Objectives The United States has the highest number of Coronavirus Disease 2019 (COVID-19) in the world, with high variability in cases and mortality between communities. We aimed to quantify the associations between socioeconomic status and Coronavirus Disease 2019 (COVID-19) related cases and mortality in the U.S. Study Design: Nationwide COVID-19 data at the county level that was paired with the Distressed Communities Index (DCI) and its component metrics of socioeconomic status. Methods Severely distressed communities were classified by DCI>75 for univariate analyses. Adjusted rate ratios were calculated for cases and fatalities per 100,000 persons using hierarchical linear mixed models. Results This cohort included 1,089,999 cases and 62,298 deaths in 3,127 counties for a case-fatality rate of 5.7%. Severely distressed counties had significantly fewer deaths from COVID-19, but higher number of deaths/100,000. In risk-adjusted analysis, the two socioeconomic determinants of health with the strongest association with both higher cases/100,000 and higher fatalities/100,000 were percent of adults without a high school degree (cases: RR 1.10; fatalities: RR 1.08) and proportion of black residents (cases and fatalities: RR 1.03). The percentage of the population over 65 was also highly predictive for fatalities/100,000 (RR 1.07). Conclusion Lower education levels and greater percentages of black residents are strongly associated with higher rates of both COVID-19 cases and fatalities. Socioeconomic factors should be considered when implementing public health interventions in order to ameliorate the disparities in the impact of COVID-19 on distressed communities.

Background Obtaining National Institutes of Health (NIH) funding over the last 10 years has become increasingly difficult due to a decrease in the number of research grants funded and an increase in the number of NIH applications. Study Design NIH funding amounts and success rates were compared for all disciplines using data from NIH, FASEB, and Blue Ridge Medical Institute. Next, all NIH grants (2006–16) with surgeons as principal investigators were identified using NIH RePORTER and a grant impact score was calculated for each grant based on the publications’ impact factor per funding amount. Linear regression and one-way ANOVA were used for analysis. Results The number of NIH grant applications has increased by 18.7% (p=0.0009), while the number of funded grants (p < 0.0001) and R01s (p < 0.0001) across the NIH has decreased by 6.7% and 17.0%, respectively. The mean success rate of funded grants with surgeons as principal investigators (16.4%) has been significantly lower than the mean NIH funding rate (19.2%) (p = 0.011). Despite receiving only 831 R01’s during this time period, surgeon scientists were highly productive with an average grant impact score of 4.9 per $100,000, which increased over the last 10 years (0.15 ± 0.05 /year, p=0.02). Additionally, the rate of conversion of surgeon scientist mentored K awards to R01’s from 2007–12 was 46%. Conclusions Despite the declining funding over the last 10 years, surgeon scientists have demonstrated increasing productivity measured by impactful publications and higher success rates in converting early investigator awards to R01s.

Redo mitral valve surgery accounts for approximately 10% of mitral valve operations and is associated with increased risk and resource utilisation. However, as the volume of redo mitral surgery increases, outcomes have dramatically improved and are now better than predicted.

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PRBC transfusion appears to be more closely associated with risk-adjusted morbidity and mortality compared with preoperative Hct level alone, supporting efforts to reduce unnecessary PRBC transfusions. Preoperative anemia independently increases the risk of postoperative morbidity and mortality. These data suggest that preoperative Hct should be included in the STS risk calculators. Finally, efforts to optimize preoperative hematocrit should be investigated as a potentially modifiable risk factor for mortality and morbidity.

Psoas index is an easily obtained and reproducible measure of frailty that predicts risk-adjusted resource utilization, morbidity, and long-term mortality. Psoas index may improve procedural selection and risk adjustment in high-risk patients with aortic valve disease.

Objectives: Institutional studies suggest robotic mitral surgery may be associated with superior outcomes. The objective of this study was to compare the outcomes of robotic, minimally invasive (mini), and conventional mitral surgery. Methods: A total of 2,351 patients undergoing non-emergent isolated mitral valve operations from 2011–2016 were extracted from a regional Society of Thoracic Surgeons database. Patients were stratified by approach: robotic(n=372), mini(n=576) and conventional sternotomy(n=1352). To account for preoperative differences, robotic cases were propensity score matched (1:1) to both conventional and mini approaches. Results Robotic cases were well matched to conventional (n=314) and mini (n=295) with no significant baseline differences. Rates of mitral repair were high in the robotic and mini cohorts (91%), but significantly lower with conventional (76%, p<0.0001) despite similar rates of degenerative disease. All procedural times were longest in the robotic cohort, including operative time (224 vs 168 minutes conventional, 222 vs 180 minutes mini; all p<0.0001). Robotic approach had comparable outcomes to conventional except fewer discharges to a facility (7% vs 15%, p=0.001) and 1 less day in the hospital (p<0.0001). However, compared to mini, robotic approach had higher transfusion (15% vs 5%, p<0.0001), atrial fibrillation rates (26% vs 18%, p=0.01) and 1 day longer average hospital stay (p=0.02). Conclusion: Despite longer procedural times, robotic and mini patients had similar complication rates with higher repair rates and shorter length of stay metrics compared to conventional surgery. However, robotic approach is associated with greater atrial fibrillation, transfusion and longer postoperative stays compared to minimally invasive approach.

The need for PPM after aortic valve replacement independently reduces long-term survival. The rate of PPM placement after surgical aortic valve replacement remains very low but dramatically increases resource utilization. As transcatheter aortic valve replacement expands to low-risk patients, the impact of PPM placement on long-term survival warrants close monitoring.