Research Spotlight

Sudhakaran, S., Tandon, A., Rafael, A.E. and Choi, J.W. (2021). “Severe Mitral Paravalvular Leak Treated with Percutaneous Paravalvular Leak Closure with Underlying Severe Mitral Annular Calcium.” Am J Cardiol Jun 20;S0002-9149(21)00425-2. [Epub ahead of print].

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Standard operative mitral valve replacement for mitral stenosis in the setting of severe mitral annular calcium has been associated with increased morbidity and mortality. Inability to ensure a well seated prosthesis may lead to periprosthetic leak. We present a case of severe paravalvular leak, causing significant hemolysis, after mitral valve replacement with underling severe mitral annular calcium. The leak was successfully repaired using a transseptal percutaneous approach, with subsequent resolution of hemolysis.

Stevens, A.B., Cho, J., Thorud, J.L., Abraham, S., Ory, M.G. and Smith, D.R. (2021). “The community-based LIVE WELL Initiative: Improving the lives of older adults.” J Prev Interv Community Jun 22;1-20. [Epub ahead of print]. 1-20.

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A collaborative partnership among community-based organizations (CBOs) could strengthen local services and enhance the capacity of a community to provide services as well as meet the diverse needs of older adults. The United Way of Tarrant County developed the LIVE WELL Initiative, partnering with six CBOs to provide nine evidence-based or evidence-informed health interventions to improve the health and lower healthcare costs of vulnerable individuals at risk for poor health. The nine programs include specific target areas, such as falls prevention, chronic disease self-management, medication management, and diabetes screening and education. A total of 63,102 clients, nearly 70% of whom were older adults, were served through the Initiative. Significant improvements in self-reported health status were observed among served clients. The percentage of clients reporting self-rated health as good, very good, and excellent increased from 47.5% at baseline to 61.1% at follow-up assessment. The mean healthy days improved from 16.9 days at baseline to 20.6 days at follow-up assessment. Additional improvements in program-specific outcomes demonstrated significant impacts of targeted intervention focus among served clients by program. The findings of this study emphasize that the impact of a collaborative partnership with multiple CBOs could promote health and well-being for older adults.

Squiers, J.J., DiMaio, J.M., Van Zyl, J., Lima, B., Gonzalez-Stawisnksi, G., Rafael, A.E., Meyer, D.M. and Hall, S.A. (2021). “Long-term outcomes of patients with primary graft dysfunction after cardiac transplantation.” Eur J Cardiothorac Surg Jun 7;ezab177. [Epub ahead of print].

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OBJECTIVES: The International Society of Heart and Lung Transplantation (ISHLT) criteria for primary graft dysfunction (PGD) after cardiac transplantation have been shown to stratify patient outcomes up to 1 year after transplantation, but scarce data are available regarding outcomes beyond the 1st year. We sought to characterize survival of patients with PGD following cardiac transplantation beyond the 1st year. METHODS: A retrospective review of consecutive patients undergoing isolated cardiac transplantation at a single centre between 2012 and 2015 was performed. Patients were diagnosed with none, mild, moderate or severe PGD by the ISHLT criteria. Survival was ascertained from the United Network for Organ Sharing database and chart review. Kaplan-Meier curves were plotted to compare survival. The hazard ratio for mortality associated with PGD severity was estimated using Cox-proportional hazards modelling, with a pre-specified conditional survival analysis at 90 days. RESULTS: A total of 257 consecutive patients underwent cardiac transplantation during the study period, of whom 73 (28%) met ISHLT criteria for PGD: 43 (17%) mild, 12 (5%) moderate and 18 (7%) severe. Patients with moderate or severe PGD had decreased survival up to 5 years after transplantation (log-rank P < 0.001). Landmark analyses demonstrated that patients with moderate or severe PGD were at increased risk of mortality during the first 90-days after transplantation as compared to those with none or mild PGD [hazard ratio (95% confidence interval) 18.9 (7.1-50.5); P < 0.001], but this hazard did not persist beyond 90-days in survivors (P = 0.64). CONCLUSIONS: A diagnosis of moderate or severe PGD is associated with increased mortality up to 5 years after cardiac transplantation. However, patients with moderate or severe PGD who survive to post-transplantation day 90 are no longer at increased risk for mortality as compared to those with none or mild PGD.

Shore, N.D., Palou Redorta, J., Robert, G., Hutson, T.E., Cesari, R., Hariharan, S., Rodríguez Faba, Ó., Briganti, A. and Steinberg, G.D. (2021). “Non-muscle-invasive bladder cancer: An overview of potential new treatment options.” Urol Oncol Jun 21;S1078-1439(21)00221-0. [Epub ahead of print].

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AIM: This review article summarizes the current clinical practice guidelines around disease definitions and risk stratifications, and the treatment of non-muscle-invasive bladder cancer (NMIBC). Recently completed and ongoing clinical trials of novel and investigational therapies in Bacillus Calmette-Guérin (BCG)-naïve, BCG-recurrent, and BCG-unresponsive patient populations are also described, e.g., those involving immune checkpoint inhibitors, targeted therapies, other chemotherapy regimens, vaccines, and viral- or bacterial-based treatments. Finally, a brief overview of enhanced cystoscopy and drug delivery systems for the diagnosis and treatment of NMIBC is provided. BACKGROUND: A global shortage of access to BCG is affecting the management of BCG-naïve and BCG-recurrent/unresponsive NMIBC; hence, there is an urgent need to assist patients and urologists to enhance the treatment of this disease. METHODS: Searches of ClinicalTrials.gov, PubMed, and Google Scholar were conducted. Published guidance and conference proceedings from major congresses were reviewed. CONCLUSION: Treatment strategies for NMIBC are generally consistent across guidelines. Several novel therapies have demonstrated promising antitumor activity in clinical trials, including in high-risk or BCG-unresponsive disease. The detection, diagnosis, surveillance, and treatment of NMIBC have also been improved through enhanced disease detection.

Shih, E., Squiers, J.J., DiMaio, J.M., George, T., Banwait, J., Monday, K., Blough, B., Meyer, D. and Schwartz, G.S. (2021). “Outcomes of Extracorporeal Membrane Oxygenation in Patients with Severe Acute Respiratory Distress Syndrome Caused by COVID-19 versus Influenza.” Ann Thorac Surg Jun 14;S0003-4975(21)01033-X. [Epub ahead of print].

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BACKGROUND: Extracorporeal membrane oxygenation (ECMO) can be effective for refractory acute respiratory distress syndrome (ARDS) in patients with influenza, but its utility in patients with COVID-19 is uncertain. We compared outcomes of patients with refractory ARDS from COVID-19 and Influenza placed on ECMO. METHODS: We conducted a retrospective analysis of 120 patients with refractory ARDS due to COVID-19 or Influenza placed on ECMO at two referral centers from 1/2013 to 10/2020. Patient characteristics and clinical outcomes were compared. The primary endpoint was survival to discharge. RESULTS: Baseline characteristics and comorbidities were similar. During the study period, 53 patients with COVID-19 and 67 patients with Influenza were supported. Veno-venous ECMO was the predominant initial cannulation strategy in both groups (COVID 92.5% vs Influenza 95.5%; p=0.5). Survival to hospital discharge was 62.3% (33/53 patients) in the COVID-19 group and 64.2% (43/67) in the Influenza group (p=0.8). In patients successfully decannulated, median length of time on ECMO was longer in COVID-19 patients (14 days [IQR 9-30] vs. Influenza 10.5 [IQR 6.8-14.3] days, p=0.004). Among patients discharged alive, COVID-19 patients had longer overall length of stay (COVID 37 [IQR 27-62] vs Influenza 13.5 [IQR 9.3-24] days; p=0.007). CONCLUSIONS: In patients with refractory ARDS from COVID-19 or Influenza placed on ECMO, there was no significant difference in survival to hospital discharge. In patients surviving to decannulation, the duration of ECMO support and total length of stay were longer in COVID-19 patients.