Abstract 17173: Association of Acute Gout Flares and Colchicine Use With Clinical Outcomes During Admission for Acute Decompensated Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Melissa E Chinn ◽  
Mary E Roth ◽  
Steven P Dunn ◽  
Kenneth C Bilchick ◽  
Sula Mazimba
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Hospital Discharge ◽  
Readmission Rate ◽  
Acute Gout ◽  
Significant Difference ◽  
The Impact ◽  
Gout Flare

Introduction: Gout is a common comorbidity in heart failure (HF) patients, and is often exacerbated by diuretic use. The impact of gout or the treatment of gout on HF outcomes is unknown. The purpose of this study was to assess clinical outcomes in patients being treated for an acute HF exacerbation and receiving colchicine for an acute gout flare. Methods: This was a single center, retrospective cohort study of patients treated for an acute HF exacerbation from March 2011 to February 2020. The gout group included patients receiving colchicine for an acute gout flare during admission. The control group included those who did not receive colchicine for an acute gout flare. The primary outcome was 30-day readmission rate. Secondary outcomes included in-hospital mortality and length of stay. Results: In the cohort of 1,047 patients (68.8 +/- 13.7 years, 38% female), 237 patients received colchicine for acute gout during admission. Length of stay was significantly greater (9.93 days vs. 7.96 days, p < 0.0001) and in-hospital mortality was significantly lower (2.2% vs. 6.6%, p = 0.009) in patients with versus without gout. In a multivariate logistic regression model, in-hospital colchicine given for a gout flare was significantly associated with reduced in-hospital mortality (OR 0.322, 95% CI 0.105-0.779, p = 0.02) after adjustment for home beta blocker use, inotrope use, age, and diabetes mellitus (p < 0.05 for all in the model). The association between colchicine and survival to hospital discharge was only observed in patients who received colchicine during the hospitalization, as opposed to home use only. There was no significant difference in 30-day readmission rate based on gout status for patients surviving to hospital discharge (21.5% vs. 19.5%, p = 0.495). Conclusions: Among patients with an acute HF exacerbation, patients treated for an acute gout flare with colchicine had a greater length of stay and lower in-hospital mortality compared with those not having gout. Future analyses are warranted to identify the relationship between colchicine use and HF outcomes.

scholarly journals 288. Follow-Up Blood Cultures in Gram-Negative Bacteremia: How Do They Impact Outcomes

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S144-S144
Author(s):  
Azza Elamin ◽  
Faisal Khan ◽  
Ali Abunayla ◽  
Rajasekhar Jagarlamudi ◽  
aditee Dash
Keyword(s):  
Clinical Outcomes ◽  
Antibiotic Treatment ◽  
Readmission Rate ◽  
Blood Cultures ◽  
Categorical Variables ◽  
Gram Negative ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

Abstract Background As opposed to Staphylococcus. aureus bacteremia, there are no guidelines to recommend repeating blood cultures in Gram-negative bacilli bacteremia (GNB). Several studies have questioned the utility of follow-up blood cultures (FUBCs) in GNB, but the impact of this practice on clinical outcomes is not fully understood. Our aim was to study the practice of obtaining FUBCs in GNB at our institution and to assess it’s impact on clinical outcomes. Methods We conducted a retrospective, single-center study of adult patients, ≥ 18 years of age admitted with GNB between January 2017 and December 2018. We aimed to compare clinical outcomes in those with and without FUBCs. Data collected included demographics, comorbidities, presumed source of bacteremia and need for intensive care unit (ICU) admission. Presence of fever, hypotension /shock and white blood cell (WBC) count on the day of FUBC was recorded. The primary objective was to compare 30-day mortality between the two groups. Secondary objectives were to compare differences in 30-day readmission rate, hospital length of stay (LOS) and duration of antibiotic treatment. Mean and standard deviation were used for continuous variables, frequency and proportion were used for categorical variables. P-value &lt; 0.05 was defined as statistically significant. Results 482 patients were included, and of these, 321 (67%) had FUBCs. 96% of FUBCs were negative and 2.8% had persistent bacteremia. There was no significant difference in 30-day mortality between those with and without FUBCs (2.9% and 2.7% respectively), or in 30-day readmission rate (21.4% and 23.4% respectively). In patients with FUBCs compared to those without FUBCs, hospital LOS was longer (7 days vs 5 days, P &lt; 0.001), and mean duration of antibiotic treatment was longer (14 days vs 11 days, P &lt; 0.001). A higher number of patients with FUBCs needed ICU care compared to those without FUBCs (41.4% and 25.5% respectively, P &lt; 0.001) Microbiology of index blood culture in those with and without FUBCs Outcomes in those with and without FUBCs FUBCs characteristics Conclusion Obtaining FUBCs in GNB had no impact on 30-day mortality or 30-day readmission rate. It was associated with longer LOS and antibiotic duration. Our findings suggest that FUBCs in GNB are low yield and may not be recommended in all patients. Prospective studies are needed to further examine the utility of this practice in GNB. Disclosures All Authors: No reported disclosures

Does MIS Surgery Allow for Shorter Constructs in the Surgical Treatment of Adult Spinal Deformity?

Neurosurgery ◽  
2017 ◽  
Vol 80 (3) ◽  
pp. 489-497 ◽  
Author(s):  
Juan S. Uribe ◽  
Joshua Beckman ◽  
Praveen V. Mummaneni ◽  
David Okonkwo ◽  
Pierce Nunley ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Loss ◽  
Clinical Outcomes ◽  
Spinal Deformity ◽  
Lumbar Lordosis ◽  
Adult Spinal Deformity ◽  
Radiographic Parameters ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
The Impact

Abstract BACKGROUND: The length of construct can potentially influence perioperative risks in adult spinal deformity (ASD) surgery. A head-to-head comparison between open and minimally invasive surgery (MIS) techniques for treatment of ASD has yet to be performed. OBJECTIVE: To examine the impact of MIS approaches on construct length and clinical outcomes in comparison to traditional open approaches when treating similar ASD profiles. METHODS: Two multicenter databases for ASD, 1 involving MIS procedures and the other open procedures, were propensity matched for clinical and radiographic parameters in this observational study. Inclusion criteria were ASD and minimum 2-year follow-up. Independent t-test and chi-square test were used to evaluate and compare outcomes. RESULTS: A total of 1215 patients were identified, with 84 patients matched in each group. Statistical significance was found for mean levels fused (4.8 for circumferential MIS [cMIS] and 10.1 for open), mean interbody fusion levels (3.6 cMIS and 2.4 open), blood loss (estimated blood loss 488 mL cMIS and 1762 mL open), and hospital length of stay (6.7 days cMIS and 9.7 days open). There was no significant difference in preoperative radiographic parameters or postoperative clinical outcomes (Owestry Disability Index and visual analog scale) between groups. There was a significant difference in postoperative lumbar lordosis (43.3° cMIS and 49.8° open) and pelvic incidence-lumbar lordosis correction (10.6° cMIS and 5.2° open) in the open group. There was no significant difference in reoperation rate between the 2 groups. CONCLUSION: MIS techniques for ASD may reduce construct length, reoperation rates, blood loss, and length of stay without affecting clinical and radiographic outcomes when compared to a similar group of patients treated with open techniques.

Abstract 242: Impact of Hospitalists on Heart Failure Outcomes in Hawaii

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Santhosh R Mannem ◽  
Ayeong Jun Ahn ◽  
Jill Miyamura ◽  
Deborah Juarez ◽  
John Chen ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Heart Failure ◽  
Length Of Stay ◽  
Hospital Discharge ◽  
Hospital Medicine ◽  
Inhospital Mortality ◽  
Limited Data ◽  
The Us ◽  
The Impact ◽  
Discharge Database

Background: Hospital Medicine is the fastest growing subspecialty in the US. However, limited data compare care provided by Hospitalists (H) with Non-Hospitalists (NH) (ie, internal medicine, family practice). Because much of heart failure (HF) care is provided by non-cardiologists, we examined HF outcomes among pts treated by H and NH. Methods: All pts discharged with primary dx of HF from 2009-11 were identified from a statewide all-payer database in Hawaii (n=6,581). We categorized pts by specialty of discharging physician and examined length of stay (LOS), 30-day readmission and inhospital mortality comparing H and NH. Because pts discharged by cardiologists accounted for a minority of cases (345/6,581 or 5.2%) and may substantially differ from other pts, they were excluded from our study. Results: There were slight differences between pts cared by H and NH, while disease severity (Charlson Index) was similar. Readmissions were similar for H and NH, although inhospital mortality was significantly lower for H. These differences persisted after adjusting for potential confounders (readmission: OR=1.08, 95% CI: 0.96-1.20; mortality: OR=0.59, 95% CI: 0.46-0.75). Conclusions: In a statewide, all-payer hospital discharge database H care for the majority of HF pts. Compared with NH, 30-day readmission was similar but inhospital mortality was lower. Further research is needed to study the impact of cardiologists, who often serve as consultants for this population.

scholarly journals Convalescent plasma for patients with severe COVID-19: a matched cohort study

2020 ◽  
Author(s):  
Ralph Rogers ◽  
Fadi Shehadeh ◽  
Evangelia Mylona ◽  
Josiah Rich ◽  
Marguerite Neill ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Hospital Discharge ◽  
Proportional Hazards ◽  
Discharge Rate ◽  
Cohort Analysis ◽  
Cox Proportional Hazards ◽  
Control Group ◽  
Matched Cohort ◽  
Significant Difference ◽  
The Impact

Background The efficacy of convalescent plasma (CP) for the treatment of COVID-19 remains unclear. Methods A matched cohort analysis of hospitalized patients with severe COVID-19. The impact of CP treatment on all cause in-hospital mortality was evaluated using univariate and multivariate Cox proportional-hazards models, and the impact of CP treatment on the time to hospital discharge was assessed using a stratified log-rank analysis. Results 64 patients who received CP a median of 7 days after symptom onset were compared to a matched control group of 177 patients. Overall in-hospital mortality was 14.9%. There was no significant difference in the risk of in-hospital mortality between the two groups (adjusted hazard ratio [aHR] 0.93, 95% confidence interval [CI] 0.39 − 2.20). There was also no significant difference in the overall rate of hospital discharge (rate ratio [RR} 1.28, 95% CI 0.91 − 1.81), but a subgroup analysis of patients 65-years-old or greater who received CP demonstrated a significantly increased hospital discharge rate among these patients (RR 1.86, 95% CI 1.03 − 3.36). There was a greater than expected frequency of transfusion reactions in the CP group (2.8% reaction rate observed per unit transfused). Conclusions The use of CP in this study was a safe treatment for COVID-19. There was no overall significant reduction of in-hospital mortality or increased rate of hospital discharge associated with the use of CP in this study, although there was a signal for improved outcomes among the elderly. Further adequately powered randomized studies should target this subgroup when assessing the efficacy CP treatment.

P4522Intravascular volume expansion mitigates the impact of impaired renal function and associated clinical outcomes in chronic heart failure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
W Miller
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Clinical Outcomes ◽  
Hospital Discharge ◽  
Volume Expansion ◽  
Impaired Renal Function ◽  
Intravascular Volume ◽  
Moderate Volume ◽  
The Impact ◽  
Related Mortality

Abstract Background/Introduction Intravascular volume is regulated by the kidneys but the interconnection of the extent of volume expansion with renal function and outcomes in patients with chronic HF has not been assessed. Therefore, we evaluated how GFR-defined renal function and HF-related clinical outcomes are impacted by the relative extent of intravascular volume expansion. Our hypothesis was that greater rather than lesser volume expansion would be protective of worse renal function and contribute to better clinical outcomes than mild-moderate volume expansion. Purpose Assess the impact of quantitated intravascular volume expansion on heart failure (HF) outcomes in relation to renal function in post-hospital clinically determined “euvolemic” chronic HF patients. Methods Blood volume (BV) was prospectively measured in 87 HF patients considered clinically “euvolemic” post-diuresis at the time of hospital discharge using a standardized radiolabeled albumin indicator-dilution technique (Daxor Corp., NY, NY). A volume cut-point of ≥+25% above normal expected BV was used to define the greater degree of volume expansion from more mild-moderate expansion. These volume subgroups were then stratified by cohort median eGFR (46 mL/min/1.73m2) and analyzed for 1-year outcomes of HF-related mortality or 1st re-hospitalization using the Kaplan-Meier method. Results Volume expansion ≥+25% was demonstrated in 53% of the cohort at the time of hospital discharge despite hospital diuretic therapy. In this subgroup over 1.0 year of follow-up the risk for the composite outcome was significantly lower than in the group with mild-moderate volume expansion (Log-Rank p=0.017). Further, in the clinical setting of greater volume expansion, worse renal function with eGFR below the cohort median (<46 mL/min/1.73m2) was not associated with increased risk for the composite end-point (Figure). In contrast, low eGFR in the presence of mild-moderate volume expansion stratified risk and was associated with worse outcome relative to a higher eGFR above the median (Figure). Figure 1 Conclusions In post-hospital chronic HF patients significant intravascular volume expansion is common, and importantly the extent of BV expansion impacts outcomes including HF-related mortality. However, greater rather than lesser volume expansion appears to favorably mitigate the impact of worse renal function (low eGFR), while normal or mild-moderate expansion does not spare the impact of worse renal function on outcomes. Thus, a favorable degree of volume expansion appears to balance the risks of worse renal function. Volume-kidney interconnections are complex with volume status modulating the impact of impaired renal function on outcomes in chronic HF. Acknowledgement/Funding None

scholarly journals Hemodynamic Congestion at Hospital Discharge Predicts Rehospitalization during Short Term Follow Up in Acute Heart Failure Patients

2019 ◽  
Vol 40 (3) ◽  
Author(s):  
Yoga Waranugraha ◽  
Mohammad Saifur Rohman ◽  
Setyasih Anjarwani
Keyword(s):  
Heart Failure ◽  
Clinical Outcomes ◽  
Hospital Discharge ◽  
Acute Heart Failure ◽  
Optimal Dose ◽  
Left Ventricular ◽  
Short Term ◽  
Significant Difference ◽  
Β Blockers ◽  
Symptoms And Signs

Background: Hemodynamic congestion is an increase in left ventricular diastolic pressure (LVEDP) without clinical symptoms and signs of congestion. Current acute heart failure (AHF) treatment goals only focused on improving clinical congestion. The purpose of this study was to investigate whether hemodynamic congestion measured by NT-proBNP level and ePCWP at hospital discharge could predict short term clinical outcomes in AHF patients. Method: This prospective cohort study was conducted at dr. Saiful Anwar General Hospital Malang from January to July 2018. All patients got AHF treatment according to the 2016 ESC guidelines for heart failure. All patients were discharged without symptoms and signs of clinical congestion. Hemodynamic congestion at hospital discharge was defined as failure of treatment during hospitalization to achieve a reduction in NT-proBNP level >30% and/or ePCWP at hospital discharge >16 mmHg. NT-proBNP level and ePCWP were measured at 0-12 hours after hospital admisssion and at hospital discharge. ePCWP was measured using echocardiography. The clinical outcomes assessed were AHF rehospitalization and cardiovascular mortality within 30 days after hospitral discharge. Subgroup analysis was performed to determine therapeutic regimens that are effective in improving hemodynamic congestion. Result: A total of 33 AHF patients were included in this study. 48% patients were discharged with hemodynamic congestion and 52% patients discharged without hemodynamic congestion. Patients with hemodynamic congestion at hospital discharge showed a higher rehospitalization within 30 days (8 [50%] vs 1 [5.9%]; P = 0.007). Mortality within 30 days in both groups did not show a significant difference (2 [12.5%] vs 0 [0%]; P = 0.277). Treatment regiment of optimal dose of ACEi/ARB, β-blockers, and diuretics was associated with improvement of hemodynamic congestion (P = 0.026; r = 0.454), a decrease in NT-proBNP> 66% (P = 0.02; r = 0,574), and achievement of ePCWP <16 (P = 0,013; r = 0,493) at hospital discharge in HFrEF patients. Conclusion: This study showed that hemodynamic congestion assessed with NT-proBNP level and ePCWP at hospital discharge increased 30 day rehospitalization in AHF patients. In HFrEF, improvements in hemodynamic congestion can be achieved by giving the treatment regiment of optimal dose of ACEi/ARB, β-blockers, and diuretics. Keyword: Acute heart failure, hemodynamic congestion, NT-proBNP, ePCWP

scholarly journals Convalescent plasma for patients with severe COVID-19: a matched cohort study

2020 ◽  
Author(s):  
Ralph Rogers ◽  
Fadi Shehadeh ◽  
Evangelia K Mylona ◽  
Josiah Rich ◽  
Marguerite Neill ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Hospital Discharge ◽  
Cohort Analysis ◽  
Cox Proportional Hazards ◽  
Control Group ◽  
Matched Cohort ◽  
Control Groups ◽  
Significant Difference ◽  
And Control ◽  
The Impact

Abstract Background The efficacy of convalescent plasma (CP) for the treatment of COVID-19 remains unclear. Methods In a matched cohort analysis of hospitalized patients with severe COVID-19, the impact of CP treatment on in-hospital mortality was evaluated using univariate and multivariate Cox proportional-hazards models, and the impact of CP treatment on time to hospital discharge was assessed using a stratified log-rank analysis. Results 64 patients who received CP a median of 7 days after symptom onset were compared to a matched control group of 177 patients. The incidence of in-hospital mortality was 12.5% and 15.8% in the CP and control groups, respectively (p = 0.52). There was no significant difference in the risk of in-hospital mortality between the two groups (adjusted hazard ratio [aHR] 0.93, 95% confidence interval [CI] 0.39 – 2.20). The overall rate of hospital discharge was not significantly different between the two groups (rate ratio [RR] 1.28, 95% CI 0.91 – 1.81), although there was a significantly increased rate of hospital discharge among patients 65-years-old or greater who received CP (RR 1.86, 95% CI 1.03 – 3.36). There was a greater than expected frequency of transfusion reactions in the CP group (2.8% reaction rate observed per unit transfused). Conclusions We did not demonstrate a significant difference in risk of mortality or rate of hospital discharge between the CP and control groups. There was a signal for improved outcomes among the elderly, and further adequately powered randomized studies should target this subgroup when assessing the efficacy of CP treatment.

scholarly journals Impact of Delayed Oral Vancomycin for Severe Clostridium difficile Infection

2018 ◽  
Vol 54 (5) ◽  
pp. 294-299 ◽  
Author(s):  
Sunish Shah ◽  
Benjamin Ereshefsky ◽  
Laura Pontiggia ◽  
Michael Cawley
Keyword(s):  
Clostridium Difficile ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Clostridium Difficile Infection ◽  
Initial Treatment ◽  
Oral Vancomycin ◽  
End Of Treatment ◽  
Significant Difference ◽  
Severe Clostridium Difficile Infection ◽  
The Impact

Background: Treatment of severe Clostridium difficile infection (CDI) with oral vancomycin (VAN) is known to be superior to treatment with metronidazole (MDZ). However, previous studies have not evaluated the impact on patients when oral VAN therapy is delayed after diagnosis of severe CDI. Materials and Methods: This was a single-center, retrospective study of adult patients who were diagnosed with severe CDI. The objective was to compare clinical outcomes for patients treated initially with oral VAN versus patients receiving delayed oral VAN after at least 48 hours of initial treatment with MDZ. The primary outcome was all-cause in-hospital mortality. Results: There were 101 patients who comprised the initial oral VAN group, while 20 patients comprised the delayed oral VAN group. There was no significant difference in all-cause in-hospital mortality for patients in the initial oral VAN treatment group compared to those who had delayed oral VAN therapy (4.95% vs 15.00%, P = 0.13). Patients who were initially treated with oral VAN experienced a significantly higher rate of clinical cure (49.50% vs 20.00%, P = 0.02), shorter median postinfection length of hospitalization (7.0 days vs 13.0 days, P < 0.001), shorter median time to resolution of leukocytosis (3.9 days vs 10.4 days, P = 0.01), and were less likely to have an end of treatment serum creatinine greater than 1.5 times their baseline (8.7% vs 29.4%, P = 0.03). Conclusion: Patients who receive oral VAN as their initial treatment for severe CDI experience improved clinical outcomes compared to patients receiving delayed oral VAN after being initially treated with MDZ.

scholarly journals 1044. Aztreonam (AZT) vs. Cephalosporin (CEP) Therapy for the Treatment of Gram-Negative Bacteremia

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S312-S312
Author(s):  
Sunish Shah ◽  
Kyle Krevolin ◽  
Tiffany Bias
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Post Infection ◽  
Clinical Cure ◽  
Multivariate Logistic Regression Model ◽  
Gram Negative ◽  
Significant Difference ◽  
Gram Negative Bacteremia ◽  
Cure Rates

Abstract Background The IDSA recommends use of AZT in patients with a confirmed beta-lactam allergy for nosocomial Gram-negative infections. Despite this recommendation, there is limited data to suggest AZT is inferior to cephalosporins (CEP) for the treatment of Gram-negative infections. This study aims to evaluate clinical outcomes in bacteremic patients treated with either AZT or CEP therapy. Methods A single-center, retrospective chart review of adult patients with positive blood cultures for Escherichia coli, Klebsiella pneumoniae or Pseudomonas aeruginosa was conducted to compare clinical outcomes between those who received ≥ 48 hours of AZT or CEP therapy (cefepime or ceftriaxone). The following clinical outcomes were assessed: clinical cure, in-hospital mortality, post-infection length of stay (LOS), post-infection intensive care unit LOS, microbiologic cure and leukocytosis resolution. Results One-hundred and twenty-nine patients met criteria for evaluation: 41 received AZT and 88 received CEP therapy. At baseline, patients who received AZT were more likely to have renal dysfunction (34.1% vs. 18.2%, P = 0.046), receive synergistic antimicrobials (61% vs. 28.4%, P &lt; 0.001) and had a longer pre-infection LOS (1 day [0–2] vs. 0 [0–1], P = 0.032) compared with those who received CEP. Although in-hospital mortality rates were similar between both groups (2.4% vs. 3.4%, P = 1.000), there was a statistically significant difference in clinical cure rates (70.7% vs. 90.9%, P = 0.003), post-infection length of stay (7 days [5–10] vs. 5 [4–8], P = 0.007), and time to clinical cure (2.8 days (1.6–5.8) vs. 2.0 (1.2–2.9), P = 0.018) in the AZT and CEP groups respectively. In a multivariate logistic regression model, patients who received AZT were significantly less likely to achieve clinical cure (OR=0.187, 95% CI (0.058–0.597). In a pre-determined subgroup analysis, clinical cure rates varied in E. coli (72% vs. 94.4%, P = 0.009), K. pneumoniae (70% vs. 90.5%, P = 0.296) and P. aeruginosa (66.7% vs. 76.9%, P = 1.000) in the AZT and CEP group respectively. Conclusion Patients who receive aztreonam for Gram-negative bacteremia may be more likely to experience clinical failure. Larger, prospective studies are warranted to confirm these findings. Disclosures All authors: No reported disclosures.

Impact of Hybrid Operating Rooms on Long-Term Clinical Outcomes Following Fenestrated and Branched Endovascular Aortic Repair

2021 ◽  
pp. 152660282199672
Author(s):  
Giovanni Tinelli ◽  
Marie Bonnet ◽  
Adrien Hertault ◽  
Simona Sica ◽  
Gian Luca Di Tanna ◽  
...  
Keyword(s):  
Operating Room ◽  
Clinical Outcomes ◽  
Cox Regression ◽  
Statistical Significance ◽  
Aortic Aneurysms ◽  
Study Patient ◽  
Cox Regression Analysis ◽  
Significant Difference ◽  
The Impact

Purpose: Evaluate the impact of hybrid operating room (HOR) guidance on the long-term clinical outcomes following fenestrated and branched endovascular repair (F-BEVAR) for complex aortic aneurysms. Materials and Methods: Prospectively collected registry data were retrospectively analyzed to compare the procedural, short- and long-term outcomes of consecutive F-BEVAR performed from January 2010 to December 2014 under standard mobile C-arm versus hybrid room guidance in a high-volume aortic center. Results: A total of 262 consecutive patients, including 133 patients treated with a mobile C-arm equipped operating room and 129 with a HOR guidance, were enrolled in this study. Patient radiation exposure and contrast media volume were significantly reduced in the HOR group. Short-term clinical outcomes were improved despite higher case complexity in the HOR group, with no statistical significance. At a median follow-up of 63.3 months (Q1 33.4, Q3 75.9) in the C-arm group, and 44.9 months (Q1 25.1, Q3 53.5, p=0.53) in the HOR group, there was no statistically significant difference in terms of target vessel occlusion and limb occlusion. When the endograft involved 3 or more fenestrations and/or branches (complex F-BEVAR), graft instability (36% vs 25%, p=0.035), reintervention on target vessels (20% vs 11%, p=0.019) and total reintervention rates (24% vs 15%, p=0.032) were significantly reduced in the HOR group. The multivariable Cox regression analysis did not show statistically significant differences for long-term death and aortic-related death between the 2 groups. Conclusion: Our study suggests that better long-term clinical outcomes could be observed when performing complex F-BEVAR in the latest generation HOR.

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