Alexander N. Goel

Heart transplantation in children with intellectual disability: An analysis of the UNOS database

Heart transplantation in children with intellectual disability (ID) is an issue of debate due to the shortage of available donor organs. We sought to perform the first large‐scale retrospective cohort study describing the prevalence and outcomes of heart transplantation in this population. The United Network of Organ Sharing database was queried from 2008 to 2015 for pediatric patients (age <19 years) receiving first, isolated heart transplant. Recipients were divided into three subgroups: definite ID, probable ID, and no ID. The chi‐square test was used to compare patients’ baseline characteristics. Kaplan‐Meier and Cox proportional hazard regression analyses were used to estimate the association between ID and death‐censored graft failure and patient survival. Over the study period, 565 pediatric patients with definite (131) or probable (434) ID received first heart transplant, accounting for 22.4% of all first pediatric heart transplants (n=2524). Recipients with definite ID did not significantly differ from those without ID in terms of gender, ethnicity, ischemia time, severity of pretransplant condition (waitlist status, mechanical ventilation, inotrope dependence, ECMO, VAD, PVRI, infection prior to transplant), or incidents of acute rejection within the first year. ID was associated with prolonged waitlist time (P<.001). Graft and patient survival at 3 years was equivalent between children with and without ID (P=.811 and .578, respectively). We conclude that intellectual disability is prevalent in children receiving heart transplants, with 22.4% of recipients over the study period having definite or probable ID. ID does not appear to negatively affect transplantation outcomes. Future studies are needed to assess long‐term outcomes of transplantation in this population.

Minor Salivary Gland Carcinoma of the Oropharynx: A Population-Based Analysis of 1426 Patients.

Objective We sought to describe the patient, tumor, and survival characteristics of minor salivary gland carcinoma (MSGC) of the oropharynx using a large, population-based database. Study Design Cross-sectional analysis of the National Cancer Institute’s SEER database (Surveillance, Epidemiology. and End Results). Subjects and Methods We reviewed the SEER database for all cases of MSGC of the oropharynx from 1988 to 2013. Relevant demographic, clinicopathologic, and survival variables were extracted and analyzed. Cox multivariate regression was performed to identify prognostic factors. Results We identified 1426 cases of MSGC of the oropharynx (mean age, 58 years; 51% female). The soft palate (39.2%) and base of tongue (38.6%) were the most commonly involved sites. The most common histologic subtypes were mucoepidermoid carcinoma (32.1%), adenocarcinoma (25.9%), and adenoid cystic carcinoma (23.3%). Five- and 10-year rates of disease-specific survival were 75.1% and 61.6%, respectively. Independent prognostic factors included tumor grade, T stage, N stage, and age >70 years. Conclusions This study represents the largest multivariate survival analysis of MSGC of the oropharynx to date. Independent prognosticators include tumor grade, T stage, N stage, and age.

Sequelae of Index Complications following Inpatient Head and Neck Surgery: Characterizing Secondary Complications

Objective To characterize patterns of secondary complications after inpatient head and neck surgery. Study Design Retrospective cohort study. Setting National Surgical Quality Improvement Program (2005-2015). Subjects and Methods We identified 18,584 patients who underwent inpatient otolaryngologic surgery. Four index complications were studied: pneumonia, bleeding or transfusion event (BTE), deep/organ space surgical site infection (SSI), and myocardial infarction (MI). Each patient with an index complication was matched to a control patient based on propensity for the index event and event-free days. Rates of 30-day secondary complications and mortality were compared. Results Index pneumonia (n = 254) was associated with several complications, including reintubation (odds ratio [OR], 11.7; 95% confidence interval [CI], 5.2-26.4), sepsis (OR, 8.8; 95% CI, 4.5-17.2), and death (OR, 5.3; 95% CI, 1.9-14.9). Index MI (n = 50) was associated with increased odds of reintubation (OR, 17.2; 95% CI, 3.5-84.1), ventilatory failure (OR, 5.8; 95% CI, 1.8-19.1), and death (OR, 24.8; 95% CI, 2.9-211.4). Index deep/organ space SSI (n = 271) was associated with dehiscence (OR, 7.2; 95% CI, 3.6-14.2) and sepsis (OR, 38.3; 95% CI, 11.6-126.4). Index BTE (n = 1009) increased the odds of cardiac arrest (OR, 3.9; 95% CI, 1.8-8.5) and death (OR, 2.9; 95% CI, 1.6-5.1). Conclusions Our study is the first to quantify the effect of index complications on the risk of specific secondary complications following inpatient head and neck surgery. These associations may be used to identify patients most at risk postoperatively and target specific interventions aimed to prevent or interrupt further complications.

Readmission after surgery for oropharyngeal cancer: An analysis of rates, causes, and risk factors: Readmission After Oropharyngeal Cancer Surgery

Determine the rate, diagnoses, and risk factors associated with 30‐day nonelective readmissions for patients undergoing surgery for oropharyngeal cancer.

Predictors, costs, and causes of readmission after surgery for sinonasal cancer: a national perspective: Readmission after sinonasal cancer surgery

Hospital readmissions are an increasingly scrutinized marker of surgical care delivery and quality. There is a paucity of information in the literature regarding the rate, risk factors, and common causes of readmission after surgery for sinonasal cancer.

Adipose-Derived Mesenchymal Stromal Cells Persist in Tissue-Engineered Vocal Fold Replacement in Rabbits

Objectives: Cell therapies using mesenchymal stromal cells (MSCs) have been proposed as a promising new tool for the treatment of vocal fold scarring. However, the mechanisms by which MSCs promote healing as well as their duration of survival within the host vocal fold have yet to be defined. The aim of this work was to assess the persistence of embedded MSCs within a tissue-engineered vocal fold mucosal replacement in a rabbit model of vocal fold injury. Methods: Male rabbit adipose-derived MSCs were embedded within a 3-dimensional fibrin gel, forming the cell-based outer vocal fold replacement. Four female rabbits underwent unilateral resection of vocal fold epithelium and lamina propria and reconstruction with cell-based outer vocal fold replacement implantation. Polymerase chain reaction and fluorescent in situ hybridization for the sex-determining region of the Y chromosome (SRY-II) in the sex-mismatched donor-recipient pairs sought persistent cells after 4 weeks. Results: A subset of implanted male cells was detected in the implant site at 4 weeks. Many SRY-II-negative cells were also detected at the implant site, presumably representing native female cells that migrated to the area. No SRY-II signal was detected in contralateral control vocal folds. Conclusions: The emergent tissue after implantation of a tissue-engineered outer vocal fold replacement is derived both from initially embedded adipose-derived stromal cells and infiltrating native cells. Our results suggest this tissue-engineering approach can provide a well-integrated tissue graft with prolonged cell activity for repair of severe vocal fold scars.

Case report. Retroesophageal Left Brachiocephalic Vein in an Infant Without Cardiac Anomalies

Abstract Retroesophageal course of the left brachiocephalic vein is a rare variant seen in patients with congenital heart disease. However, this anomaly without associated cardiac or aortic abnormalities is nearly unheard of, with only one prior case described in the literature. We present an infant with anomalous retroesophageal left brachiocephalic vein that was an incidental finding on computed tomography (CT). We also briefly discuss its embryologic and clinical significance.