Palak Patel

Outcomes of transcatheter aortic valve replacement for bicuspid aortic stenosis – a systematic review of existing literature

ABSTRACT Introduction: Patients with bicuspid aortic valve (BAV) have traditionally been excluded from large randomized clinical trials involving transcatheter aortic valve replacements (TAVR). Technical enhancements, availability of new generation devices and improved outcomes have led to a marked increase in TAVR volume across the world including off label use in patients with BAV stenosis. Areas covered: In this manuscript, we have reviewed the currently available data regarding safety, efficacy, and outcomes of TAVR in patients with BAV stenosis. 11 large observational studies with near 1300 patients with BAV stenosis were included to summarizes outcomes of TAVR. Expert Commentary: The present review suggested that TAVR may be a safe and feasible treatment modality in BAV stenosis patients. New generation devices were associated with high device success rate whereas higher adverse procedural events were observed in early generation devices. There are no differences in post procedural outcomes with new generation TAVR devices for BAV when compared to tricuspid aortic anatomy. Larger studies are needed to evaluate the long-term outcome and durability of TAVR in patients with BAV.

Influence of same-day admission on outcomes following transcatheter aortic valve replacement.

Since elective transcatheter aortic valve replacements (TAVRs) can be performed on the day of admission, i.e., Day 0, or on the next day of admission, i.e., Day 1, we sought to investigate if there is an advantage to either approach.

Effect of hospital volume on outcomes of percutaneous peripheral atherectomy – An observational analysis from National Inpatient Sample

Background Although the published literature has reported an inverse association between hospital volume and outcomes of coronary interventions, sparse data are available for percutaneous peripheral atherectomy (PPA). The aim of our study was to examine the effect of hospital volume on outcomes of PPA. Methods Using the Nationwide Inpatient Sample (NIS) database of the year 2012, PPA with ICD-9 code of 17.56 was identified. The primary outcomes were mortality and amputation rates; secondary outcomes were peri-procedural complications, cost, and length of hospitalization and discharge disposition of the patient. Multivariate models were generated for predictors of the outcomes. Results We identified a total of 21,015 patients with mean age of 69.53 years, with 56% males. Higher hospital volume centers were associated with a significantly lower mortality (OR 0.42, 95% CI 0.30–0.57, p < 0.0001), amputation rates (5.34% vs. 9.32%, p < 0.0001), combined endpoint of mortality and complications (OR 0.53, 95% CI 0.49–0.58, p < 0.0001), shorter length of hospital stay (LOS) (4.86 vs. 6.79 days, p < 0.0001) and lower hospitalization cost (

High risk for obstructive sleep apnea hypopnea syndrome predicts new onset atrial fibrillation after cardiac surgery: a retrospective analysis

23,062 vs.

Stability-indicating high-performance thin-layer chromatographic method for simultaneous estimation of the active pharmaceutical ingredients metolazone and spironolactone

30,794, p < 0.0001). Subgroup analysis for acute and chronic limb ischemia showed similar results. Conclusion Hospital procedure volume is an independent predictor of mortality, amputation rates, complications, LOS, and costs in patients undergoing PPA with an inverse relationship.

High Risk for OSA: An Independent Risk Factor for Development of New-Onset Atrial Fibrillation After Cardiac Surgery

PurposeObstructive sleep apnea hypopnea syndrome (OSAHS) is highly prevalent in patients undergoing coronary artery bypass surgery (CABG). OSAHS is a risk factor for the development of atrial fibrillation (AF), but the risk of AF in patients who are high risk for OSAHS is unclear.MethodsA retrospective study was conducted on consecutive patients undergoing CABG from 2013 to 2015 without AF pre-operatively. Patients were categorized as low risk for OSAHS, high risk for OSAHS, or diagnosed OSAHS based on medical records review. All diagnosed OSAHS patients were on active treatment with positive airway pressure. Outcomes assessed were postoperative AF (POAF), postoperative length of stay, re-intubation, in-hospital mortality, and cost of hospitalization.ResultsOut of 209 eligible patients, 66.5% were low-risk for OSAHS, 18.7% high-risk for OSAHS, and 14.8% diagnosed/treated for OSAHS. POAF developed in 96 patients (45.9%) with greater frequency in high-risk OSAHS patients (69.2% high risk, 41.9% low risk, 40.3% diagnosed/treated, p = 0.01). In analyses adjusted for age, sex, ethnicity and comorbidities, high risk for OSAHS was associated with 2.9 greater odds (95% CI [1.2, 7.3], p = 0.02) for POAF while diagnosed/treated OSAHS was not associated with elevated risk (OR = 1.4, 95% CI [0.6, 3.6], p = 0.50) compared to patients at low risk for OSAHS.ConclusionsHigh risk for OSAHS is an independent predictor for POAF in patients undergoing CABG. In contrast, patients diagnosed and treated for their OSAHS are not at elevated risk of POAF. These findings support evaluation of a standardized OSAHS screening and treatment program as part of the pre-operative evaluation for elective CABG.

Impact of hospital volume on outcomes of lower extremity endovascular interventions: the better half?

This work represents the validation of a stability-indicating thin-layer chromatographic technique for the simultaneous estimation of metolazone (METO) and spironolactone (SPIRO) from marketed formulation (tablets). Thin-layer chromatography was performed using precoated silica gel plate 60 F254 using ethyl ac-etate—chloroform—GAA (5:5:0.1 v/v) as the mobile phase for the separation of METO and SPIRO. The stability study forms an integral part of the formulation development process, and its use is also encouraged by various guidelines. Stress study was performed on active pharmaceutical ingredients (APIs) as well as on formulation for establishing a stability-indicating thin-layer chromatographic method for both drugs. The APIs were subjected to change under various environmental conditions such as pH, temperature, oxidation, etc. to determine their effect on the stability of drugs. The developed method was able to resolve drugs and their degradation products formed under the aforementioned conditions. The wavelength selected for quantitation was 238 nm. The method was validated as per the International Conference on Harmonization (ICH) guidelines and found to be linear in the range of 50–300 ng spot−1 for METO and 200–1200 ng spot−1 for SPIRO. The relative standard deviation (% RSD) values of the precision study were <2% which indicated that the developed method was precise; recovery was found to be 99.02–100.58% and 99.26–100.17% for METO and SPIRO, respectively. It could be concluded from the stability study that METO was prone to acidic hydrolysis and photolysis while SPIRO was prone to alkaline degradation.

Outcomes of Peripheral Endovascular Interventions Based on Hospital Volume: a Mini Review of Published Literature

METHODS: We retrospectively analyzed the association between high-risk undiagnosed OSA and the incidence of new-onset POAF in a total of 209 patients who underwent coronary artery bypass grafting surgery with or without concomitant valvular surgery in our university-affiliated community hospital from 2013-2015. After IRB approval, baseline demographics and perioperative characteristics were obtained and study cohort divided into low, high risk and diagnosed cases of OSA. High-risk for OSA defined by presence of 3 or more criteria out of age >65 years, hypertension, presence of snoring, body mass index

TCT-797 Effect of Hospital Volume on Cost of Hospitalization and Length of Stay of Percutaneous Peripheral Atherectomy in the United States

35 kg/ m and Mallampatti score

TCT-70 In-hospital Mortality and Peri-procedural complications of Percutaneous Peripheral Atherectomy of the United States: Influence of Hospital Volume

3. A primary study outcome was new onset POAF, with secondary outcomes were in-hospital mortality, postoperative length of stay (LOS) and cost of hospitalization. Statistical analysis was performed by SAS 9.4 software with chi-square and Wilcoxon rank sum tests. A multivariate logistic model was developed for predictors of new onset POAF.