A Single Site, Retrospective Chart Review of Renal Transplant Graft Failure and Mortality Rates Pre and Post COVID-19 Pandemic.

INTRODUCTION: Immunosuppressed patients are at an increased risk of complications from COVID-19. Despite the morbidity and mortality associated with COVID-19, there is little information regarding its effect on post-renal transplant patients. This study investigated the impact of a COVID-19 diagnosis on renal transplant recipients in terms of graft failure and mortality. METHODS: Renal transplant recipients were included if they had a functioning graft between March 2020 and March 2022. COVID-19 test results, duration from COVID-19 to graft failure and mortality, vaccination status, and COVID-19 treatment regimen were recorded and analyzed. RESULTS: There were 175 renal transplant recipients who met study criteria. Of these, 82 patients had documented COVID-19 cases, and 93 patients did not have a documented case. Of the patients who had a COVID-19 positive test, 3 experienced renal graft failure, and 15 experienced mortality. When comparing graft failure rate between the two groups, there was no significant difference. The mortality risk was significantly increased in COVID-19 positive patients (p=0.021). The COVID-19 immunization rate (at least one dose) was 82.5% for renal transplant recipients compared to 77.2% for all of South Dakota. CONCLUSIONS: There was no significant difference in renal graft failure rate between the two groups, but there was a significantly increased mortality risk in patients with COVID-19 positivity.

Clinical factors associated with physician choice of femoral versus radial access: A real-world experience from a single academic center.

OBJECTIVES: To analyze clinical factors associated with operator's preference in selection of femoral versus radial access for angiography and percutaneous intervention (PCI) procedures. BACKGROUND: There has been an increase in radial access in cardiac catheterization and PCI in the last few decades. METHODS: Data from 11 226 consecutive cardiac catheterization procedures were collected from Sanford University Medical Center (University of South Dakota, Sanford School of Medicine) from 2011 to 2015. RESULTS: In the overall cases, clinical factors that favored upfront femoral access include patients presenting as ST-elevation myocardial infarction (STEMI) or emergent, coronary artery bypass graft, body mass index (BMI) <30 kg/m2 and age ≥70 years, whereas morbidly obese patients (BMI ≥35) and age <70 favored upfront radial access. Radial access in the overall group had lower fluoroscopy time (6.5 vs 8.4 min, P < 0.0001) and lower contrast use (68.8 vs 80.6 cc, P < 0.0001). In the PCI group, efficacy of upfront radial access is less evident with radial fluoroscopy time (10.1 vs 11.0 min, P < 0.0028) and contrast use being higher in radial group (113.8 vs 108.2 cc, P < 0.037). Interventional cardiologists were more efficient in diagnostic cases than non-interventional cardiologists. CONCLUSION: STEMI or emergent cases and elderly patients favor upfront femoral access. As BMI increases and age decreases, radial access is progressively favored. In diagnostic cases, radial access appears to be superior to femoral access in efficacy, but the distinction is less obvious in PCI and STEMI or emergent cases.

Transcatheter tricuspid valve-in-valve implantation for very early bioprosthetic tricuspid stenosis secondary to pacemaker lead entrapment: a case report.

Background: Tricuspid stenosis (native and prosthetic) is rare. Redo-sternotomy for isolated tricuspid replacement is associated with a higher risk. The efficacy and durability of transcatheter valve implantation for severe tricuspid stenosis are unclear. Case summary: Successful tricuspid valve-in-valve implantation (Edwards 26 mm Ultra) was performed to exteriorize a retained, unextractable pacemaker lead causing very early surgical bioprosthetic valve dysfunction in a 66-year-old Caucasian woman. The original indication for surgical replacement was pacemaker lead-related severe tricuspid regurgitation. History of CABG and subsequent surgical replacement rendered the risk of a third sternotomy and open-heart surgery prohibitive. Conclusion: Successful reduction in the severity of bioprosthetic tricuspid stenosis and improvement of right heart failure with transcatheter valve-in-valve implantation was observed. Percutaneous tricuspid valve implantation could be considered an alternative to redo-sternotomy for severe bioprosthetic tricuspid stenosis.