Elsisy, Mohamed

Background Transcatheter closure of patent ductus arteriosus (PDA) in small, premature infants is increasingly performed in the contemporary practice. Data regarding optimal timing of PDA closure are scarce. We therefore decided to compare morbidity and mortality of early and late device closure in preterm infants. Methods Hospitalizations of 166,583 newborn infants diagnosed with PDA were identified from the Kids’ Inpatient Database (KID) in 2009, 2012, 2016, and 2019. Of these, 299 preterm infants (gestational age (GA) ≤32 weeks, birth weight <1500 grams) underwent percutaneous PDA closure. Characteristics and periprocedural outcomes were compared between early (≤30 days) ( n = 120) and late PDA closure (>30 days) ( n = 179). Results Mean age (±standard deviation) for early PDA closure was 18.6 days ± 7 and 67.3 days ± 36.5 in late PDA closure. Comorbidities including respiratory distress syndrome/bronchopulmonary dysplasia, heart failure, and pulmonary hypertension were comparable between the two groups. There was no difference in mortality or referral for surgical ligation between early and late closure. Postprocedural vascular complications were low, but higher in patients with early PDA closure (3.3% vs 0%; p = 0.025). While the total length of hospital stay was longer in late PDA closure group (121.1 days ± 51.7 vs 81.5 days ± 48.8; p = <0.01), postprocedural length of stay was paradoxically longer in the early closure group (69 days ± 43.6 vs 57.5 days ± 43, p = 0.03). Conclusion There was no statistical difference in in-hospital mortality; however, there is a trend toward higher mortality in the early closure group. Major periprocedural complications are comparable between early and late PDA closure, except vascular complications that were higher with early PDA closure.

Abstract Background Transcatheter closure of patent ductus arteriosus (PDA) in small, premature infants is increasingly performed in the contemporary practice. Data regarding optimal timing of PDA closure are scarce. We therefore decided to compare morbidity and mortality of early and late device closure in preterm infants. Methods Hospitalizations of 166,583 newborn infants diagnosed with PDA were identified from the Kids’ Inpatient Database (KID) in 2009, 2012, 2016, and 2019. Of these, 299 preterm infants (gestational age (GA) ≤32 weeks, birth weight <1500 grams) underwent percutaneous PDA closure. Characteristics and peri-procedural outcomes were compared between early (≤ 30 days) (n=120) and late PDA closure (>30 days) (n=179). Results Mean age (±standard deviation) for early PDA closure was 18.6 days ± 7 and 67.3 days ± 36.5 in late PDA closure. Co-morbidities including respiratory distress syndrome/bronchopulmonary dysplasia, heart failure and pulmonary hypertension were comparable between the two groups. There was no difference in mortality or referral for surgical ligation between early and late closure. Post-procedural vascular complications were low, but higher in patients with early PDA closure (3.3% vs 0%; p=0.025). Length of hospital stay was longer in late PDA closure group (121.1 days ± 51.7 vs 81.5 days ± 48.8; p=<0.01). Conclusion Preterm or very low birth weight infants may benefit from early percutaneous PDA closure as it is associated with a shorter hospital LOS. There was no difference in in-hospital mortality or major periprocedural complications between early and late PDA closure, except vascular complications that were higher with early PDA closure.

Introduction: Patients with systemic lupus erythematosus (SLE) are at increased cardiovascular risk. Data about outcomes after cardiac surgery are scarce. Hypothesis: We sought to evaluate early and late outcomes after cardiac surgery for patients with SLE during a 27- year period at a single institution. Methods: A retrospective review of the institutional Society of Thoracic Surgeons (STS) database between 1993 and 2019 was performed. A total of 329 patients with SLE (median age, 62.4 years, and 68.4% females) had undergone cardiac surgery. Patients’ characteristics and outcomes were analyzed. A logistic regression model was used to assess factors associated with mortality. Results: Incidence of cardiac surgery in patients with SLE has steadily increased with time (0.8% from 1993-2000, 0.9% from 2001-2010, 1.4% from 2011-2019). Of 329 patients, 166 patients (50.5%) had valve surgery, 82 patients (24.9%) had coronary artery bypass grafting (CABG), 48 patients (14.6%) had CABG + valve surgery, and 24 patients (7.3%) had pericardiectomy or pericardial window +/- others procedures. Patients with SLE were more likely to be females, white, older, and have hypertension, diabetes, dyslipidemia, chronic kidney disease, prior myocardial infarction, and congestive heart failure. The requirement of corticosteroids occurred in 91% of patients. The status of surgery was urgent or emergent in 20% of patients. Operative mortality was 4.6% and length of hospital stay was 6.1 days [IQR, 5.1, 9.2]. Overall long-term survival at 1, 5, and 10 years was 89%, 73% and 52%, respectively (Figure). Older age, re-operative dialysis, chronic lung disease, prior cardiac surgery, and dialysis required after surgery were strongly associated with long-term mortality. Conclusion: Cardiac surgery in SLE patients can be performed with acceptable morbidity and mortality. These data are beneficial in risk stratification of patients with SLE referred for cardiac surgery.

Abstract OBJECTIVES Delayed sternal closure (DSC) after cardiac surgery is a temporizing measure to address coagulopathy or haemodynamic instability after cardiac surgery. We sought to study: (i) indications and temporal trends for DSC, (ii) factors associated with time to chest closure and (iii) its impact on short-term and long-term outcomes. METHODS From January 2007 to December 2017, 494 patients (median age 67 years, 66% males) required DSC after cardiac surgery. Medical records were reviewed for indications, risk factors, time to DSC and outcomes. Multivariable Cox regression via landmark analysis of 486 5-day survivors was used to investigate the impact of time to chest closure on early and late survival. RESULTS Coagulopathy and haemodynamic instability were the most common indications. Median time to chest closure was 2 days. Pre-/intraoperative extracorporeal membranous oxygenation, severe right ventricular dysfunction and diabetes mellitus were associated with longer time to chest closure. Longer time to closure was associated with increased risk of operative complications and operative mortality, but did not have a statistically significant association with late mortality. Increasing age, pulmonary hypertension and a greater number of prior sternotomies were also found to be associated with overall mortality. CONCLUSIONS While longer time to chest closure was associated with increased rates of operative complications and operative mortality, it did not reveal a statistically significant association with long-term survival.