venoarterial ECMO, 70 (13.8%) on venovenous ECMO, and 286 (56.4%) on ECPR. For patients on venoarterial ECMO (48 [71.6%] vs. 52 [63.4%]; p = 0.374), venovenous ECMO (23 [63.9%] vs. 15 [45.5%]; p = 0.195), and ECPR (54 [50.0%] vs. 69 [39.2%]; p = 0.097), there were no significant differences in survival on ECMO. The last recorded mean hemoglobin value was also significantly decreased for venoarterial ECMO (8.10 [7.80-8.50] vs. 7.50 [7.15-8.25]; p = 0.001) and ECPR (8.20 [7.90-8.60] vs. 7.55 [7.10-8.88]; p < 0.001) following implementation of the restrictive transfusion protocol. These data suggest that a restrictive transfusion protocol is noninferior to ECMO patient survival. Additional, prospective randomized trials are required for further investigation of the safety of a restrictive transfusion protocol.

Impact of age on survival for patients receiving ECPR for refractory out-of-hospital VT/VF cardiac arrest

BackgroundExtracorporeal cardiopulmonary resuscitation (ECPR) has been shown to improve neurologically favorable survival for patients with refractory ventricular tachycardia (VT)/ventricular fibrillation (VF) out-of-hospital cardiac arrest. Prior studies of the impact of age on outcomes in ECPR have demonstrated mixed results and we aim to investigate this relationship. MethodsPatients treated with ECPR at the University of Minnesota Medical Center for refractory out-of-hospital VT/VF arrest from December 2015 to February 2023 were included. The primary endpoints included neurologically favorable survival to discharge. A receiver operating characteristic curve was used to determine an optimal predictive age limit with the highest accuracy for neurologically favorable survival. Results391 consecutive patients were included: 22% (n = 86) were female and the mean age was 56.9 ± 11.8 years. Age was independently associated with neurologically favorable survival to discharge, with a 30% decrease in survival with every 10-year increase in age (OR 0.7 (0.57–0.87), p = 0.001. Among those with neurologically favorable survival to discharge, older patients had longer length of hospital stay compared to younger age groups (p = 0.002) while patients who failed to achieve neurologically favorable survival to discharge had similar length of stay independent of age (p = 0.51). ConclusionsAge is associated with neurologically favorable survival to discharge for patients receiving ECPR for refractory out-of-the-hospital VT/VF cardiac arrest. However, with a survival rate of 23% in the oldest age group, caution should be used when choosing age criteria for patient selection.

Does ginger supplementation improve knee pain and function in patients with known knee osteoarthritis?

University of Minnesota Medical Center, Family Medicine Residency Program, Minneapolis, MN The corresponding author is Christian Matthews; [email protected]. The authors declare no conflicts of interest.

CORR Insights®: What Factors Are Associated With Delayed Wound Closure in Open Reduction and Internal Fixation of Adult Both-bone Forearm Fractures?

1Assistant Professor, University of Minnesota Medical Center: University of Minnesota Health, Orthopaedic Surgery and Rehabilitation, Minneapolis, MN, USA M. P. Nguyen, Department of Orthopaedic Surgery, Mailstop 11503L, Regions Hospital, 640 Jackson Street, Saint Paul, MN, 5510, USA, Email: [email protected] This CORR Insights® is a commentary on the article “What Factors Are Associated With Delayed Wound Closure in Open Reduction and Internal Fixation of Adult Both-bone Forearm Fractures?” by Shu and colleagues available at: DOI: 10.1097/CORR.0000000000002543. The author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR® or The Association of Bone and Joint Surgeons®.

Abstract TP173: Factors Associated With Decision-making To Close A PFO For Secondary Stroke Prevention

Background: Clinical trial evidence supports patent foramen ovale (PFO) closure to reduce recurrent stroke risk in select patients. Guidelines recommend a multi-disciplinary approach to identify patients who may benefit from PFO closure. We assess factors associated with the decision to close PFO in a real-world cohort. Methods: We studied patients from University of Minnesota Medical Center and Yale-New Haven Hospital with TIA or ischemic stroke and PFOs evaluated by dedicated multidisciplinary teams of vascular neurologists and interventional cardiologists at each institution. Demographic, clinical, radiographic, and echocardiographic information was extracted by chart review. The study outcome was PFO closure. Descriptive analyses were performed comparing characteristics associated with PFO closure using Mann Whitney test and Chi-squared test. Multivariable logistic regression model was built with variables significant in descriptive analyses. Results: The analytic cohort included 173 patients, of whom 58 patients (33.5%) underwent closure (39.8% of Yale and 20% of UMMC patients were closed). Patients who were closed versus not were similar in age (median age 56 [IQR 21] versus 58 [IQR 21] years), sex, race, diagnosis of TIA or stroke, and co-morbidities except malignancy which was significantly less prevalent among closed patients (2.3% versus 12.1%). Closed patients had a higher RoPE score (median 6 versus 5, p=0.032), and were more likely to have a stroke or TIA of undetermined etiology (55.2 versus 49.6%) and high-risk PFO characteristics (p&lt;0.001, Table). High-risk PFO characteristics (OR 6.4, 95% CI 2.1-19.7), RoPE score (OR 1.5, 95% CI 1.1-2.1), and undetermined etiology (OR 5.5, 95% CI 1.1-28.3) were independent predictors of PFO closure. Conclusions and Relevance: In this study of a real-world cohort, we identify patient characteristics that drive decision-making for PFO closure for secondary stroke prevention.

CORR Insights®: Reverse Total Shoulder Arthroplasty Demonstrates Better Outcomes Than Angular Stable Plate in the Treatment of Three-part and Four-part Proximal Humerus Fractures in Patients Older Than 70 Years.

1Assistant Professor, University of Minnesota Medical Center: University of Minnesota Health, Orthopaedic Surgery and Rehabilitation, Minneapolis, MN, USA M.P. Nguyen, University of Minnesota Medical Center, Orthopaedic Surgery and Rehabilitation, 2450 Riverside Avenue, Suite R200, Minneapolis, MN 55454, USA, Email: [email protected] This CORR Insights® is a commentary on the article “Reverse Total Shoulder Arthroplasty Demonstrates Better Outcomes Than Angular Stable Plate in the Treatment of Three-part and Four-part Proximal Humerus Fractures in Patients Older Than 70 Years” by Lanzetti and colleagues available at: DOI: 10.1097/CORR.0000000000002480. The author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR® or The Association of Bone and Joint Surgeons®.

The Feasibility of Using the "Artery Sign" for Pre-Procedural Planning in Navigational Bronchoscopy for Parenchymal Pulmonary Lesion Sampling.

Electromagnetic navigation bronchoscopy (ENB) and robotic-assisted bronchoscopy (RAB) systems are used for pulmonary lesion sampling, and utilize a pre-procedural CT scan where an airway, or "bronchus sign", is used to map a pathway to the target lesion. However, up to 40% of pre-procedural CT's lack a "bronchus sign" partially due to surrounding emphysema or limitation in CT resolution. Recognizing that the branches of the pulmonary artery, lymphatics, and airways are often present together as the bronchovascular bundle, we postulate that a branch of the pulmonary artery ("artery sign") could be used for pathway mapping during navigation bronchoscopy when a "bronchus sign" is absent. Herein we describe the navigation success and safety of using the "artery sign" to create a pathway for pulmonary lesion sampling. We reviewed data on consecutive cases in which the "artery sign" was used for pre-procedural planning for conventional ENB (superDimension™, Medtronic) and RAB (Monarch™, Johnson & Johnson). Patients who underwent these procedures from July 2020 until July 2021 at the University of Minnesota Medical Center and from June 2018 until December 2019 at the University of Chicago Medical Center were included in this analysis (IRB #19-0011 for the University of Chicago and IRB #00013135 for the University of Minnesota). The primary outcome was navigation success, defined as successfully maneuvering the bronchoscope to the target lesion based on feedback from the navigation system. Secondary outcomes included navigation success based on radial EBUS imaging, pneumothorax, and bleeding rates. A total of 30 patients were enrolled in this analysis. The median diameter of the lesions was 17 mm. The median distance of the lesion from the pleura was 5 mm. Eleven lesions were solid, 15 were pure ground glass, and 4 were mixed. All cases were planned successfully using the "artery sign" on either the superDimension™ ENB (n = 15) or the Monarch™ RAB (n = 15). Navigation to the target was successful for 29 lesions (96.7%) based on feedback from the navigation system (virtual target). Radial EBUS image was acquired in 27 cases (90%) [eccentric view in 13 (43.33%) and concentric view in 14 patients (46.66%)], while in 3 cases (10%) no r-EBUS view was obtained. Pneumothorax occurred in one case (3%). Significant airway bleeding was reported in one case (3%). We describe the concept of using the "artery sign" as an alternative for planning EMN and RAB procedures when "bronchus sign" is absent. The navigation success based on virtual target or r-EBUS imaging is high and safety of sampling of such lesions compares favorably with prior reports. Prospective studies are needed to assess the impact of the "artery sign" on diagnostic yield.

Abstract 13296: The Internal Jugular Vein for Leadless Pacemaker Implantation in Patients Under 30 Kg

Pacemaker placement in pediatrics involves consideration for potential complications with leads, pocket erosion and infection. Pacemaker generators also carry their own complications such as hematoma formation and additional infection. This is why a reliable leadless pacemaker implantation technique is desired. In this dual center, single operator, retrospective study we demonstrate the feasibility of leadless pacemaker implantation via internal jugular vein in patients under 30 kg. This technique does not require surgical cut-down and preserves the patency of the involved vessels. Procedures were conducted by an electrophysiologist at the University of Minnesota and UC Davis Medical Center and University of Minnesota Medical Center from 2018-2021 with the Micra (Medtronic, Minneapolis, MN, USA). Vascular access in the largest diameter internal jugular vein was obtained in the right or left internal jugular veins via the Seldinger technique with serial dilation from 5 or 8 French size to 27 French. Results showed that in eight patients under 30kg, leadless pacemaker can implanted via the internal jugular vein with no need for surgical cut down due to having good short-term and mid-term vein patency. Seven out of eight patients were discharged the next day after the procedure. No venous complications related to access were noted. All patients met an indication for pacemaker implantation with ventricular-only pacing needed or had prophylactic leadless pacemaker placed or was the patient and cardiology team preference after multi-disciplinary discussion. We recommend echocardiographic guidance to minimize perforation risk.

Abstract 119: Resuscitation Outcomes In Covid-19-associated Out-of-hospital Cardiac Arrest

BACKGROUND: Since the beginning of the pandemic, there have been numerous reports of increased mortality in the setting of both in-hospital (IHCA) and out-of-hospital cardiac arrest (OHCA) in patients with novel coronavirus-19 (COVID-19) infection. Due to these alarming mortality rates, it has been proposed that resuscitation may represent futility when COVID-19 is suspected or confirmed in patients with cardiac arrest. However, it continues to remain unclear whether the currently available data is sufficient to be broadly applied to all patients and hospitals. HYPOTHESIS: In COVID-positive patients presenting after OHCA, resuscitation should be pursued and is not futile as has previously been suggested. METHODS: 264 consecutive patients presenting to the University of Minnesota Medical Center were obtained from the Cardiac Arrest Registry to Enhance Survival (CARES) database from March 2020 through April 2022. Patient data was obtained retrospectively for COVID19 infection status, initial documented arrest rhythm, and survival to hospital discharge. RESULTS: 264 patients were collected for analysis with 2 being excluded due to incomplete data. Of the remaining 262, 16 were found to be COVID-positive. Of these patients, 2 (12.5%) survived to hospital discharge compared to 72 (29.2%) in the group without COVID. In COVID-positive patients presenting with initially shockable rhythm (11 patients), survival was 18.2% compared with no survival noted in those with initially non-shockable rhythm. 9 patients with COVID were cannulated for ECMO, with 1 (11.1%) surviving to hospital discharge. CONCLUSIONS: This study provides insight into resuscitation in the setting of OHCA when COVID is suspected or confirmed. Though small in overall number of patients, our study indicates that resuscitation efforts in COVID-positive patients are not futile, as has previously been suggested.

Viral Hepatitis Among African Immigrants with Hepatocellular Carcinoma in Minnesota: High Prevalence Yet Low Awareness.

We aimed to study the virologic profile of immigrants from Africa with viral hepatitis-related hepatocellular carcinoma (HCC) who received care at our institution. We conducted a descriptive study among African-born patients with HCC who received care at University of Minnesota Medical Center from 2011 to 2018. We analyzed the prevalence, virologic profiles and treatment of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections prior to HCC diagnosis. 74 African-born patients with HCC were eligible for analysis. 54 had HCV and 20 had HBV infection. 80% of HBV patients were treated but remained with inadequate viral suppression at the time of HCC diagnosis while only 39% of HCV patients were treated prior to HCC diagnosis. Lost to follow up was common in both groups. Our findings suggest thatthere is a significant gap in appropriate viral hepatitis care in an African immigrant population in Minnesota. Culturally-appropriate strategies are needed to bridge this gap.

Clinical Outcomes and Patterns of Failure in Esthesioneuroblatoma: A Single Institutional Experience.

Esthesioneuroblastoma (ENB) is a rare sinonasal malignancy that is typically managed with a combination of surgical resection, radiotherapy and chemotherapy. Data used to guide therapeutic decision making are scant and typically obtained from small retrospective series due to the relative infrequency of the diagnosis. Here, we report our own institutional experience in the management of patients with ENB to help compliment these prior single institutional reports. Records from patients receiving treatment for ENB at the University of Minnesota Medical Center were obtained from 1994 to 2019. A total of 17 patients were identified from our retrospective review. Kadish stage at initial presentation was A in 2 (12%), B in 5 (29%), C in 9 (53%) and D in 1 (6%). All patients underwent surgical resection. Adjuvant radiotherapy was utilized in 12 (71%) patients with concurrent chemotherapy administered in 3 (18%) patients. One patient received neoadjuvant chemoradiotherapy followed by surgical resection. Four patients developed recurrent disease with locoregional failure presenting as the most common site of initial relapse within our study population. Isolated local recurrence occurred in 2 patients, one patient developed combined local and regional failure, while another had combined regional and distant failure with osseous metastases. Recurrent disease was managed by either combined salvage surgery and radiotherapy (RT) or RT alone. Three of the 4 patients who developed recurrence eventually succumbed to their disease. Estimates for 5-year DFS and OS were 65% and 90%, respectively, for the entire cohort.

Diversifying the clinical pipeline: The necessity of diverse, equitable, and inclusive initiatives to advance the placement of underrepresented minoritized students in postgraduate pharmacy training

JACCP: JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACYVolume 5, Issue 3 p. 270-272 EDITORIAL Diversifying the clinical pipeline: The necessity of diverse, equitable, and inclusive initiatives to advance the placement of underrepresented minoritized students in postgraduate pharmacy training Yodit Teklu Pharm.D., Yodit Teklu Pharm.D. orcid.org/0000-0002-1613-5968 Department of Pharmacy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USASearch for more papers by this authorMaya Bell Pharm.D., Maya Bell Pharm.D. Department of Pharmacy, University of Minnesota Medical Center, Minneapolis, Minnesota, USASearch for more papers by this authorIla M. Saunders Pharm.D., Ila M. Saunders Pharm.D. UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, California, USASearch for more papers by this authorJacinda C. Abdul-Mutakabbir Pharm.D., MPH, Corresponding Author Jacinda C. Abdul-Mutakabbir Pharm.D., MPH jabdulmutakabbir@llu.edu orcid.org/0000-0003-4162-6408 Department of Pharmacy Practice, Loma Linda School of Pharmacy, Loma Linda, California, USA Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California, USA Correspondence Jacinda C. Abdul-Mutakabbir, Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, CA 92350. Email: jabdulmutakabbir@llu.eduSearch for more papers by this authoron behalf of the PharmGradWishlist Leadership and Advisory Teams, PharmGradWishlist Leadership and Advisory TeamsSearch for more papers by this author Yodit Teklu Pharm.D., Yodit Teklu Pharm.D. orcid.org/0000-0002-1613-5968 Department of Pharmacy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USASearch for more papers by this authorMaya Bell Pharm.D., Maya Bell Pharm.D. Department of Pharmacy, University of Minnesota Medical Center, Minneapolis, Minnesota, USASearch for more papers by this authorIla M. Saunders Pharm.D., Ila M. Saunders Pharm.D. UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, California, USASearch for more papers by this authorJacinda C. Abdul-Mutakabbir Pharm.D., MPH, Corresponding Author Jacinda C. Abdul-Mutakabbir Pharm.D., MPH jabdulmutakabbir@llu.edu orcid.org/0000-0003-4162-6408 Department of Pharmacy Practice, Loma Linda School of Pharmacy, Loma Linda, California, USA Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California, USA Correspondence Jacinda C. Abdul-Mutakabbir, Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, CA 92350. Email: jabdulmutakabbir@llu.eduSearch for more papers by this authoron behalf of the PharmGradWishlist Leadership and Advisory Teams, PharmGradWishlist Leadership and Advisory TeamsSearch for more papers by this author First published: 10 March 2022 https://doi.org/10.1002/jac5.1597Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume5, Issue3March 2022Pages 270-272 RelatedInformation

Invasive hemodynamics are equivocal for functional outcomes after MitraClip.

ObjectivesTo evaluate invasive hemodynamics in assessing MC therapy success as well as evaluate its effectiveness as a predictor of functional outcomes.BackgroundMitral regurgitation grade is a poor predictor of functional outcomes after a MitraClip. There is a paucity of data on invasive hemodynamics as a predictor of outcomes.MethodsSixty‐nine patients underwent MC between 2015 and 2018 at the University of Minnesota Medical Center and were retrospectively analyzed. Invasive hemodynamics were performed before and after device deployment with transesophageal echocardiographic guidance. Statistical analysis was performed using STATA version 16. Student's t test was used for continuous variables and Pearson's chi‐squared test for categorical variables. Mann‐Whitney test was performed for continuous variables where data were not normally distributed. Logistic and linear regression were used to investigate relationships between variables and outcomes.ResultsA total of 69 patients were included in the study. The mean age was 83 (75‐87) years and 38 (55%) were male. Eighty‐one percentage had >/= NYHA III symptoms. Eighty‐seven percentage had severe MR. Pulmonary capillary wedge pressure was 20 (15‐24). Overall, there was significant improvement in left atrial pressure including mean left atrial pressure index, MR, and NYHA class after MC (<.001). There was no significant association between invasive hemodynamics (including left atrial mean pressure index or its reduction rate) and functional outcomes (p = NS). MR grade was also not predictive of functional outcomes.ConclusionLeft atrial pressure may not be a significant predictor of functional outcomes, and, in isolation, may not be an improvement over MR grade.

1374. Clinical Outcomes of Sepsis According to Race at University of Minnesota Medical Center

BackgroundSepsis is a life-threatening condition associated with significant in-hospital mortality. Sepsis disproportionately affects Black Americans and is a top-10 leading cause of death for Black people. Previous studies examining sepsis mortality rates by race have yielded inconsistent findings. This retrospective study evaluates the relationship between race and in-hospital sepsis-related mortality in adults at University of Minnesota Medical Center.MethodsWe reviewed all sepsis diagnoses in adults between January 1, 2020 and June 30, 2020 at the University of Minnesota Medical Center. Demographic information including age, sex, race, insurance status, primary language, expected and observed mortality score, discharge status, treatment information, and in-hospital mortality were also recorded. Self-reported race was categorized as African American, White, American Indian or Alaska Native, Asian, African, Hispanic or Latino, Hawaiian or other Pacific Islander, “some other race,” and “two or more races.” Statistical tests including χ 2 test, Student t test, Kaplan-Meier estimator, and binary logistic regression were performed.ResultsWe identified 780 cases of sepsis. Black patients were consistently younger than White patients (median age of 50 years, compared to 61 years, p< 0.001). Black patients were more likely to have comorbidities at baseline. However, logistic regression analyses, after controlling for language, race, primary payer, and expected mortality, showed no association between sepsis outcome and race.Sepsis Cases at UMMC between January and June 2020 by Self-Reported Race *Other includes the categories “Some other race” and “Two or more races.”Hospital Outcomes by Race Patient Demographics by Race ConclusionWhile there was no significant difference between in-hospital mortality and race, Black patients were more likely to present at a younger age with more medical comorbidities than White patients.Disclosures All Authors: No reported disclosures

Abstract 9457: Safety and Feasibility of a Mixed Reality Head Mounted Display in the Cardiac Catheterization Laboratory

Introduction: Mixed reality (MR) head-mounted displays (HMDs) have been used in a variety of industrial applications. The safety and feasibility of HMDs in cardiac catheterization laboratories (CCLs) for image and procedure guidance have not been studied. Hypothesis: We assessed the hypothesis that MR HMDs are safe and feasible for procedure guidance in CCLs. Methods: 50 patients undergoing diagnostic coronary angiography and right heart catheterization at the University of Minnesota Medical Center were prospectively enrolled in a single-arm trial using an MR HMD for image and procedure guidance including vascular access, fluoroscopy, telemetry, and vital monitoring. Traditional 2D displays were available as back-up. A CCL specific MR HMD (SG Devices LLC, MN) was used. Pearson’s correlation coefficient was used to assess the relationships between procedural outcomes. Results: A total of 62 procedures were performed (47% coronary angiograms, 90% radial). Median age was 64 (58-69) with 66% males (Table 1). Mean procedure time was 22 min (+/- 12) with a mean fluoroscopy time of 3.2 min (+/- 4.1). Contrast volume used was 59 cc (+/-5). Fluoroscopy time was correlated to procedure time (R=0.54, p&lt;0.001) and contrast volume (R=0.72, p&lt;0.001). There were no complications observed peri-procedurally (bleeding, myocardial infarction, stroke, death). Procedure success was 98% (1 procedure could not be completed due to a battery issue). Conclusion: Dedicated CCL MR HMDs are safe and feasible for invasive diagnostic procedures in the CCL, and may improve procedure time, reduce contrast use, and radiation exposure.

Abstract 10360: Trends in Surgical Aortic Valve Replacement Outcomes in the Post Transcatheter Aortic Valve Replacement

Introduction: Transcatheter aortic valve replacement (TAVR) is currently the mainstay of treatment of severe aortic stenosis (AS). We aim to investigate the evolution of transaortic mean gradients in surgical aortic valve replacement (SAVR) patients before and after the Food and Drug Administration (FDA) approval of TAVR. Hypothesis: We assessed the hypothesis that mean gradients across the aortic valve were higher in 2011-2012 before FDA approval of TAVR. Methods: Patients who underwent SAVR in 2011-2012 (n=138) and 2019-2020 (n=134) at the University of Minnesota Medical Center were included. Those with implanted mechanical valves (n=602) were excluded. Valve size and mean aortic gradients were compared between the 2 study groups. Results: Out of 272 patients included in this study, 65.8% were males. Patients underwent SAVR at an older age in 2011-2012 (median 74, IQR 65-82) compared to 2019-2020 (median 67, IQR 60-73). The mean aortic valve gradient post-SAVR was higher in 2011-2012 (median 12, IQR 8-18 vs. median 10, IQR 7-13 in 2019-2020, p=0.016). The median valve size was smaller in 2011-2012 (21 mm vs. 23 mm, p&lt;0.001) (table) . Conclusion: Patients who underwent SAVR in 2011-2012 were older, more likely to receive smaller valve sizes, and had higher mean aortic valve gradients after SAVR.

Nonsupercharged Retrosternal Roux-en-Y Esophagojejunostomy for Distal Esophageal Reconstruction

BackgroundDelayed distal esophageal reconstruction with nonsupercharged jejunum is an option when gastric conduit is not available. This study aimed to describe a single-center experience with distal esophageal reconstruction with retrosternal Roux-en-Y esophagojejunostomy (RYEJ) and compare perioperative outcomes with retrosternal gastric pull-up (GP). MethodsAn Institutional Review Board–exempt retrospective chart review was conducted of patients who underwent esophagostomy closure by the retrosternal route at the University of Minnesota Medical Center (Minneapolis, MN) from January 2009 to July 2019. Patients with colonic conduits were excluded. The study compared patients with RYEJ with a contemporary cohort of patients who underwent GP. The anatomic criteria for RYEJ were the absence of a gastric conduit and an esophageal remnant that reached the sternomanubrial joint. Patient characteristics, anastomotic leak and stricture rate, postoperative complications, hospital length of stay, 30-day readmission, and 90-day mortality were recorded. Statistical analysis was performed using the Fisher exact test and the Wilcoxon rank-sum test with a significance level at P ≤.05. ResultsA total of 9 patients underwent RYEJ, and 10 patients had GP. Previous esophageal adenocarcinoma was more common in the RYEJ group (n = 5) compared with the GP group (n = 0) (P = .01). Patient demographics and comorbidities were comparable between the groups. No differences were found in all end points, including operating time, estimated blood loss, anastomotic leak or stricture rate, Clavien-Dindo class III to IV complications, hospital length of stay, or mortality. ConclusionsRetrosternal RYEJ without microvascular augmentation is a safe alternative for esophagostomy closure in patients with adequate esophageal length when the stomach is not available. The nonsupercharged jejunum can safely reach the level of the sternomanubrial joint.

Detection of Isocitrate Dehydrogenase Mutated Glioblastomas Through Anomaly Detection Analytics.

The rarity of Isocitrate Dehydrogenase mutated (mIDH) glioblastomas relative to wild-type IDH glioblastomas, as well as their distinct tumor physiology, effectively render them "outliers". Specialized tools are needed to identify these outliers. To carefully craft and apply anomaly detection methods to identify mIDH glioblastoma based on radiomic features derived from magnetic resonance imaging. T1-post gadolinium images for 188 patients and 138 patients were downloaded from The Cancer Imaging Archive's (TCIA) The Cancer Genome Atlas (TCGA) glioblastoma collection, and from the University of Minnesota Medical Center (UMMC), respectively. Anomaly detection methods were tested on glioblastoma image features for the precision of mIDH detection and compared to standard classification methods. Using anomaly detection training methods, we were able to detect IDH mutations from features in noncontrast-enhancing regions in glioblastoma with an average precision of 75.0%, 69.9%, and 69.8% using three different models. Anomaly detection methods consistently outperformed traditional two-class classification methods from 2 unique learning models (67.9%, 67.6%). The disparity in performances could not be overcome through newer, popular models such as neural networks (67.4%). We employed an anomaly detection strategy in the detection of IDH mutation in glioblastoma using preoperative T1 postcontrast imaging. We show these methods outperform traditional two-class classification in the setting of dataset imbalances inherent to IDH mutation prevalence in glioblastoma. We validate our results using an external dataset and highlight new possible avenues for radiogenomic rare event prediction in glioblastoma and beyond.

Coronary artery disease burden relation with the presentation of acute cardiac events and ventricular fibrillation.

Evaluate the differences in coronary artery disease (CAD) burden between patients with ischemic resuscitated, ischemic refractory VT/VF OHCA events and N/STEMI. Refractory out-of-hospital cardiac arrest patients presenting with initial shockable rhythms (VT/VF OHCA) have the highest mortality among patients with acute cardiac events. No predictors of VT/VF OHCA refractoriness have been identified. A retrospective cohort design was used to assess baseline characteristics, clinical outcomes, and the angiographic severity of disease among patients with VT/VF OHCA undergoing emergent coronary angiography at the University of Minnesota Medical Center. The Gensini score was calculated for all patients to assess the angiographic burden of CAD. For patients with ischemia-related cardiac arrest, outcomes were further compared to an independent non-OHCA population presenting with N/STEMI. During the study period, 538 patients were admitted after VT/VF OHCA. Among them, 305 presented with resuscitated, and 233 with refractory VT/VF. 66% of resuscitated and 70% of refractory VT/VF had an underlying, angiographically documented, ischemic etiology. Ischemic resuscitated and refractory VT/VF had significant differences in Gensini score, (80.7 ± 3.6 and 127.6 ± 7.1, respectively, p <0.001) and survival (77.3% and 30.0%, respectively, p <0.001). Both groups had a higher CAD burden and worse survival than the non-OHCA N/STEMI population (360 patients). Ischemic refractory VT/VF was significantly more likely to present with chronic total occlusion in comparison to both N/STEMI and ischemic resuscitated VT/VF. Ischemia-related, refractory VT/VF OHCA has a higher burden of CAD and the presence of CTOs compared to resuscitated VT/VF OHCA and N/STEMI.

Applying Machine Learning Across Sites: External Validation of a Surgical Site Infection Detection Algorithm

Surgical complications have tremendous consequences and costs. Complication detection is important for quality improvement, but traditional manual chart review is burdensome. Automated mechanisms are needed to make this more efficient. To understand the generalizability of a machine learning algorithm between sites, automated surgical site infection (SSI) detection algorithms developed at one center were tested at another distinct center. NSQIP patients had electronic health record (EHR) data extracted at one center (University of Minnesota Medical Center, Site A) over a 4-year period for model development and internal validation, and at a second center (University of California San Francisco, Site B) over a subsequent 2-year period for external validation. Models for automated NSQIP SSI detection of superficial, organ space, and total SSI within 30 days postoperatively were validated using area under the curve (AUC) scores and corresponding 95% confidence intervals. For the 8,883 patients (Site A) and 1,473 patients (Site B), AUC scores were not statistically different for any outcome including superficial (external 0.804, internal [0.784, 0.874] AUC); organ/space (external 0.905, internal [0.867, 0.941] AUC); and total (external 0.855, internal [0.854, 0.908] AUC) SSI. False negative rates decreased with increasing case review volume and would be amenable to a strategy in which cases with low predicted probabilities of SSI could be excluded from chart review. Our findings demonstrated that SSI detection machine learning algorithms developed at 1 site were generalizable to another institution. SSI detection models are practically applicable to accelerate and focus chart review.