In this study, we sought to evaluate the prevalence and association of pre-transplant atrial fibrillation (AF) on 30-day postoperative outcomes in patients undergoing orthotopic liver transplant (OLT). The National Inpatient Sample Database was queried from 2011 to 2017 for relevant ICD-9 and ICD-10 procedural and diagnostic codes. Baseline characteristics and in-hospital outcomes were compared in patients who underwent OLT with AF and those without. Among 45,357 patients who underwent OLT, women made up 35.8 % of the overall population. The prevalence of AF prior to transplant was 2932 (6.5%) with a trend towards increasing prevalence, with an annual change rate of 4.19%. Applying propensity score matching to control for potential confounding factors, there was no association between pre-transplant AF and in-hospital mortality in patients undergoing OLT, however, there was a higher incidence of perioperative complications. Older age, the presence of heart failure, and anemia were independently predictive of higher mortality in patients with pre-transplant AF undergoing OLT. In patients undergoing OLT, pre-transplant AF is increasing in prevalence and appears to be associated with similar in-hospital mortality but worse perioperative outcomes. Greater emphasis should be placed on AF in the preoperative cardiovascular risk stratification of patients undergoing OLT.

Introduction: Due to the inability to keep up with the demand for heart transplantation, there is an increased utilization of left ventricular assist devices (LVAD). However, paucity of data exists regarding the association of household income with in-hospital outcomes after LVAD implantation. Methods: Retrospective cohort study using the NIS to identify all patients ≥18 years who underwent LVAD implantation from 2011-2017. Statistical analysis was performed comparing low household income (≤50th percentile) and high income (>50th percentile). Results: A total of 25,503 patients underwent LVAD implantation. The low-income group represented 53% and the high-income group corresponded to 47% of the entire cohort. The low-income group was found to be younger (mean age 55 ±14 vs. 58 ±14 years), higher proportion of females (24% vs. 22%), and higher proportion of blacks (32% vs. 16%, p<0.001 for all). The low-income group was found to have higher prevalence of hypertension, chronic pulmonary disease, smoking, dyslipidemia, obesity and pulmonary hypertension (p<0.001 for all). However, the high-income cohort had higher rate of atrial tachyarrhythmias and end-stage renal disease (p<0.001). During hospitalization, patients in the high-income group had increased rates of ischemic stroke, acute kidney injury, acute coronary syndrome, bleeding and need of extracorporeal membrane oxygenation (p<0.001 for all). We found that the unadjusted mortality had an OR 1.30 (CI [1.21-1.41], p<0.001) and adjusted mortality of OR 1.14 (CI [1.05-1.23], p=0.002). Conclusion: In patients undergoing LVAD implantation nationwide, low-income was associated with increased comorbidity burden, younger age, and fewer in-hospital complications and all-cause mortality.

Over the last two decades, the medical community witnessed an outstanding and accelerated development on minimally invasive therapies. With the dorsal spine of supportive data from large randomized control trials, transcatheter aortic valve replacement (TAVR), aortic and mitral valve-in-valve, mechanical circulatory support and peripheral endovascular interventions all share the need of accessing a vascular bed with a large bore catheter. Nevertheless, to date, there has yet to be a universal consensus on defining large-bore vascular access (LBVA) in the world of transcatheter therapies. We explore the evolution, characteristics and vascular compatibility of the current commercially available devices, analyze the devices along with access site-specific complications rates and finally review the present methods for percutaneous vascular closure.