Ankit Agrawal

Background: Transcatheter mitral valve replacement (TMVR) using the Sapien (Edwards Lifesciences, Irvine, CA) transcatheter heart valve has become the preferred treatment for high‐risk patients with failed mitral bioprosthetic valves or prior surgical mitral valve repairs. Differences in anatomy and procedural complexity between valve‐in‐valve TMVR (ViV‐TMVR) and valve‐in‐ring TMVR (ViR‐TMVR) may influence clinical outcomes. Methods: We systematically searched OVID Medline, Embase, SCOPUS, Web of Science, and Cochrane for studies published between 2015 and 2022 comparing ViV‐TMVR and ViR‐TMVR. The primary end point was 30‐day all‐cause mortality. Secondary outcomes included in‐hospital mortality, stroke, acute kidney injury, major bleeding, reintervention, left ventricular outflow tract obstruction, and device embolization. Random‐effects models were used to pool outcomes. Results: Eight studies including 1947 patients (ViV‐TMVR: 1435; ViR‐TMVR: 512) were analyzed. Patients undergoing ViV‐TMVR were older and had a greater baseline comorbidity burden. No significant differences were observed in 30‐day mortality (odds ratio [OR]: 0.70 [95% CI: 0.47–1.05]; I ² =0%) or in‐hospital mortality (OR: 1.05 [95% CI: 0.34–3.21]; I ² =3%). Similarly, stroke, major bleeding, and device embolization did not differ significantly between groups. However, ViV‐TMVR was associated with lower rates of left ventricular outflow tract obstruction (OR: 0.30 [95% CI: 0.18–0.51]), reintervention (OR: 0.19 [95% CI: 0.13–0.30]), and acute kidney injury (OR: 0.51 [95% CI: 0.29–0.90]), with no significant heterogeneity. Conclusions: Compared with ViR‐TMVR, ViV‐TMVR was associated with lower rates of left ventricular outflow tract obstruction, reintervention, and acute kidney injury, whereas mortality and other major complications were comparable. These findings may inform patient selection and procedural planning for transcatheter mitral valve interventions.

Introduction: This study investigates the relationship between long-term aspirin use and mortality in patients experiencing acute radiation-induced pulmonary complications. Methods: We conducted a secondary analysis from the National Inpatient Sample from 2016 to 2020. Our cohort comprised patients diagnosed with acute pneumonitis secondary to chest radiation. We adhered strictly to the STROBE checklist, extracting various patient characteristics for analysis. Categorical variables were compared using Pearson’s chi-square test, while continuous variables were assessed using Student’s two-sample t test. To assess the relationship, we employed multivariable-adjusted logistic regression, presenting results as odds ratios (ORs) with 95% confidence intervals (CIs). Results: The study included a total of 6064 hospitalizations: 5204 hospitalizations were in the not-taking-aspirin group (NAG), while 860 were in the aspirin group (AG). The mean age of the NAG cohort was 68.67 ± 12.31 years (mean ± SD), while for the AG it was 72.64 ± 8.87 (mean ± SD) years. Our multivariable analysis revealed that aspirin use is associated with 29% lower odds mortality (aOR = 0.71, 95% CI = 0.54–0.94, p = 0.02) than the NAG. Patients with heart failure (aOR = 0.34, 95% CI = 0.18–0.64, p < 0.001) showed the most significant mortality benefits. No mortality advantages of aspirin were observed in patients with coronary artery disease, percutaneous coronary intervention, or coronary artery bypass grafting. Conclusions: Aspirin use in patients with acute chest radiation is associated with decreased odds of mortality, particularly in those with a history of congestive heart failure.

Background: Peripheral artery disease (PAD) affects >236 million people globally, particularly among those with type 2 diabetes. GLP‐1 (glucagon‐like peptide‐1) receptor agonists (GLP‐1 RAs) offer cardiovascular and kidney benefits, but their impact on PAD‐specific outcomes is underexplored. This study evaluates long‐term GLP‐1 RA effects on adverse outcomes in this population. Methods: A retrospective cohort study using the TriNetX platform (January 1, 2010–January 1, 2025) included patients with both PAD and type 2 diabetes prescribed either GLP‐1 RAs or metformin, excluding those with recent cardiovascular events, end‐stage renal disease, or prior amputations. Propensity score matching was performed to account for confounding. Outcomes at 5 years included mortality, myocardial infarction, hospitalization, stroke, revascularization, amputations, dialysis, major adverse cardiovascular events, and kidney events. Results: After matching, 2133 patients per cohort were analyzed in the overall group with PAD. At 5 years, GLP‐1 RA therapy was associated with lower mortality (10.31% versus 14.49%; hazard ratio [HR], 0.74 [95% CI, 0.62–0.88]; P =0.0005), hospitalization (69.3% versus 74.7%; HR, 0.87 [95% CI, 0.81–0.94]; P =0.0002), revascularization (4.69% versus 7.27%; HR, 0.64 [95% CI, 0.50–0.82]; P =0.0004), major amputation (2.30% versus 4.36%; HR, 0.52 [95% CI, 0.37–0.74]; P =0.0002), and minor amputation (4.03% versus 6.42%; HR, 0.63 [95% CI, 0.48–0.83]; P =0.0007). major adverse cardiovascular events, myocardial infarction, stroke, and major adverse kidney events were similar between groups. Conclusions: GLP‐1 RAs were associated with lower rates of mortality, major amputation, revascularization, and hospitalization in PAD and type 2 diabetes patients. These findings support prioritizing GLP‐1 RAs for limb‐specific and cardiovascular outcomes in this high‐risk group.

Background: Upper gastrointestinal bleeding is a severe postoperative complication after coronary artery bypass grafting. We aimed to identify the incidence, predictors, and outcomes of nonvariceal upper gastrointestinal bleeding (NVUGIB) readmissions within 30 days after coronary artery bypass grafting from a nationwide database. Methods: The Nationwide Readmission Database 2016 to 2020 was queried to identify patients who had isolated coronary artery bypass grafting and were readmitted with NVUGIB in 30 days. International Classification of Diseases , Tenth Revision , Clinical Modification ( ICD‐10‐CM ) and Procedure Coding System codes were used to identify the cohort. As the Nationwide Readmission Database is an anonymous public database, the study was exempt from the institutional review board. The analysis was conducted using Stata 17 (StataCorp LLC, College Station, TX). Results: Of 801 221 patients who underwent isolated coronary artery bypass grafting, 784 280 were discharged alive. Within 30 days, of the 5180 patients who were readmitted with a diagnosis of NVUGIB, the mortality rate was 5.4%. Compared with nonreadmitted patients, patients with NVUGIB had a lower proportion of women (25.4% versus 31.2%, P P P P 65 years) (HR, 1.25 [95% CI, 1.01–1.53]; P =0.04). Female sex (odds ratio, 2.01 [95% CI, 1.28–3.17]; P =0.002) was strongly associated with death. Early (≤24 hours) esophagogastroduodenoscopy had better mortality outcomes (odds ratio, 0.23 [95% CI, 0.09–0.53]; P <0.001). Conclusions: NVUGIB readmissions after coronary artery bypass grafting are linked to significant morbidity and death. Early esophagogastroduodenoscopy is associated with improved outcomes, emphasizing its role in management.

Pulmonary embolism (PE) can be a life-threatening complication following coronary artery bypass grafting (CABG). However, the impact of PE on short-term outcomes such as readmission and mortality remains poorly characterized. The Nationwide Readmission Database 2016 to 2021 was queried to identify patients with isolated CABG who were readmitted with PE within 30 days. International Classification of Diseases (ICD) 10th Revision Clinical Modification and Procedure Coding System codes were used to identify the cohort. Rates and patient characteristics were compared between post-CABG patients with and without PE. Multivariable logistic regression analysis was performed to identify risk factors for PE within 30 days of isolated CABG, as well as risk factors for mortality in these patients. Patients with PE had a higher prevalence of female sex (32.7% vs 30.7%, P = .04) and obesity (25.7% vs 22.3%, P < .001), but lower rates of hypertension and diabetes. Thirty-day mortality was higher in PE patients in univariable (Odds ratio (OR) 1.53, 95% confidence interval (CI) 1.16-2.05, P = .002) and multivariable analyses (OR 1.45, 95% CI 1.00-2.11, P = .04). PE following CABG is associated with increased 30-day readmission and mortality. These findings underscore the need for improved risk stratification, early detection, and targeted prevention strategies in the postoperative period.