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Introduction: In recent years, octogenarian population (≥80 years) has been increasingly referred for percutaneous coronary intervention (PCI). However, the outcome of octogenarian compared with younger population is unknown. Therefore, we sought to compare in-hospital clinical outcomes after PCI for octogenarian compared with non-octogenarian patients. Methods: Using national inpatient sampling (NIS), we identified all octogenarian patients who underwent PCI and compared with patients who are younger than 80 years old. Results: A total of 1544563 octogenarian patients (mean age 83.96 ± 3.29 years, 50.1% women) and 9511996 non-octogenarian patients (mean age 62.28 ± 11.04 years, 34% women) were identified. After multivariate adjustment, octogenarians had higher in-hospital mortality (3.3% vs 1.3% adjusted Odds Ratio [aOR], 1.62; 95% CI, 1.60-1.64, P<0.0001), longer LOS (3 vs. 2 days, p<0.0001), higher cardiac complications (3.4% vs. 2.4% aOR 1.07; 95% CI 1.06 to 1.08; p < 0.0001), permanent pacemaker implantation (1.4% vs. 0.4% aOR 1.94; 95% CI 1.94 to 1.98; p<0.0001), post-procedural stroke (6.3% vs. 3.8% aOR 1.32; 95% CI 1.32 to 1.33; p < 0.0001) and hemorrhage requiring transfusion (2.1% vs. 1.0% aOR 1.301 ; 95% CI 1.281 to 1.281; p < 0.0001). Conclusions: Overall, octogenarian patients who underwent PCI were at increased risk for in-hospital mortality and morbidity compared to non-octogenarians. The decision to proceed with PCI in this patient population should be individualized taking into consideration, known risk factors and expected impact on quality of life. [ABSTRACT FROM AUTHOR]

Introduction: Bicuspid aortic valve (BAV) disease is considered the most common congenital heart disease and the main etiology of aortic valve stenosis (AS) in young adults. While transcatheter aortic valve replacement (TAVR) is routinely used in high- and intermediate risk patients with AS, BAV patients with AS were excluded from all pivotal trials that led to TAVR approval. Hypothesis: We sought to examine TAVR trends and in-hospital outcomes in patients with BAV AS. Methods: Using the National Inpatient Sample (NIS) from January 1, 2011, through December 31, 2014. We identified patients with BAV with International Classification of Diseases-Ninth Revision-CM (ICD-9) code 746.4. Patients who underwent TAVR were identified using ICD-9 codes 35.05 and 35.06. Baseline characteristics were created from definitions in the Elixhauser Comorbidity Index. Results: We identified 423 patients with BAV and AS who underwent TAVR which represents 2.1% of the total BAV patients. One-third of enrolled patients were female, and the majority of the patients were white with a mean age of 65.9±15.1 years. TAVR utilization for BAV stenosis significantly increased from 0.39% in 2011 to 4.16% in 2014 (p < 0.001) which represents a 3.77% overall growth in procedure rate. The median length of stay decreased significantly throughout the study period [mean 12.2±8.2 days to 7.1±5.9 days, p-value <0.001]. The overall vascular complications, the need for blood transfusion and the requirement for emergent open cardiac surgery have declined over the same period. Conclusions: Despite lack of FDA approval, there is a steady increase in TAVR utilization for BAV patients with AS along with a significant decrease in length of stay and procedural complications. [ABSTRACT FROM AUTHOR]

Introduction: Several studies have shown an "obesity paradox" in which obese people have a favorable outcome following cardiac surgeries. However, the impact of obesity on mitral valve surgery is unknown. Hypothesis: We sought to evaluate the impact of obesity on in-hospital outcomes in patients who underwent mitral valve repair or replacement. Methods: Using the Nationwide Inpatient Sample, we identified all adult patients who underwent isolated mitral valve surgery (MVS) from 2002 to 2014 using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic and procedures codes. Multivariable analyses and propensity score matching was used to compare the in-hospital clinical outcomes in obese patients (BMI ≥ 30 kg/m2) compared with non-obese (BMI < 30 kg/m2). Results: A total of 368,568 patients who underwent MVS procedure were identified. Of which, 41,533 were obese, and 327,035 were non-obese. Obese patients were younger, had more Caucasian women, but had more co-morbidity. In-hospital mortality was lower in the obese group (adjusted odds ratio 0.87; 95% confidence interval 0.87 to 0.94; adjusted p < 0.001). Similarly, obese patients had a lower major adverse cardiovascular event (MACE) and stroke, but a higher length of stay, bleeding, and acute kidney injury (Figure). After propensity matching, the in-hospital mortality and MACE were still significantly lower in the obese group whereas obese patients had a comparable risk of stroke and net adverse clinical events (Table). Conclusions: Obese patients have favorable in-hospital outcomes after mitral valve surgery compared with non-obese patients. This finding is in favor of "obesity paradox" in this patient population. [ABSTRACT FROM AUTHOR]

Introduction: Patent foramen ovale (PFO) with atrial septal aneurysm (ASA) is suggested as an important potential source for cryptogenic strokes. Percutaneous PFO closure to reduce the recurrence of stroke compared to medical therapy has been intensely debated. Hypothesis: The aim of this study is to assess whether PFO closure in patients with cryptogenic stroke is safe compared with medical therapy. Methods: A search of PubMed, Medline and Cochrane Central Register for randomized controlled trails (RCT), which compared PFO closure to medical therapy in patients with cryptogenic stroke. We used the items "Patent Foramen Ovale", "PFO Closure" and "stroke". Data was pooled for the primary outcome measure using the random-effects model as pooled Rate Ratio (RR). The primary outcome was reduction in recurrent strokes. Results: 6 studies were selected. Our analysis included 3,560 patients (mean age 47 years, 55% men, mean follow-up 3.25 years), 1,889 in the PFO closure group and 1,671 in the medical therapy group. The I2 heterogeneity test was found to be 57%. A random effects model combining the results of the included studies demonstrated a statistically significant risk reduction in risk of recurrent stroke in the PFO closure group when compared with medical therapy group (1.9% vs 4.6%, RR 0.38; 95% CI 0.18 to 0.81, P = 0.01). Risk difference of 0.03 [0.01, 0.05] leading to a number needed to harm 33. Atrial fibrillation occurred in 79 patients in the PFO closure group compared with 12 (0.7%) patients in the medical therapy group [RR 4.58, 95% CI: 2.47, 8.51, I2= 0%, p < 0.0001]. Furthermore, there was slight difference in risk of bleeding complication favoring PFO closure group; however, this difference was not statistically significant Risk Ratio of 0.82[0.50,1.35], P=0.43. Conclusions: Pooled data from 6 large RCTs showed that PFO closure in patients with cryptogenic stroke is safe and effective intervention for prevention of stroke recurrence compared with medical therapy. [ABSTRACT FROM AUTHOR]

Introduction: Since the approval of transcatheter aortic valve replacement (TAVR) utilization has been increasing for high and intermediate risk patients. Nonetheless, the outcome of TAVR in African American (AA) patients compared to other populations has not been explored. Hypothesis: We sought to evaluate the in-hospital outcomes of AA patients post TAVR. Methods: Using National Inpatient Sample (NIS) database between 2011 and 2014, we identified patients who undergone TAVR as a primary procedure. AA patients were compared to patients from other ethnicities. Multivariate logistic regression analysis was performed for the primary outcome of in-hospital mortality. Results: Out of 39,253 patients who underwent TAVR, only 1,526 (3.9%) were AA. AA patients were younger (median 78 vs 81 years, P < 0.006), and had more females (61.4% vs. 47.2%, P < 0.001). While both groups had comparable comorbidities, congestive heart failure, coagulopathy, diabetes mellitus and hypertension were more common in AA group compared with non-AA (p < 0.004 for all). However, coronary artery disease, carotid artery disease, and atrial fibrillation were lower in the AA group (P ≤ 0.001). After adjusting for potential risk factors, AA patients had lower in-hospital mortality (3.6% vs 4.2%, OR = 0.737; 95% CI 0.551, 0.984 P = 0.039), cardiac complications (3.2% vs 9.6%, OR = 0.360; 95% CI 0.269, 0.482 P < 0.001) and respiratory complications (12.1% vs 13.4%, OR = 0.772; 95% CI 0.652, 0.913 P = 0.003) compared with non-AA group. Conclusions: TAVR has been underutilized in African American compared with other ethnicities despite lower in-hospital mortality and in-hospital complications compared with other ethnicities. We suggest that TAVR might be a safe and viable option for African American patients. [ABSTRACT FROM AUTHOR]