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Objective: The purpose of this study is to evaluate patterns of failure after stereotactic body radiation therapy for early stage NSCLC and determine the role of salvage therapy on patient outcome.Methods: Eighty-two consecutive medically inoperable patients treated with definitive SBRT for early-stage NSCLC were examined. Ninety-four percent of patients had biopsy proven disease, the remainder refused. The median biologic effective dose (BED) for the cohort was 100 Gy (range, 78-180 Gy). Recurrence was defined clinically by RECIST and FDG-PET or by pathologic diagnosis. Results:The estimated median survival for the entire cohort was 29.2 months (range, 1 -40.3). The estimated 2 year overall survival (OS) was 65%. The 2 year local recurrence free survival, locoregional recurrence free survival and distant metastatic free survival were 89%, 78% and 72%, respectively. Of those with locoregional failure, ten were treated with salvage SBRT at a median time of 10 months from prior SBRT. Six patients were treated with systemic chemotherapy and 2 patients were offered palliative care. All patients treated with salvage SBRT remained controlled at a median time of 12 months. Treatment was well tolerated with 2 patients experiencing grade 2 pneumonitis, 1 patient experiencing grade 3 chest wall pain and 1 with rib fracture. OS was compared between 3 subgroups: no locoregional failure (n = 65), locoregional failure without SBRT salvage (n = 7) and locoregional failure with SBRT salvage (n = 10). The estimated median survival 31.3 months, 14.3 months and 29.9 months, respectively (p = 0.007). Conclusion:In our single institution patient cohort, SBRT in the salvage setting for locoregional recurrences after initial definitive SBRT for early-stage NSCLC is a potential option. Additional prospective data is needed.

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Introduction: Fluoroscopic-guided endomyocardial biopsy (FGEB) of the right ventricle is the most common method for rejection surveillance among heart transplant recipients. Echocardiogram guided endomyocardial biopsy (EGEB) has been shown to be a safe alternative, but not widely adopted, in part due to perceived longer procedural time. Hypothesis: EGEB is has comparable total procedural and biopsy time compared to FGEB and significantly lowers radiation exposure. Methods: A single center retrospective study was performed on patients who underwent biopsy via right internal jugular vein approach from 1/1/15 to 2/1/19. Biopsy time was time of bioptome insertion to sheath removal. Total procedure time was from physician entrance to exit into procedure lab. Results: 100, patients, 487 biopsies. The mean biopsy time of EGEB was similar to FGEB; 30.0 ± 10.2 min (95% CI: 27.9-32.1 min) to 29.7 ± 9.91 min (95% CI: 28.7 - 30.7 min) respectively, p = 0.73. The mean total procedural time of the EGEB was similar to FGEB; 70.3 ± 18.9 min (95% CI: 34-125 min) to 73.4 ± 18.5 min (95% CI: 21 - 129 min), p = 0.102. Mean fluoroscopy time for EGEB was lower than FGEB; 1.78 min (95% CI: 1.4-2.2 min) vs 5.53 min (95% CI: 5.22-5.83 min) p < 0.0001. A mixed model analysis of mean fluoroscopy time was performed to account for the same patients receiving multiple endomyocardial biopsies, sometimes by different guidance, showed a difference of 1.89 mins less with EGEB than FGEB (p < 0.0001). Conclusions: EGEB has similar biopsy and total procedural time but significantly reduced fluoroscopy time. EGEB should be routinely considered in patients for endomyocardial biopsy.

Background Most guidelines directing clinicians to manage valve disease are directed at single valve lesions. Limited data exists to direct our understanding of how concomitant valve disease impacts the left ventricle (LV). Methods We identified 2817 patients with aortic stenosis (AS) from the echocardiography laboratory database between September 2012 and June 2018 who had a LV ejection fraction (EF) ≥50%. LV mass, LV mass index, LV systolic pressure (systolic blood pressure + peak aortic gradient). Covariates were collected from the electronic medical record. Multi‐variate analysis of covariance was used to generate adjusted comparisons. Results Our population was 66% female, 17% African‐American with a mean age of 65 years. Of note, 7.3% were noted to have significant (moderate/severe) aortic regurgitation (AR), and 11% had significant (moderate/severe) mitral regurgitation (MR). Adjusting for covariates at different levels, significant MR had a much stronger association with heart failure compared to those with significant AR (p < .001 vs. p = .313, respectively) at all levels of adjustment. Both significant mitral and AR exhibited an association with increasing left ventricular mass, even with adjustment for baseline demographics and clinical features (p < .001 vs. p = .007, respectively). Conclusion In patients with AS, 16% also experience at least moderate MR or AR. Further, significant MR has a stronger association with heart failure than significant AR, even though both increase left ventricular mass. Those with moderate AS and significant MR or AR experience similar or higher levels of heart failure compared to severe AS without regurgitation. Mixed valve disease merits further studies to direct longitudinal management.