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Background Although cardiovascular mortality (CVM) rates in the United States have been declining overall, our study evaluated whether this holds true for areas with increased social deprivation. Methods and Results We used county‐level cross‐sectional age‐adjusted CVM rates (aa‐CVM) (2000–2019) linked to the Centers for Disease Control and Prevention Social Vulnerability Index (SVI–2010). We grouped counties as per SVI (Groups I 0–0.2, II 0.21–0.4, III 0.41–0.6, IV 0.61–0.8, and V 0.81–1) and calculated the relative change in the aa‐CVM between 2000 to 2003 and 2016 to 2019. We used adjusted linear regression analyses to explore the association between a higher SVI and temporal aa‐CVM improvement; we studied this temporal change in aa‐CVM across subgroups of race, sex, and location. The median aa‐CVM rate (per 100 000) was 272.6 (interquartile range [IQR]: 237.5–311.7). The aa‐CVM was higher in men (315.6 [IQR: 273.4–363.9]) than women (221.3 [IQR: 189.6–256.7]), and in Black residents (347.2 [IQR: 301.1–391.1]; P

Aortic valve replacement in patients with dextrocardia and situs inversus totalis is technically challenging due to anatomical considerations. Modifications of the cannulation strategy and operative tool sets are helpful. We report a 47-year-old man who had dextrocardia with situs inversus totalis with severe aortic regurgitation. Our approach was precisely planned depending on the clear anatomy outlined by preoperative contrast-enhanced computed tomography of the chest. We used a surgical approach in which the main surgeon was standing on the left side of the patient. Left sided approach provided excellent exposure for aortic valve replacement in this case scenario.

Ischemic stroke following cardiac surgery is one of the devastating complications that surgeons may encounter, and may lead to serious disabilities for the patient. The clinical course of such a complication may be prolonged if it is not treated properly. Making a quick decision when choosing a revascularization method is very helpful in this matter. Effective treatment options are usually limited. Neurointerventional maneuvers have recently emerged as a possible therapeutic modality in this field. We present the case of a 52-year-old woman who had open heart surgery in Queen Alia Heart Institute, Jordan, to replace a severely stenotic rheumatic mitral valve and repair a leaking tricuspid valve. Her surgery went smoothly with no major event. However, she developed a massive ischemic stroke during her recovery period despite being on adequate anticoagulation therapy. Urgent radiological work-up confirmed the diagnosis of ischemic stroke in the territory of the right middle cerebral artery. We chose a neuro-interventional method for her treatment, and mechanical thrombectomy was performed with a successful outcome and no apparent complications.

Therapeutic Area: ASCVD/CVD Risk Reduction Background: Increased place-based social deprivation is known to be associated with higher cardiovascular mortality (CVM) rates. While CVM rates in the US have been declining overall, our study evaluated whether this holds true for areas with increased social deprivation. Methods: In this cross-sectional study, we used county-level CVM rates between 2000 and 2019 and linked it to the CDC Social Vulnerability Index (SVI), and analyzed data from 3052 counties nationwide. We grouped counties as per their SVI (Group I 0 - 0.2, Group II 0.21 - 0.4, Group III 0.41 - 0.6, Group IV 0.61 - 0.8,and Group V 0.81 – 1) and obtained the relative change in the age adjusted CVM between 2000-2003 and 2016-2019. We studied the temporal change in CVM across SVI groups, overall and separately according to race (white vs black), sex (men vs women) and county location (metro vs non-metro). We used adjusted linear regression analyses to explore the association between increasing SVI and the relative change in CVM. Results: The median county-level age-adjusted CVM (aa-CVM) rate (per 100,000) overall was 272.6 [IQR: 237.5, 311.7]. Men (315.6 [IQR: 273.4, 363.9]) had higher aa-CVM rates than women (221.3 [IQR: 189.6, 256.7]), and blacks (347.2 [IQR: 301.1, 391.1]) had higher aa-CVM rates than whites (258.9 [IQR: 226, 299.1], p < 0.001). The aa-CVM for SVI I (233.6 [IQR: 214.8, 257.0]) was significantly higher than group V (323.6 [IQR: 277.2, 359.2], p < 0.001). The relative reduction in CVM was significantly higher for SVI group I (32.2% [IQR: 24.2%, 38.4%]) than SVI group V (27.2% [IQR: 19%, 34.1%]) counties. An increasing SVI index was associated with lower relative percent decline in the age-adjusted CVM (model coefficient -6.01 [0.73], p < 0.001). Conclusions: We observed higher age-adjusted CVM in more socially deprived counties in the US. While the overall age-adjusted CVM has declined in the past 20 years, this improvement is substantially lesser in more socially deprived counties.