Eva K. Boyd

Bio: Eva K. Boyd is an academic researcher from University of California, Los Angeles. The author has contributed to research in topics: Intensive care unit & Population. The author has an hindex of 2, co-authored 5 publications receiving 10 citations.

Perioperative Management of Transcatheter Aortic Valve Replacement: Current Advancements and Controversies

Abstract: Transcatheter aortic valve replacement (TAVR) is a rapidly evolving procedure for the management of high-risk patients with severe aortic stenosis who require surgical intervention. Multidisciplinary specialty teams perform a rigorous selection process to optimally manage patients during this innovative procedure. With increasing experience, indications for TAVR are continuously expanding around the world, and the use in patients with aortic regurgitation and prior bioprosthetic aortic valves has been described. Alternative TAVR devices, procedural approaches, and various anesthetic approaches are emerging. While initially general anesthesia was employed, experience with TAVR under monitored anesthesia care is rapidly growing. Postoperatively, patients are typically monitored for procedure-specific complications in the ICU for the first 3 days. As different management techniques continue to develop, the decisions regarding anesthetic technique, monitoring, and postoperative care are based on specific patient selection and institutional experience.

Prognostic implications of pulmonary hypertension in patients with severe aortic stenosis undergoing transcatheter aortic-valve implantation: study from the FRANCE 2 registry

Abstract: Aims: Pulmonary hypertension (PH) is associated with poor prognosis in patients with severe aortic stenosis (AS). The aim of this multicentre study was to describe clinical outcome after transcatheter aortic-valve implantation (TAVI). Methods: The FRANCE 2 registry included all patients undergoing TAVI in France in 2010 and 2011. Patients were divided into 3 groups depending on pre-TAVI systolic pulmonary artery pressure (sPAP) estimated in transthoracic echocardiography: group I, sPAP 60 mmHg (severe PH). Patients were followed up for 1 year. Results: 2,435 patients whose pre-TAVI sPAP was reported were included. 845 were in group I (34.7%), 1,112 in group II (45.7%) and 478 in group III (19.6%). Procedural success, early complications and 30-day mortality were statistically similar across sPAP groups. 1-year mortality was higher in groups II and III (group I, 21.6%; group II, 27.8%; group III, 28.4%; p=0.032). Mild-to-moderate and severe PH was identified as an independent factor of all-cause mortality. The major adverse cardiovascular event rates did not differ according to sPAP. NYHA functional class improved significantly in all groups. View this table: Table 1. Events at 1 year Conclusion: PH (sPAP > 40 mmHg) in AS patients undergoing TAVI was associated with increased 1-year mortality especially when severe (sPAP > 60 mmHg) but not with increased 30-day mortality, and functional status was significantly improved.

Trends in patient characteristic, cost, and mortality among mechanically ventilated adult patients with congenital heart disease in the United States

Abstract: Background There is an increasing number of adults with congenital heart disease (ACHD), but critically ill ACHD patients remain understudied. The objective of this study was to evaluate patient characteristics and trends in mortality of mechanically ventilated patients with ACHD. Methods We evaluated ACHD with an ICD-9 procedure code for mechanical ventilation using the National Inpatient Sample (NIS), a public all-payer inpatient United States database, from 2005-2014. Primary and secondary outcomes were evaluated using multivariable logistic regression. Results 10,962 of 77,334,704 discharges, representing 52,876 (0.6%) hospitalizations, were ACHD who required mechanical ventilation (MV). Mean age was 59 years (IQR 45-71), with 45.3% female. The number of ACHD requiring MV increased over the years (2,342 to 7,775, p Conclusion The number of mechanically ventilated ACHD has increased over the years. Remarkably, despite an increase in the age and comorbidity burden in this cohort, case-fatality ratio of these patients and the cost per patient remained stable. Nonetheless, there is a growing need for healthcare resources in the management of this cohort of patients. Further studies will need to be conducted to evaluate the underlying physiological impact and prognosis of MV in specific subsets of ACHD.

Trends in Patient Characteristic, Cost, and Mortality Among Mechanically Ventilated Adult Patients With Congenital Heart Disease in the United States

Abstract: There is an increasing number of adults with congenital heart disease (ACHD), but critically ill patients with ACHD remain understudied. The objective of this study was to evaluate patient characteristics and trends in mortality of mechanically ventilated patients with ACHD.We evaluated ACHD with an ICD-9 procedure code for mechanical ventilation using the National Inpatient Sample (NIS), a public all-payer inpatient United States database, from 2005 to 2014. Primary and secondary outcomes were evaluated using multivariable logistic regression.There were 10,962 of 77,334,704 discharges, representing 52,876 (0.6%) hospitalizations that were for patients with ACHD who required mechanical ventilation (MV). Mean age was 59 years (interquartile range: 45-71); 45.3% were female patients. The number of patients with ACHD requiring MV increased over the years (2342 to 7775, P < 0.001). Age and comorbidities of this cohort also increased (55 to 59, P < 0.001; 1 to 2, P < 0.001). Case-fatality ratio remained stable over the years (0.254 to 0.259, P = 0.42). Median cost of hospital stay was USD $49,583 and remained stable over the study period (P = 0.42), whereas total cost increased from $115 million to $564 million (P < 0.001).The number of mechanically ventilated ACHD has increased over the years. Remarkably, despite an increase in the age and comorbidity burden in this cohort, case-fatality ratio of these patients and the cost per patient remained stable. Nonetheless, there is a growing need for health care resources in the management of this cohort of patients. Further studies will need to be conducted to evaluate the underlying physiological impact and prognosis of MV in specific subsets of ACHD.Il existe un nombre croissant d’adultes atteints d’une cardiopathie congénitale (CC), mais peu d’études portent sur les patients gravement atteints d’une CC. L’objectif de la présente étude était l’évaluation des caractéristiques des patients et des tendances de la mortalité des patients atteints d’une CC sous ventilation mécanique.Nous avons évalué les patients atteints d’une CC sous ventilation mécanique (VM, code ICD-9) à l’aide de l’échantillon national des patients hospitalisés (NIS, National Inpatient Sample), une base de données sur les patients hospitalisés des États-Unis accessible au public, de 2005 à 2014. Nous avons évalué les critères de jugement principal et secondaire à l’aide de la régression logistique multivariée.Les 10 962 sorties d’hôpital sur 77 334 704, soit 52 876 (0,6 %) hospitalisations, concernaient des patients atteints d’une CC qui avaient nécessité une VM. L’âge moyen était de 59 ans (écart interquartile : 45-71); 45,3 % étaient des femmes. Le nombre de patients atteints d’une CC qui avaient nécessité une VM augmentait au fil des années (de 2 342 à 7 775, P < 0,001). L’âge et les comorbidités de cette cohorte augmentaient aussi (de 55 à 59, P < 0,001; de 1 à 2, P < 0,001). Le taux de létalité restait stable au fil des années (de 0,254 à 0,259, P = 0,42). Le coût médian des séjours à l’hôpital était de 49 583 $ US et restait stable au cours de la période de l’étude (P = 0,42), alors que le coût total passait de 115 M$ à 564 M$ (P < 0,001).Le nombre de patients atteints d’une CC sous VM a augmenté au fil des années. Étonnamment, en dépit d’une augmentation de l’âge et du fardeau des comorbidités dans cette cohorte, le taux de létalité de ces patients et le coût par patient demeurait stable. Néanmoins, il existe un urgent besoin de ressources de soins de santé pour la prise en charge de cette cohorte de patients. Il sera nécessaire de mener d’autres études pour évaluer les effets physiologiques sous-jacents et le pronostic des patients sous VM dans des sous-ensembles spécifiques de CC.

Duration of regional cerebral oxygen saturation under 40% is a risk factor for neurological injury following pulmonary thromboendarterectomy: A prospective observational study

Abstract: Deep hypothermic circulatory arrest (DHCA) is nowadays commonly used in pulmonary thromboendarterectomy (PTE). Neurological injury related to DHCA severely impairs the prognosis of patients. However, the risk factors and predictors of neurological injury are still unclear.