TOTALLY ANOMALOUS PULMONARY VENOUS CONNECTION OUTCOMES FROM A SINGLE CENTER

Objectives: There is limited data on totally anomalous pulmonary venous connection (TAPVC) repair results in our country. The aim of this study is to evaluate the early postoperative results of a large series of TAPVC patients operated in our clinic. Patients and Methods: The data of the patients who underwent TAPVC repair in our clinic between May 2005 and May 2021 were retrospectively reviewed using hospital records Results: A total of 150 TAPVC patients aged between 0 days and 39 years (median 3 months, IQR: 18 days – 9 months), 92 males (61%) and 58 females (39%) underwent surgical intervention. The median length of hospital stay was 12 (IQR:7-16) days. Overall mortality was 14% (21 patients). Seventeen out of 32 patients with additional cardiac anomalies (53%) and 4 out of 118 patients with isolated TAPVC (3%) died. The presence of additional cardiac anomalies was associated with mortality (p<0.00001). Mortality rate in univentricular patients was 59% (10 patients). This rate was higher in comparison to the mortality rate of biventricular patients (8%; p<0,00001). Three patients were reoperated due to postoperative pulmonary venous stenosis. Conclusion: The TAPVC outcomes in isolated and biventricular patients were favorable with a low mortality and postoperative pulmonary venous stenosis in this cohort. Patients with a single ventricle physiology and/or heterotaxia had a significantly increased risk of mortality, which might be due to the intrinsic challenges of the univentricular physiology regarding the balance between the pulmonary and systemic circulations. Tendency for increased mortality in the cases with preoperative pulmonary venous obstruction is a potential target for improvement.

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Short-term results of sutureless closure for primary total anomalous pulmonary venous connection: seventeen cases

MedPharmRes ◽

10.32895/ump.mpr.5.4.4 ◽

2021 ◽

Vol 5 (4) ◽

pp. 27-33

Author(s):

Quang Le-Thanh Dinh ◽

Kim Thoi Ngo ◽

Duc Tuan Nguyen ◽

Thi Cam Giang Do ◽

Minh Hai Nguyen ◽

...

Keyword(s):

Case Series ◽

Rare Condition ◽

Pulmonary Venous Obstruction ◽

Short Term ◽

Female Ratio ◽

Sutureless Technique ◽

Venous Stenosis ◽

Pulmonary Venous Stenosis ◽

Prospective Case Series ◽

Anomalous Pulmonary Venous Connection

Introduction: Total anomalous pulmonary venous connection (TAPVC) is a rare condition. Mortality of TAPVC has improved dramatically in the present. Sutureless closure had initially used for congenital pulmonary venous stenosis (PVS) or post-repair PVS. Recently, it had been adopted for primary TAPVC to prevent postoperative pulmonary venous obstruction, a leading cause of death. This technique had gradually applied at our institute for primary TAPVC since 2018. Methods: Prospective case series was conducted from mid-2019. Including criteria consists of patients with primary TAPVC. These are all supracardiac, infracardiac, mixed type and intracardiac TAPVC with pulmonary venous stenosis. Excluding measures are TAPVC with single ventricle, isomerism or heterotaxy. End-point outcomes were mortality and short-term PVS. Results: Seventeen TAPVC cases were enrolled in this study from 06/2019-12/2020 at Children's Hospital 1. Male/female ratio was 12/5. Median age at admission was 44 (3-1010) days old. The median operative weight was 3.9 kg (2.4-11). Of those, fourteen (82.4%) cases were supracardiac TAPVC and 3 (17.6%) cases were infracardiac TAPVC. Nine (52.9%) cases were emergency operations. Median aortic clamp time was 66 (32-138) mins. Median bypass time was 112 (86-212) mins. There were 9 (52.9%) cases with arrhythmias, 2 (11.8%) cases with chylothorax. Mean ventilation time was 3.6±0.5 days; mean CICU time was 6.5 (1-20), median LOS was 14.5 (8-39). In-hospital mortality was 5.9% (1). Mean follow-up time was 12.3±6.4 months (range 4-24), there was no PVS with median pulmonary venous score of 0 (range 0-1). Conclusions: Sutureless technique could be a safe option for primary TAPVC repair.

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Explanatory Style in Patients with Rheumatoid Arthritis: An Unrecognized Predictor of Mortality

The Journal of Rheumatology ◽

10.3899/jrheum.160026 ◽

2016 ◽

Vol 44 (2) ◽

pp. 170-173 ◽

Cited By ~ 1

Author(s):

Aaron D. Crowson ◽

Robert C. Colligan ◽

Eric L. Matteson ◽

John M. Davis ◽

Cynthia S. Crowson

Keyword(s):

Rheumatoid Arthritis ◽

Mortality Rate ◽

Minnesota Multiphasic Personality Inventory ◽

Explanatory Style ◽

Population Based ◽

Similar Magnitude ◽

Risk Of Mortality ◽

Increased Risk ◽

Comparison Cohort ◽

Pessimistic Explanatory Style

Objective.To determine whether pessimistic explanatory style altered the risk for and mortality of patients with rheumatoid arthritis (RA).Methods.The study included subjects from a population-based cohort with incident RA and a non-RA comparison cohort who completed the Minnesota Multiphasic Personality Inventory.Results.Among 148 RA and 135 non-RA subjects, pessimism was associated with development of rheumatoid factor (RF)–positive RA. Pessimism was associated with an increased risk of mortality [HR 2.88 with similar magnitude to RF+ (HR 2.28)].Conclusion.Pessimistic explanatory style was associated with an increased risk of developing RA and increased mortality rate in patients with RA.

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Mortality, causes of death and influence of medication use in patients with systemic lupus erythematosus vs matched controls

Rheumatology ◽

10.1093/rheumatology/keaa267 ◽

2020 ◽

Vol 60 (1) ◽

pp. 207-216

Author(s):

Irene E M Bultink ◽

Frank de Vries ◽

Ronald F van Vollenhoven ◽

Arief Lalmohamed

Keyword(s):

Mortality Rate ◽

Lupus Erythematosus ◽

Mortality Rates ◽

Cox Proportional Hazards ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Risk Of Mortality ◽

Increased Risk ◽

Specific Mortality ◽

Age And Sex

Abstract Objectives We wanted to estimate the magnitude of the risk from all-cause, cause-specific and sex-specific mortality in patients with SLE and relative risks compared with matched controls and to evaluate the influence of exposure to medication on risk of mortality in SLE. Methods We conducted a population-based cohort study using the Clinical Practice Research Datalink, Hospital Episode Statistics and national death certificates (from 1987 to 2012). Each SLE patient (n = 4343) was matched with up to six controls (n = 21 780) by age and sex. Cox proportional hazards models were used to estimate overall and cause-specific mortality rate ratios. Results Patients with SLE had a 1.8-fold increased mortality rate for all-cause mortality compared with age- and sex-matched subjects [adjusted hazard ratio (HR) = 1.80, 95% CI: 1.57, 2.08]. The HR was highest in patients aged 18–39 years (adjusted HR = 4.87, 95% CI: 1.93, 12.3). Mortality rates were not significantly different between male and female patients. Cumulative glucocorticoid use raised the mortality rate, whereas the HR was reduced by 45% with cumulative low-dose HCQ use. Patients with SLE had increased cause-specific mortality rates for cardiovascular disease, infections, non-infectious respiratory disease and for death attributable to accidents or suicide, whereas the mortality rate for cancer was reduced in comparison to controls. Conclusion British patients with SLE had a 1.8-fold increased mortality rate compared with the general population. Glucocorticoid use and being diagnosed at a younger age were associated with an increased risk of mortality. HCQ use significantly reduced the mortality rate, but this association was found only in the lowest cumulative dosage exposure group.

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Mortality From Burns Sustained on Home Oxygen Therapy Exceeds Predicted Mortality

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa097 ◽

2020 ◽

Vol 41 (5) ◽

pp. 976-980

Author(s):

Kathleen E Singer ◽

Jalen A Harvey ◽

Victor Heh ◽

Elizabeth L Dale

Keyword(s):

Mortality Rate ◽

Length Of Stay ◽

Average Length ◽

Severity Index ◽

Burn Severity ◽

Chi Square ◽

Risk Of Mortality ◽

Increased Risk ◽

Secondary Outcomes ◽

Chi Square Analysis

Abstract The Boston Criteria and the Abbreviated Burn Severity Index are two widely accepted models for predicting mortality in burn patients. We aimed to elucidate whether these models are able to predict the risk of mortality in patients who sustain burns while smoking on home oxygen given their clinical fragility. We conducted a retrospective chart review of 48 patients admitted to our burn center from November 2013 to September 2017 who sustained a burn while smoking on home oxygen. Yearlong mortality was the primary outcome of the investigation; secondary outcomes included discharge to facility, length of stay, and need for tracheostomy. We calculated the expected mortality rate for each patient based on Boston Criteria and Abbreviated Burn Severity Index and compared the mortality rate observed in our cohort. Patients in our cohort suffered a 54% mortality rate within a year of injury, compared to a 23.5% mortality predicted by Boston Criteria, which was found to be statistically significant by chi-square analysis (P < .05). Abbreviated Burn Severity Index predicted mortality was 19.7%. While the absolute value of the difference in mortality was greater, this was not significant on chi-square analysis due to sample size. Our secondary outcomes revealed 42% discharge to facility, the average length of stay of 6.2 days, and 6.25% required tracheostomy. Patients whose burns are attributable to smoking on home oxygen may have an increased risk of mortality than prognostication models would suggest. This bears significant clinical impact, particularly regarding family and provider decision making in pursuing aggressive management.

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A possible role for steroid therapy in preventing postoperative stenosis in totally anomalous pulmonary venous connection

Cardiology in the Young ◽

10.1017/s1047951100006156 ◽

1998 ◽

Vol 8 (2) ◽

pp. 240-242 ◽

Cited By ~ 3

Author(s):

Andrew Sands ◽

Brian Craig ◽

Frank Casey

Keyword(s):

Steroid Therapy ◽

Cardiac Catheterisation ◽

Pulmonary Wedge Pressure ◽

Therapeutic Measure ◽

The Third ◽

Venous Stenosis ◽

Pulmonary Venous Stenosis ◽

Anomalous Pulmonary Venous Connection ◽

Wedge Pressure

AbstractWe report three cases of pulmonary venous stenosis developing after repair of totally anomalous pulmonary venous connection. In each case, we used steroids as a therapeutic measure following re-operation. In two cases, we were successful in preventing significant re-stenosis. The third patient rapidly developed stenosis (mean pulmonary wedge pressure approximately 20 mmHg at cardiac catheterisation) after stopping steroids. This patient subsequently died after a third operation. The remaining patients continue to do well.

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Comparison of the effects of primary somatostatin analogue therapy and pituitary adenomectomy on survival in patients with acromegaly: a retrospective cohort study

Acta Endocrinologica ◽

10.1530/eje-13-0166 ◽

2013 ◽

Vol 169 (3) ◽

pp. 367-376 ◽

Cited By ~ 17

Author(s):

Fausto Bogazzi ◽

Annamaria Colao ◽

Giuseppe Rossi ◽

Martina Lombardi ◽

Claudio Urbani ◽

...

Keyword(s):

Regression Analysis ◽

Mortality Rate ◽

Cox Regression ◽

Diabetic Patients ◽

Somatostatin Analogue ◽

Primary Therapy ◽

Cox Regression Analysis ◽

Risk Of Death ◽

Risk Of Mortality ◽

Increased Risk

ObjectiveAcromegalic patients have an increased risk of mortality. The objective of this study was to compare the effect of different therapies for acromegaly on mortality.Design and methodsThe mortality rate of 438 consecutive acromegalic patients was compared with that of the general population using the standardized mortality ratio (SMR); the effect of different therapies on survival was evaluated using Cox regression analysis.ResultsTwenty patients (4.5%) died between 1999 and 2009. Age- and sex-adjusted SMR was 0.70 (95% CI 0.43–1.08). The Cox regression analysis revealed that, in the whole population, both general risk factors (age and physical status) and specific factors for acromegaly (macroadenoma, hypopituitarism and uncontrolled disease) were associated with death. The most compromised patients at diagnosis had a higher mortality rate (P=0.001), which also occurred in patients with controlled acromegaly. Death occurred in 2.4% (adenomectomy), 2.6% (adenomectomy followed by somatostatin analogue (SSA) therapy) and 11.4% (SSA therapy as the primary therapy) of the patients. The risk of death was higher in patients receiving SSA therapy as the primary therapy (hazard ratio (HR) 5.52, 95% CI 1.06–28.77,P=0.043) than in all patients submitted to adenomectomy; however, a higher risk of death occurred only in diabetic patients treated with SSAs alone (HR 21.94, 95% CI 1.56–309.04,P=0.022). Radiotherapy was associated with an increased risk of mortality, which occurred in patients with the more locally advanced disease.ConclusionsTherapies for acromegaly and comorbidities have lowered the risk of mortality to the level of the general population; the effect of SSA therapy alone or that following pituitary adenomectomy was comparable to that of curative neurosurgery on survival in non-diabetic patients; on the contrary, SSA therapy as the primary therapy may be less effective than adenomectomy in reducing mortality rate in diabetic patients.

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COVID-19-related outcomes in immunocompromised patients: A nationwide study in Korea

PLoS ONE ◽

10.1371/journal.pone.0257641 ◽

2021 ◽

Vol 16 (10) ◽

pp. e0257641

Author(s):

Moon Seong Baek ◽

Min-Taek Lee ◽

Won-Young Kim ◽

Jae Chol Choi ◽

Sun-Young Jung

Keyword(s):

Mortality Rate ◽

Hospital Mortality ◽

Multivariable Analysis ◽

Immunocompromised Patients ◽

Multivariable Logistic Regression Model ◽

Inverse Probability ◽

Risk Of Mortality ◽

Vulnerable Patients ◽

Increased Risk ◽

Immunocompromised Status

Background Given the rapid increased in confirmed coronavirus disease 2019 (COVID-19) and related mortality, it is important to identify vulnerable patients. Immunocompromised status is considered a risk factor for developing severe COVID-19. We aimed to determine whether immunocompromised patients with COVID-19 have an increased risk of mortality. Method The groups’ baseline characteristics were balanced using a propensity score-based inverse probability of treatment weighting approach. Odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated for the risks of in-hospital mortality and other outcomes according to immunocompromised status using a multivariable logistic regression model. We identified immunocompromised status based on a diagnosis of malignancy or HIV/AIDS, having undergone organ transplantation within 3 years, prescriptions for corticosteroids or oral immunosuppressants for ≥30 days, and at least one prescription for non-oral immunosuppressants during the last year. Results The 6,435 COVID-19 patients (≥18 years) included 871 immunocompromised (13.5%) and 5,564 non-immunocompromised (86.5%). Immunocompromised COVID-19 patients were older (60.1±16.4 years vs. 47.1±18.7 years, absolute standardized mean difference: 0.738). The immunocompromised group had more comorbidities, a higher Charlson comorbidity index, and a higher in-hospital mortality rate (9.6% vs. 2.3%; p < .001). The immunocompromised group still had a significantly higher in-hospital mortality rate after inverse probability of treatment weighting (6.4% vs. 2.0%, p < .001). Multivariable analysis adjusted for baseline imbalances revealed that immunocompromised status was independently associated with a higher risk of mortality among COVID-19 patients (adjusted odds ratio [aOR]: 2.09, 95% CI: 1.62–2.68, p < .001). Conclusions Immunocompromised status among COVID-19 patients was associated with a significantly increased risk of mortality.

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Abstract WMP25: Periprocedural Predictors of Acute Ischemic Stroke and Mortality in Endovascular Treatment of Unruptured Intracranial Aneurysm

Stroke ◽

10.1161/str.47.suppl_1.wmp25 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Tapan V Mehta ◽

Mohammed Hussain ◽

Priya Narwal ◽

Paul Mazaris ◽

Violiza Inoa-Acosta ◽

...

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

Antiplatelet Agents ◽

Multivariate Logistic Regression Model ◽

Limited Data ◽

Risk Of Mortality ◽

Unruptured Intracranial Aneurysms ◽

Increased Risk ◽

Study Population ◽

Clinically Significant

Introduction: Periprocedural risk of ischemic stroke (IS) in patients undergoing endovascular treatment for unruptured intracranial aneurysms (EUIA) can be as high as 40%, with clinically significant strokes occurring in 3-10% of patients. There is limited data on how typical vascular risk factors can increase peri-procedural risk of IS and mortality in patients undergoing EUIA. Methods: We queried the Healthcare Cost and Utilization Project's (HCUP) Nationwide Inpatient Sample (NIS) data between 2004 and 2012. ICD-9 codes 437.3 (intracerebral unruptured aneurysm) and 39.72 (endovascular repair/embolization of head and neck vessel) were used to identify the study population. Multivariate logistic regression model was used to identify independent predictors of IS and mortality after controlling confounders including age, race, sex, atrial fibrillation (Afib), diseases of endocardium, alcohol, smoking, diabetes mellitus, hypertension, use of anticoagulants, use of antiplatelet agents, carotid artery stenosis, atherosclerosis and hyperlipidemia. We also investigated whether Afib, DM, hypertension and hyperlipidemia in possible combinations further increased the risk of IS and mortality. Results: A total of 50,478 EUC cases were identified, of which 10,600 (20.9%) reported an IS event. A total of 661 (0.01%) died of which 115 (17.4%) had an IS event. After controlling for confounders, age >70 (OR 1.521 95% CI 1.145- 2.020, P< 0.01) and diabetes (OR 1.426, 95%CI 1.092-1.861, p 70 (OR 2.472, CI 1.616-3.782, p<.01)and Afib (OR 2.697, CI 1.509-4.819, p<.01) independently increased risk of mortality in endovascular treated patients. A fib, DM, hypertension and hyperlipidemia in different potential combinations did not increase peri-procedural risk of IS and mortality. Conclusions: In patients undergoing EUIA, Age >70 is an independent risk factor for IS and mortality. Diabetes independently increased risk of IS but not mortality; Afib independently increased risk of mortality but not IS.

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Correlation between hospitalized patients’ demographics, symptoms, comorbidities, and COVID-19 pandemic in Bahia, Brazil

PLoS ONE ◽

10.1371/journal.pone.0243966 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0243966

Author(s):

Márcio C. F. Macedo ◽

Isabelle M. Pinheiro ◽

Caio J. L. Carvalho ◽

Hilda C. J. R. Fraga ◽

Isaac P. C. Araujo ◽

...

Keyword(s):

Hospital Stay ◽

Length Of Hospital Stay ◽

Hospitalized Patients ◽

The State ◽

P Value ◽

Initial Symptom ◽

Shortness Of Breath ◽

Risk Of Mortality ◽

Increased Risk ◽

Record Data

In this paper, we provide a retrospective cohort study with patients that have been hospitalized for general or intensive care unit admission due to COVID-19, between March 3 and July 29, 2020, in the state of Bahia, Brazil. We aim to correlate those patients’ demographics, symptoms and comorbidities, with the risk of mortality from COVID-19, length of hospital stay, and time from diagnosis to definitive outcome. On the basis of a dataset provided by the Health Secretary of the State of Bahia, we selected 3,896 hospitalized patients from a total of 154,868 COVID-19 patients that included non-hospitalized patients and patients with invalid registration in the dataset. Then, we statistically analyzed whether there was a significant correlation between the patient record data and the COVID-19 pandemic, and our main findings reinforced by the use of a multivariable logistic regression were that older age (Odds Ratio [OR] = 1.03, 95% Confidence Interval [CI] = 1.03-1.04, p-value (p) <0.001), an initial symptom of shortness of breath (OR = 1.88, 95% CI = 1.60-2.20, p < 0.001), and the presence of comorbidities, mainly chronic kidney disease (OR = 2.41, 95% CI = 1.67-3.48, p < 0.001) are related to an increased risk of mortality from COVID-19. On the other hand, sore throat (OR = 0.74, 95% CI = 0.58-0.95, p = 0.02) and length of hospital stay (OR = 0.96, 95% CI = 0.58-0.95, p < 0.001) are more related to a reduced risk of mortality from COVID-19. Moreover, a multivariable linear regression conducted with statistically significant variables (p < 0.05) showed that age (OR = 0.97, 95% CI = 0.95-0.98, p < 0.001) and time from diagnosis to definitive outcome (OR = 1.67, 95% CI = 1.64-1.71, p < 0.001) are associated with the length of hospital stay.

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Fetal Case of Rare Association of Hypoplastic Left Heart Syndrome and Absent Atrial Septum Accompanied by Mixed Form of Supracardiac Total Anomalous Pulmonary Venous Connection

10.22541/au.162336963.34069982/v1 ◽

2021 ◽

Author(s):

Wakako Maruyama ◽

Yuki Kawasaki ◽

Yosuke Murakami ◽

Mitsuhiro Fujino ◽

Takeshi Sasaki ◽

...

Keyword(s):

Hypoplastic Left Heart Syndrome ◽

Atrial Septum ◽

Left Heart ◽

Hypoplastic Left Heart ◽

Venous Flow ◽

Venous Stenosis ◽

Pulmonary Venous Flow ◽

Pulmonary Venous Stenosis ◽

Left Heart Syndrome ◽

Anomalous Pulmonary Venous Connection

Abnormal pulmonary venous flow patterns on fetal echocardiography and a nutmeg lung pattern on fetal magnetic resonance imaging are seen in patients with pulmonary venous stenosis. The association between these findings and the degree of pulmonary venous stenosis remains unknown. We report an extremely rare case of a fetus diagnosed with hypoplastic left heart syndrome complicated by an absent atrial septum and supracardiac total anomalous pulmonary venous connection with left pulmonary venous congestion. This case suggests that compared to non-pulsatile continuous pulmonary venous flow, the nutmeg lung pattern can only be observed with severe pulmonary congestion and advanced pulmonary lymphangiectasia.

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