Background: Minimally invasive heart valve surgery has previously been shown to be safe and feasible in obese patients. Within this population, we investigated the effect of obesity class on the patient outcomes of minimally invasive aortic valve replacement (mini-AVR). Methods: A single center retrospective cohort study of consecutive patients with obese body mass indices (BMIs) who underwent mini-AVR between 2012 and 2018. Patients were stratified into 3 groups according to Centers for Disease Control and Prevention adult obesity classifications: Class I (BMI 30.0 to < 35.0), Class II (BMI 35.0 to < 40.0), and Class III (BMI ≥ 40.0). The primary outcomes were postoperative length of stay (LOS), 30-day mortality within, and cost. Results: Amongst 182 obese patients who underwent mini-AVR, LOS (Class I 4 [3-6] vs. Class II 4 [3-6] vs. Class III 5 [4-6] days; p=0.098) and costs (Class I $24,487 [$20,199-$27.480] vs. Class II $22,921 [$20,433-$27,740] vs. Class III $23,886 [$20,063-$33,800] USD; p=0.860) did not differ between obesity class cohorts. Postoperative 30-day mortality (Class I 2.83% [n=2] vs. Class II 0% [n=0] vs. Class III 0% [n=0]; p=0.763) was limited by an insufficient sample size relative to a low event rate but did not differ between patient cohorts. Conclusions: Mini-AVR is safe and feasible to perform for obese patients regardless of their obesity class. Patients with obesity should be afforded the option of minimally invasive aortic valve surgery regardless of their obesity class.

As SARS-CoV-2 continues to challenge hospital systems, the safety of heart transplantation must be evaluated. Retrospective review of all heart recipients transplanted at a single academic medical center in a U.S. SARS-CoV-2 epicenter found two patients with non-ischemic dilated cardiomyopathy. The 34-year-old male (ejection fraction <10%) was bridged to transplant with extracorporeal membrane oxygenation and microaxial left ventricular assist device. His perioperative course was uncomplicated except for transient SARS-CoV-2 seropositivity two months post-transplant. He was asymptomatic and remained so eight months to follow. The 20-year-old female (ejection fraction 5%) was bridged to transplant with microaxial left ventricular assist device. She progresses well with SARS-CoV-2 seronegativity eight months post-transplant. Our early experience suggests that intentional recipient, donor, and provider testing, cautious organ procurement, strategic intrahospital patient organization and transport, and well-coordinated follow-up permits uninterrupted provision of this definitive therapy for heart failure without subjecting these patients to greater risk.

Granular Cell Tumors (GrCTs) often present as slowly growing painless nodules, and can arise in essentially any anatomical location, but occur most commonly in the head and neck. GrCTs are unique and so named because of the classic histomorphology of the tumor cells having abundant granular eosinophilic cytoplasm. The presence of these tumors in the chest wall has unique implications compared to other anatomical locations. The purpose of our case report is to review the diagnosis and management of a patient with a granular cell tumor of the chest wall.

Objective As the population ages, increasing number of older patients are undergoing adult cardiac surgery. The purpose of the study is to assess the impact of age on postoperative outcomes in patients that undergo coronary artery bypass grafting (CABG). Methods Patients that are ≥70 years old who underwent CABG were selected from the Nationwide/National Inpatient Sample from 2010 to 2015 using ICD-9-CM diagnosis and procedure codes. The patients who were 70–79 years old were compared to patients aged 80–89 years old to determine if the age difference of the patients had an impact on surgical outcomes. In addition, the gender of the patients 80-89 years old were compared. The rates of postoperative complications, and mortality were compared. Results A total of 67,568 patients were identified who were ≥70 years old and underwent CABG. Compared to the Septuagenarians, the Octogenarians were more likely to develop cardiac complications (OR [odds ratio] =1.20, 95% CI [confidence interval] 1.12-1.23. They were also more likely to develop renal complications (P <0001), and respiratory complications (P <0001). The Octogenarians were also more likely to bleed postoperatively (P <0.0001) and have a higher mortality (P <0001). Furthermore, the female Octogenarians had a higher mortality (OR 1.25 95% CI 1.07–1.46) compared to males in the same age group. Conclusions The patients who were ≥80 – 89 years old had worse postoperative outcomes. The Octogenarians who were females had a higher mortality compared to their male counterparts.