Oral Presentation Session II

Background/Significance:

Hypertriglyceridemia (HTG) remains a significant but poorly understood complication in extremely low birth weight infants receiving intravenous lipid emulsions. While lipids are crucial for growth and development, the optimal management strategy and risk factors for HTG development remain unclear. Currently, there is no consensus on surveillance or management guidelines for optimal lipid infusion or HTG in this vulnerable population.

Purpose:

To determine the incidence of HTG (defined as triglyceride level >250 mg/dL) in infants with birth weight (BW) < 1250 grams receiving intravenous lipid emulsions and identify associated risk factors.

Methods:

Single-center retrospective study examining infants < 1250 grams BW admitted between August 2020-July 2024. Statistical analysis included ANOVA, correlation coefficients, and comparison between HTG and non-HTG groups. Significance was set at p < 0.05.

Results:

Among 155 infants analyzed, the overall HTG incidence was 28.4%. Incidence was significantly higher in lower gestational age (GA) infants (73.33% in ≤26 weeks vs 17.60% in >26 weeks) and very low BW infants (72.73% in < 750g vs 16.39% in ≥750g). Longitudinal analysis revealed that HTG infants had significantly higher initial triglyceride levels that decreased from week 1 to week 4 (249.14 to 145.33 mg/dL, overall ANOVA p=0.007; week 1 vs week 4 p=0.003), while non-HTG infants maintained stable levels throughout (127.97 to 131.04 mg/dL, p=0.541). HTG was significantly associated with lower GA (26.7 vs 28.7 weeks, p < 0.001), lower BW (794g vs 1029g, p < 0.001), and lower Apgar scores at both 1 minute (4.7 vs 5.9, p=0.002) and 5 minutes (7.2 vs 7.9, p=0.013). Correlation analyses revealed only weak associations between triglyceride levels and at-risk clinical variables, with BW showing the strongest negative correlation (r=-0.279). Maternal body mass index showed no significant difference between groups (p=0.218).

Conclusion:

This study demonstrates that preterm infants ≤26 weeks GA and < 750g BW are at highest risk for HTG development. The pattern of changing triglyceride levels and weak correlations with clinical risk factors suggest HTG is primarily related to infant maturity. These findings support the need for targeted monitoring strategies in high-risk infants, particularly during the first week of life. Future prospective studies are needed to establish optimal lipid administration protocols for these vulnerable infants and validate predictive risk factors for HTG development.

Background/Significance:

Atrial fibrillation (AF) is a common arrhythmia that increases risk for stroke when left untreated. The standard treatment for AF includes ablation to achieve pulmonary vein isolation (PVI). Pulsed field ablation (PFA) is a novel modality for PVI in patients with AF, recently introduced in the US.

Purpose:

We sought to evaluate differences in baseline and procedure characteristics, complications, and PFA implementation learning curves in academic versus non-academic centers to determine if learners may impact the aforementioned.

Methods:

Data on AF patients treated with PFA during a three-month period at two academic centers and one non-academic center were collected. Baseline and procedure characteristics were compared. Continuous variables are presented as median (Q1, Q3). Categorical variables are presented as n (%). For categorical variables, either chi-square test or Fisher’s exact test was used. For the numeric variables, the Wilcoxon Rank Sum test was used. Learning curve slopes for procedure and fluoroscopy time were compared using regression analysis.

Results:

Overall (n=147), the non-academic cohort (n=34) had significantly younger patients (years) 63.7 (56.7, 66.8) vs. 68 (61.7, 73.2), P=0.0085, smaller LA volume index (ml/m2) 30 (18.0, 37.5) vs. 35.4 (28.1, 46.0), P=0.0198, lower CHA2DS2-VASc score, 2 (1,2) vs. 3 (2,4) P=0.0018, and fewer patients with coronary artery disease, 3 (8.8) vs. 32 (28.3), P=0.0193, and diastolic dysfunction, 4 (17.4) vs. 37 (40.7), P=0.0378. There were no significant differences in sex, body mass index, prior stroke, left ventricular ejection fraction, or obstructive sleep apnea (P>0.05). Non-academic centers gave PVI plus additional lesions more often, 34 (100), than academic 61 (54.0) (P< 0.0001). The non-academic center had significantly lower procedure time (min) 46 (36.0, 66.0) vs. 119 (94.0, 149.3) and fluoroscopy use (min) 11.5 (7.5, 17.1) vs. 23.1 (15.6, 35.6) (P< 0.0001). The thirty-day complication rate was similar in non-academic, 3 (8.8) and academic, 3 (2.6) centers (P=0.1367). There was no difference in the slope of learning curve by procedure time (P=0.8907) or by fluoroscopy duration (P=0.9761) between cohorts.

Conclusion:

In the implementation of PFA as a new PVI modality, there was no learning curve observed in academic or non-academic centers. Procedure complications in academic centers were low despite the use of physician trainees and sicker patients.

Background/Significance:

Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer. The KEYNOTE-522 Protocol (PROTOCOL), combining standard-of-care chemotherapy with pembrolizumab improves outcomes but notably risks adrenal insufficiency (AI). Guidelines lack standardized recommendations for routine testing in patients leading to varied practice among oncologists within the Aurora Legacy system, Wisconsin (AURORA).

Purpose:

This quality improvement project evaluates adrenocorticotropic hormone (ACTH) and cortisol testing patterns in TNBC patients undergoing neoadjuvant pembrolizumab per PROTOCOL within AURORA. The goal is to enhance care by optimizing the monitoring and management of potential AI related to pembrolizumab.

Methods:

Utilizing Advocate Health Midwest cancer registry data, we identified TNBC patients receiving neoadjuvant treatment per PROTOCOL between February 1, 2020, and March 31, 2024, within AURORA. Data was obtained through research analytics and manual chart review. Primary outcomes were ACTH and cortisol testing patterns. Secondary outcomes included TNBC frequency and adrenal insufficiency prevalence.

Results:

384 TNBC patients were identified. 123 were found to be treated per PROTOCOL. 55 patients (44.7%) were tested for AI, regardless of symptoms. 238 tests were performed (4.3 tests/patient averaged). Most patients (54.4%) had 1-2 tests, while one patient had 28. Cortisol testing (66.8%) was more common than ACTH (33.2%). 7 patients (12.7%) of those tested were found to have pembrolizumab-associated AI.

Conclusion:

This study noted variability in AI testing patterns for TNBC patients receiving pembrolizumab. On chart review, approaches ranged from routine screening to symptom-based testing, with fatigue as the main trigger for testing. Notably, fatigue’s prevalence in chemotherapy complicates its interpretation as an indicator. Based on our research, we propose a standardized testing protocol.

Background /Significance:

Surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) are both beset with structural valve degeneration several years after the procedure. As valve-in-valve TAVR expands into the low-risk and intermediate-risk inpatient population, the number of patients requiring future reintervention is expected to be high.

Purpose:

Limited data are available on reintervention of failed bioprosthetic valve-in-valve treated with valve-in-valve-in-valve (ViViV). We aimed to analyze clinical characteristics and procedural and clinical outcomes of SAVR-in-TAVR-in-TAVR.

Methods:

Data were collected on 3,742 TAVRs performed at our center from January 1, 2012, to January 31, 2024. A total of 7 patients were identified as having undergone a ViViV in the form of SAVR-in-TAVR-in-TAVR. The primary endpoint of this study was procedural success rate, defined as postprocedural correct positioning of the valve and absence of procedural complications such as coronary artery obstruction and/or valve displacement. Secondary endpoints of this study were procedural major adverse cardiovascular and cerebrovascular events (MACCE), residual aortic valve gradient post-procedure, and 30-day and 1-year survival.

Results:

Median age was 77 years at the time of ViViV. The median time between SAVR and first TAVR was 11.6 years. The median time between TAVR and re-do TAVR was 38.5 months. There were 4 males and 3 females. Four of the 7 patients were in NYHA functional class III or IV. Procedural success was 100%. Median aortic valve mean gradient post-procedure was 16.5 mmHg. There were no procedural MACCE events. At 30 days and 1 year, survival was 100% for both.

Conclusions:

In this small cohort of 7 patients who underwent a ViViV, we found very favorable results with acceptable post-procedural mean gradient in addition to 100% survival at both 30 days and 1 year.