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Open in new tab Download slide OBJECTIVES This population-based cohort study investigated mid-term outcome after surgical aortic valve replacement with a bioprosthetic or mechanical valve prosthesis in patients aged <50 years in a European social welfare state. METHODS We analysed patient data from the main social insurance carriers in Austria (2010–2020). Subsequent patient-level record linkage with national health data provided patient characteristics and clinical outcome. Survival, reoperation, myocardial infarction, heart failure, embolic stroke or intracerebral haemorrhage, bleeding other than intracerebral haemorrhage and major adverse cardiac events were evaluated as outcomes. RESULTS A total of 991 patients were analysed. Regarding demographics, no major differences between groups were observed. Multivariable Cox regression revealed no significant difference in overall survival (P  = 0.352) with a median follow-up time of 6.2 years. Reoperation-free survival was decreased (hazard ratio = 1.560 [95% CI: 1.076–2.262], P  = 0.019) and the risk for reoperation was increased (hazard ratio = 2.770 [95% CI: 1.402–5.472], P  = 0.003) in patients who received bioprostheses. Estimated probability of death after reoperation was 0.23 (CL: 0.08–0.35) after 2 years and 0.34 (CL: 0.06–0.53) after 10 years over both groups. Regarding further outcomes, no significant differences between the two groups were observed. CONCLUSIONS In patients below 50 years of age receiving aortic valve replacement, implantation of bioprostheses when compared to mechanical heart valve prostheses was associated with a significantly higher rate of reoperations and reduced reoperation-free survival. Nevertheless, we could not observe a difference in overall survival. However, long-term follow-up has to evaluate that a significantly lower rate of reoperations may translate in consistently improved long-term survival. [ABSTRACT FROM AUTHOR]

Primary graft dysfunction of the transplanted lung still is a serious problem and greatly impacts outcome. Despite medical and technological progress, primary graft dysfunction continues to be a leading cause of morbidity and mortality in recipients, necessitating early intervention. Assessment of lung function post-transplantation, particularly static compliance, emerges as a promising indicator of short-term outcomes. We, therefore, investigated whether static compliance determined immediately after lung transplantation for end-stage pulmonary failure is predictive of 30-day mortality. In this single-centre retrospective investigation we analysed data from 755 consecutive patients who underwent orthotopic lung-transplantation between the years 2014 and 2023. The primary endpoint was 30-day mortality. Patients older than 18 years of age undergoing lung transplantation were eligible for inclusion. Patients who underwent single lung transplantation, multi-organ transplantation, or re-transplantation were excluded from the analysis. Respiratory parameters for calculating static compliance were collected after chest closure and muscle relaxation at the end of surgery. Lung-protective ventilation strategies were applied whenever feasible. Univariate and multivariate analyses were conducted and Receiver Operating Characteristic curves constructed. Results Two hours after surgery, 695 of the 755 patients (65%), were classified as having primary graft dysfunction grade 0, 30 patients (4%) were classified as grade 1, 40 patients (5%) received a grade 2 classification, 91 patients (12%) a grade 3, and 85 patients (11%) were categorized as ungradable. In this huge cohort we observed a thirty-day mortality of 1.9%. Increased static compliance was predictive for 30-day survival with an acceptable area under the curve of 0.735 (95% CI: 0.5-0.9; p=0.003). Moreover, a static compliance below 25 mL/mbar had a statistically increased hazard ratio of 6.0 (95% CI: 1.3-27.0; P=0.005) for 30-day mortality. As determined in this study, static compliance measured immediately after lung transplantation could serve as a predictive marker for short-term outcome. Integrating this measure into clinical practice could potentially improve risk stratification and guide early interventions. Nevertheless, further prospective studies are needed for validation of this data and for a better understanding of the underlying pathophysiology. [ABSTRACT FROM AUTHOR]

Competing Interests: Declaration of competing interest The authors declare no conflicts of interest.

In intensive care units (ICU), patients who are not able to eat or are considered at nutritional risk typically receive medical nutrition therapy based on partially contradictory guidelines as well as the strategies used in large randomized trials. The aim of this study is to analyze patient data from the nutritionDay project in intensive care to describe current clinical approaches to nutrition support worldwide, in Europe and in the group of German-speaking countries, the DACH (i.e., Germany, Austria, Switzerland) region. From 2007-2021, data of 18,918 adult patients in 1595 ICUs from 63 different countries were included in this cross-sectional study. The aim was to recruit all patients present in ICUs. Median stay in the ICU was 4 days on nutritionDay. Little difference in patient characteristics were observed between worldwide, Europe, and the DACH region. Patient were 64 years old, 40% female, 50% ventilated, 29% sedated, and 10% needed renal replacement therapy. A quarter of the patients died in hospital within 60 days and about half of the patients had been discharged home. Enteral nutrition was given twice as frequently as parenteral nutrition (48% versus 24%). Many patients received oral nutrition (39%) and a substantial number received no nutrition support (10%). Parenteral nutrition was used more frequently in Europe than in other world regions, the lowest use being observed in North America. The amount of nutrition given is very similar in all regions regardless of the nutrition route with about 1500 kcal and 60 g of protein per day. A clear association with body weight was not observed and the variation around the median was very large with half of patients receiving amounts 25% below or above the median. Upon completion of data entry, the nutritionDay project allows each ICU to download a unit report summarizing data that allows comparison with worldwide data in numeric and graphical form to permit easy benchmarking of medical nutrition therapy., (© 2023. The Author(s).)