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Connective tissue disorders predispose patients to earlier aortic dissections and aneurysms. However, there is limited large cohort data given its low incidence.The National Inpatient Sample was searched for all adults with Marfans (MFS) and Ehlers Danlos (EDS) disease between 2010 and 2017. ICD codes were used to select those with a type A aortic dissection or aneurysm.There was a total of 19,567 cases, giving the estimated incidence of MFS and EDS of 18 and 22.4 per 100k people, respectively. After inclusion criteria, there were 2553 MF and 180 EDS patients. There was no statistical difference in mortality between the MFS and EDS cohorts (4.6% vs. 2.8%, p = .26). EDS patients were more likely to undergo a TEVAR procedure (2.8% vs. 1.0%, p = .03). MF patients were more likely to have a complication of acute kidney injury (p = .02). EDS patients were more likely older (50 vs. 42, p .001) and female (47% vs. 33%, p .001). MFS patients were more likely to have a type A aortic dissection (44% vs. 31%, p .001). The majority (89%) of patients were treated at urban teaching hospitals. On univariable logistic regression, aortic dissection was a predictor for mortality (odds ratio 7.31, p .001). The type of connective tissue disease was not a significant predictor.National level estimates show low mortality for patients with MF or ED presenting to the hospital with aortic dissection or aneurysm. The differences in age and gender can guide surveillance for these patient populations, leading to more elective admissions and reduced hospital mortality.

BACKGROUND Time of day for surgical procedures has been a topic of considerable controversy, with some suggesting that later operating times are associated with worse outcomes. METHODS All patients who underwent open cardiac surgery from 2011 to 2018 were included. Patients that had ventricular assist devices, heart transplant, transcatheter aortic valves, aortic dissections, and emergent operations were excluded. Primary outcomes included postoperative mortality and survival; secondary outcomes included postoperative complications and readmission. RESULTS The initial patient population consisted of 7883 patients who underwent index cardiac surgery. Following propensity matching (3:1), there were 2569 patients in the a.m. cohort (7-11 a.m.) and 860 patients in the p.m. cohort (3-11 p.m.). All baseline characteristics were matched to equivalent proportions. Total intensive care unit time following surgery was longer for the a.m. cohort (46.5 vs. 40.0 h; p

BACKGROUND The wide availability of transcatheter aortic valve replacement (TAVR) and broadening of its indications to most patients with aortic stenosis may increase its utilization in the urgent setting. However, a comparison of long-term outcomes of patients undergoing urgent TAVR when compared to elective TAVR have not been well studied. METHODS All patients that underwent TAVR from 2011 to 2018 were included. Primary outcomes included operative (30-day), 1-, and 5-year survival and readmissions. RESULTS The total patient population undergoing TAVR was divided into urgent (n = 247) and elective (n = 946) cohorts. Thirty days mortality (6.5% vs. 2.3%; p = .001), acute kidney injury (2.8% vs. 0.6%; p = .003), and length of stay (12 vs. 3 days; p

BACKGROUND Dialysis-dependent patients have a higher risk of short-term morbidity and mortality following cardiac surgery. However, longitudinal survival and readmissions in this patient population after isolated coronary artery bypass grafting (CABG) are lacking in the literature. METHODS All patients undergoing isolated CABG from 2011 to 2017 were included. Perioperative data were retrospectively extracted from a prospectively maintained cardiac surgical database with a primary focus on longitudinal mortality and readmissions. RESULTS The total study population consisted of 6874 nondialysis-dependent patients and 174 patients with dialysis dependence. Patients in the dialysis-dependent group presented a higher risk of morbidity and mortality as reflected in the Society of Thoracic Surgeons-Predicted Risk of Morbidity and Mortality (STS-PROM) (8.4% ± 9.7% vs 2.3% ± 3.9%; P

Aortic graft prostheses are susceptible to infection that can have catastrophic consequences with an operative mortality of nearly 50%. Management options include graft excision and replacement, aortic re-routing, and graft preservation techniques. This review summarizes the management of thoracic aortic graft infections.

Background The aim of this study was to evaluate hospital readmission rates and clinical outcomes between bioprosthetic (bAVR) and mechanical (mAVR) aortic valve replacements (AVR). Methods Adults aged 50 years or older undergoing isolated or concomitant AVR between 2011 and 2017 were included. The primary outcome was 5-year hospital readmission. Multivariable logistic regression analysis was used to evaluate the risk-adjusted impact of bAVR versus mAVR on outcomes. Results A total of 2981 patients were included: 406 (14%) mAVR and 2575 (86%) bAVR. Mean follow-up was 2.9 ± 1.9 years. Operative mortality was comparable (4% bAVR vs 3% mAVR; P = 0.30). There was no risk-adjusted difference in 30-day (hazard ratio [HR] 1.32, P = 0.46), 1-year (HR 1.17, P = 0.52), or 5-year mortality (HR 0.99, P = 0.93). Aortic valve 5-year reoperation rates were comparable (1%, P = 0.32). Risk-adjusted hospital readmissions were similar at 30 days (14% vs 15%; P = 0.63), 1 year (30% vs 27%; P = 0.43), and 5 years (55% vs 53%; P = 0.83) in the bAVR and mAVR groups, respectively. Similar findings were demonstrated when evaluating readmissions for bleeding (5-year readmission: 8% bAVR vs 10% mAVR; P = 0.36). Conclusions In this analysis of over 2900 AVRs, readmissions within 5 years were comparable between groups at approximately 50%, with patients being at highest risk in the early postdischarge period. Readmissions for bleeding constituted a minority of all readmissions for both cohorts.

A 58-year-old man with multiple myeloma, prior bioprosthetic valve, spinal hardware and multiple episodes of Corynebacterium amycolatum bacteremia was found to have a well-seated valve without vegetations, paravalvular leak, abscess or degeneration over a period of 6 months on five separate transesophageal echocardiographic studies. Computed tomography angiography was performed which revealed vegetation at the level of the left ventricular outflow tract. Reoperative sternotomy and interrogation of the valve confirmed a 1.5-cm vegetation with the same bacterium. The patient underwent a redo aortic valve replacement and recovered without any complications. He has been asymptomatic and culture negative on surveillance.