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Background Transcatheter aortic valve replacement (TAVR) has emerged as an alternative treatment for aortic stenosis in patients who are at moderate to high risk for surgical aortic valve replacement. The use of conscious sedation (CS) as compared with general anesthesia (GA) has shown better clinical outcomes for TAVR patients. Whether CS has any cost-benefit is still unknown. We analyze our local TAVR registry with a focus on the cost comparison between CS and GA for the TAVR population. Methods It is a retrospective chart review of 434 patients who received TAVR at our local center from December 2012 to April 2018. Patients who had their procedure aborted and those requiring a cardiopulmonary bypass or surgical conversion (16 patients) were excluded. The final sample size was 418. Patients were divided into two groups based on whether they received CS or GA. Primary outcomes were intensive care unit (ICU) hours, length of stay in hospital, readmission, or death at 30 days. The secondary outcome was the cost of TAVR admission. The cost was divided into direct and indirect costs. The student's T-test and chi-square tests were used for continuous and categorical variables, respectively. Adjusted logistic regression and multivariate analyses were run for primary and secondary outcomes. Results Of the 418 patients (age: 80.9±8.5, male: 52%) CS was given to 194 patients (46.4%) while GA was given in 224 patients(53.6%). The GA group had comparatively older age (81.8 vs. 80.0; p=0.03) and a higher average Society of Thoracic Surgery (STS) score (8.4 vs 5.7; p<0.001). Patients who received CS had a significantly shorter ICU stay (31.5 vs. 41.6 hours, p<0.001) and total days in the hospital (2.9 vs. 3.8 days, p=0.01). Readmission and mortality at 30 days were not different between the groups. There was no statistical difference in cost between the two groups ($72,809 vs. $71,497: p=0.656). Conclusion Using CS compared with GA improves morbidity for TAVR patients, in the form of ICU stay and the total length of stay in hospital. We did not find a significant difference in the cost of TAVR admission between CS and GA.

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Background: Transcatheter aortic valve replacement (TAVR) can be complicated with a high-degree atrioventricular block requiring a permanent pacemaker (PPM) in 5% - 25% of patients. Association between body mass index (BMI) and pacemaker implantation has not been extensively studied. We compared standard BMI classes with the odds of requiring a PPM implantation in patients undergoing TAVR with Edwards SAPIEN™ 3 valves (ESV3) (Edwards Lifesciences, Irvine, CA, USA). Methods: Our study involved a single-center retrospective cohort analysis of 449 patients undergoing TAVR from December 2012 to April 2018. First, we excluded patients with a TAVR procedure done with valves other than the ESV3 (127 patients). Second, patients with a prior PPM or an implantable cardioverter-defibrillator (37 patients) were excluded. Finally, patients with an aborted procedure and surgical conversion were excluded (16 patients). The final sample size was 269. The primary outcome was pacemaker implantation. Statistical analysis was done using the Chi-square test, T-test, and adjusted logistic regression. Results: Of the 269 patients (50.6% males; mean age of 79.5 ± 8.7 years; mean Society of Thoracic Surgeons (STS) score: 6.2), pacemaker implantation was performed in 17 patients (6.3%). Time to pacemaker implantation was 1.3 days. Patients were divided into four categories based on their BMI: as underweight (BMI < 25; 67 patients), normal (BMI: 25 to ≤ 30; 87 patients), overweight (BMI: 30 to ≤ 35; 60 patients), and obese (BMI ≥ 35; 55 patients). Pacemaker implantation was significantly higher in patients with a BMI of > 30 (13 vs. 4, p = 0.037). After logistic linear regression, the odds of getting a PPM after TAVR were significantly higher in patients who were overweight (odds ratio (OR): 12.77, p = 0.024; confidence interval (CI): 1.39 - 17.25) and obese (OR: 15.02, p = 0.036, CI: 1.19 - 19.92). Conclusions: Our study demonstrates that increased BMI is a possible risk factor for a high-degree atrioventricular block in patients receiving ESV3.

Background Transcatheter aortic valve replacement (TAVR) can be complicated with a complete atrioventricular block requiring permanent pacemaker (PPM) implantation. The cost of index hospitalization for such patients is higher than usual. However, the magnitude of this increased cost is uncertain. We have looked at our five-year TAVR experience to analyze the detailed cost for PPM implantation in TAVR. Methods This study is a retrospective analysis of patients undergoing TAVR at our tertiary care center from December 2012 to April 2018. The initial sample size was 449. We excluded patients with prior PPM or an implantable cardioverter defibrillator (37). Patients who had their procedure aborted or required a cardiopulmonary bypass (16) and those with missing data variables (14) were excluded. The final sample size was 382. The cost for admission was calculated as the US dollars incurred by the hospital. Cohort costs were categorized as a direct cost, which is patient based, and an indirect cost, which represents overhead costs and is independent of patient volume. Patients were divided into two groups based on the placement of PPM after TAVR. Chi-square test, t-test, and logistic linear regression were used for the statistical analysis. Results Of 382 patients, 19 (4.9%) required PPM after TAVR. Baseline variables, including age, gender, and BMI, were not statistically significant. The PPM group had a significantly longer intensive care unit (ICU) stay (48.6 hours vs. 36.7 hours; p<0.001) and total stay in the hospital (4.2 days vs. 3.4 days; p=0.047). PPM implantation after TAVR increased cost on an average of $10,213 more than a typical TAVR admission (p=0.04). The direct cost was also significantly high for the PPM group ($7,087; p=0.02). On detailed analysis, almost all major cost categories showed a higher cost for pacemaker patients when compared with control. Conclusions PPM implantation adds a significant cost burden to TAVR admissions.

Objective Diffuse alveolar hemorrhage (DAH) is a severe pulmonary complication of numerous diseases, including rheumatic conditions. We have conducted an observational study using inpatient data from the National Inpatient Sample to study the relationship of DAH with rheumatic conditions along with their descriptive characteristics. Methods An observational study was conducted on hospitalizations in 2016-2018 with a principal diagnosis of DAH from the United States National Inpatient Sample database. A multivariate logistic regression analysis was performed to calculate adjusted odds ratios (OR adj ) for risk factors of DAH. Results A total of 5420 DAH hospitalizations were identified among 90 million hospitalizations. Mortality in this group was found to be 24.3%. Majority of patients admitted with DAH were white and male, with a mean age of 61.8 years and a mean LOS of 10.6 days. Multivariate analysis showed that multiple rheumatic diseases were associated with DAH, including antineutrophil cytoplasmic antibody-associated vasculitis (AAV) (OR adj 72.56) (95% C.I. 50.607-104.043), antiphospholipid antibody syndrome (APLS) (OR adj 6.51) (95% C.I. 3.734-11.366), eosinophilic granulomatosis with polyangiitis (EGPA) (OR adj 7.13) (95% C.I. 1.886-26.926), Goodpasture's (OR adj 30.58) (95% C.I. 16.360-57.176), rheumatoid arthritis (RA) (OR adj 1.60) (95% C.I. 1.158-2.212), sarcoidosis (OR adj 3.99) (95% C.I. 2.300-6.926), and systemic lupus (SLE) (OR adj 5.82) (95% C.I. 3.993-8.481). Conclusion Although DAH is a relatively rare entity, it carries a very high mortality. Multiple rheumatic diseases were associated with DAH hospitalizations including AAV, APLS, EGPA, Goodpasture's, RA, sarcoidosis, and SLE. Key points • It is known that DAH carries a high morbidity and mortality based on prior literature. However, large datasets on the association of rheumatic diseases with DAH are lacking • This study identifies the descriptive characteristics of patients admitted to the hospital with DAH • This study also identifies the strength of association of rheumatic diseases with DAH

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Introduction: With the increasing adoption of left atrial appendage occlusion (LAAO) procedures and the eligibility of patients for pulmonary vein isolation (PVI) post device placement, we examined the feasibility and safety of laser balloon (LB) for PVI in patients with prior LAAO.Methods: We retrospectively examined consecutive patients with paroxysmal or persistent, drug-resistant atrial fibrillation (AF) who underwent LB PVI, after Watchman FLX device implantation at Rush University Medical Center between January 2020 and December 2021.Results: Seven patients (four persistent and three paroxysmal) with a mean age of 64 ± 11 years, predominantly male sex (86%), were included in the study. Two (29%) patients had prior cryoablation PVI with recurrence of AF. The mean CHA 2 DS 2 VASc is 2.6 ± 0.5 and the mean HAS-BLED score is 3.4 ± 0.8. The mean follow-up duration was 10 ± 7 months. The mean duration between Watchman FLX device implantation and LB PVI was 592 days. Acute first pass left pulmonary vein (PV) isolation was achieved in 100% of the procedures. There were no periprocedural complications such as death, pericardial tamponade or effusion, phrenic nerve injury, PV stenosis, device perforation or embolization, or worsening peri-device leak in any of the patients. None of the patients had AF recurrence after the blanking period. Conclusion:LB PVI was safe and effective with 100% acute isolation of left-sided veins in patients with prior LAAO device.