Catholic Medical Center

Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) have transformed the management of severe aortic stenosis across a wide range of patient risk profiles. As populations age and indications extend to lower-risk and younger patients, determining the appropriate role of age in selecting TAVR versus SAVR has become increasingly complex. Current guidelines emphasize individualized decision-making, yet age-based referral patterns remain common in clinical practice. This review examines how age thresholds are applied in contemporary guidance from the United States (US), Europe, and the Asia-Pacific region. Additionally, this review evaluates whether chronological age alone is a defensible basis for referral or treatment selection. This evidence-based narrative review queried PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) from January 1, 2013, through December 31, 2025, using the search terms: ("aortic stenosis" AND ("TAVR" OR "transcatheter aortic valve implantation (TAVI)" OR "SAVR")) AND ("age" OR "appropriateness"). English-language abstracts and full texts were screened in duplicate. Eligible studies included randomized controlled trials, national or continental registries, health economic simulations, and clinical practice guidelines that reported age-stratified outcomes or recommendations. Single-case reports, editorials, and animal studies were excluded. Of the 1628 titles screened, 87 full texts were reviewed, and 45 studies were retained. Across regions, guidelines converge on a core principle: age is informative but insufficient in isolation. U.S. guidance generally favors SAVR in patients younger than 65 years or those with a life expectancy greater than 20 years, and favors transfemoral TAVR in patients older than 80 years or with a life expectancy shorter than 10 years. European guidance typically favors SAVR in patients younger than 75 years and TAVR in those older than 75 years. Meanwhile, Asia-Pacific recommendations adopt a similarly individualized approach but place greater emphasis on bicuspid anatomy, rheumatic disease, local health system infrastructure, and cost. Recent data support a cautious approach in younger patients. In observational U.S. analyses of patients younger than 65 years, TAVR use increased substantially despite guideline preference for surgery, and TAVR was associated with higher long-term mortality or higher pacemaker and readmission burdens in selected cohorts. Contemporary randomized data suggest broadly similar outcomes between TAVR and SAVR in older or intermediate-age populations; however, uncertainty persists in younger low-risk patients, particularly those with bicuspid anatomy and long projected survival. Age-based cutoffs should be interpreted as decision anchors rather than rigid rules. The most defensible framework integrates age with life expectancy, valve durability, anatomy, frailty, comorbidity burden, coronary artery disease, feasibility of future valve-in-valve therapy, and patient preferences within a multidisciplinary heart team. Expansion of TAVR into younger populations should remain measured until more robust long-term durability and lifetime management data become available.

Background Patients who present with ST-elevation myocardial infarction (STEMI) to a hospital without primary percutaneous coronary intervention (PPCI) capability may be transferred for PPCI or receive fibrinolytic therapy, depending on whether the first medical contact to balloon time of ≤120 minutes can be achieved. We hypothesized that travel distance to the percutaneous coronary intervention (PCI) center might impact STEMI outcomes in a rural STEMI system of care. Methods We retrospectively analyzed 6225 consecutive STEMI patients from the Northern New England Cardiovascular Disease Study Group registry from 2018 to 2023. Residential distance to care was calculated by road travel distance between ZIP Code centroids and grouped into quartiles. Patients were categorized by treatment strategy: initial presentation to a PCI center, transfer for PPCI, or pharmacoinvasive PCI. The primary outcome was in-hospital mortality. Multivariable logistic regression evaluated the association between residential distance and treatment strategy with in-hospital mortality. Results The median residential distance to PCI center for STEMI patients in Northern New England was 38.2 miles (IQR, 47.1). Of the overall cohort, 44.4% (median travel distance: 17.2 miles) had index presentation to a PCI hospital, 23.8% (median travel distance: 40.1 miles) underwent interhospital transfer for primary PCI, and 31.9% (median travel distance: 66.5 miles) were transferred for pharmacoinvasive PCI after initial lytic therapy. There was no association between distance to PCI hospital and adjusted in-hospital mortality after STEMI, irrespective of the treatment group. Conclusions In Northern New England with contemporary regional STEMI referral networks, distance to PCI hospital did not impact STEMI mortality despite substantial travel distances for many patients.

e22540 Background: NUT carcinoma (NC) or NUT midline carcinoma is an extremely rare, undifferentiated or a poorly differentiated squamous cell malignancy that can arise anywhere in the body, but often originates along the midline structures (head, neck or lungs). It is characterized by chromosomal rearrangement of NUT gene, commonly BRD3 or BRD4 gene. This fusion oncogene produces abnormal NUT (Nuclear protein in testis) protein causing dysplastic squamous cell proliferation. NC presents at later stages with B-symptoms and symptoms specific to the organ of origin. The purpose of this study is to determine epidemiology and factors affecting survival in NC. Methods: We extracted cases of NUT carcinoma diagnosed after the age of 20 years, using the ICD Code 8023/3, from Surveillance, Epidemiology and End Result database Research Plus Data, 17 Registries, Nov 2023 Sub (2000-2021). The data was stratified based on age, sex, race, laterality, primary site labelled, stage, median household income inflation adjusted to 2022, and treatment modalities used. Survival curves were compared using Log-Rank test (GraphPad Prism). Results: Only 49 cases of NUT carcinoma were found from 2000 to 2021. Of these cases, 69.4% were males and 30.6% were females. Racial distribution in descending order was noted as: White (59.18%) patients followed by Hispanics (20.41%), Asians/Pacific Islanders (16.33%), and Blacks (4.1%). No cases were reported in Alaskans or Native Americans. Over 90% of the cases had positive regional lymph nodes at the time of diagnosis. The median age of diagnosis was 54 years. The overall median of survival (MoS) was 10 months, with a 1-year survival of 0.415 (CI 95%, 0.26-0.563), 3-year survival of 0.29 (CI 95%, 0.14-0.46). The median of survival (MoS) based on age, race, gender, laterality and median household income showed no statistical significance. MoS for primary site was significant for head & neck (14), GI (<1), lungs (8), peritoneum (1.5) and unknown site (undefined, due to no reported death in this category) (p <0.0001). Analysis based on stage revealed higher MoS for localized while lowest MoS for distant disease (p 0.0088). Treatment base survival was calculated as: chemotherapy (14) vs no chemotherapy (1) (p <0.0001), and radiation therapy (14) vs no XRT (2) (p 0.0009). Similarly, survival calculated for surgery was significantly higher than without it (p 0.0173). Conclusions: NUT carcinoma is an ultra-rare malignancy with only 49 cases reported in the past two decades in SEER database. This aggressive neoplasm favoured males and Caucasians race. Overall, better survival outcomes were associated with earlier stages, tumors originating from head & neck or lungs, and management involving either surgery, chemotherapy or radiotherapy. Prognosis was independent of age, gender, race, laterality and income. Further research is warranted to determine the impact of next generation sequencing based immunotherapy on the survival outcomes.

e20091 Background: Mesothelioma is a rare malignancy with a historically poor prognosis. The development is mostly related to asbestos exposure. However recent studies indicate genetic predisposition also plays a major role in their development. Understanding prognosticators can help predict outcomes and can guide personalized treatment planning based on patient characteristics. Methods: The data was collected from Surveillance, Epidemiology, and End Result database research plus data, 17 registries, November 2023 Sub (2000-2021). In total, 8556 cases of mesothelioma in adults aged 18 years or above were extracted using the ICD code 9050/3. We then stratified the data based on age, sex, race, primary site, laterality, and vital status. The analysis was further completed by comparing survival using the log-rank (Mantel-Cox) test (GraphPad Prism). Results: Of the 8557 patients analyzed, 74.92% were males. The incidence rates by race were white 79.1%, black 5.4%, Hispanic 11.6%, Asian/Pacific Islanders (PIs) 3.24%, and American Indians (AIs)/Alaskan Natives (ANs) 0.46%. The median age at diagnosis was 75 years, and the median overall survival (MoS) was 7 months. MoS for men was 6 months and 9 months for women (p<0.0001). MoS by age group was 26 months for 18–50 years, 9 months for 51–75 years, and 5 months for >76 years (p<0.0001). MoS by race was 7 months for whites and Asian/PIs, 6 months for blacks, 9 months for Hispanics, and 8 months for AIs/ANs (p<0.0001). MoS by primary site was 5 months for respiratory/thoracic organs, 3 months for abdominal/retroperitoneal structures, 1 month for the GI tract, and 25 months for reproductive organs (p<0.0001). The survival was statistically insignificant based on laterality. Conclusions: The significantly higher incidence in the white population suggests potential genetic factors that warrant further investigation. Median survival declines with age. Better outcomes in patients with reproductive organ primaries may result from localized presentation enabling more effective surgical resections, with possible contributions from histological and hormonal factors as well. Similarly, improved outcomes in females may involve hormonal influences, as prior evidence suggests female sex hormones positively affect peritoneal mesothelioma outcomes. Combining these anatomical and prognostic indicators with clinical and radiological factors could enhance outcome prediction.

11062 Background: Sepsis is a leading cause of mortality worldwide, with cancer patients at higher risk due to immune suppression from the disease and its treatments. Despite advancements in sepsis care, their impact on sepsis-related mortality among cancer patients remains unclear. Understanding these trends is crucial for developing targeted interventions to improve sepsis outcomes in patients with malignancies. Methods: We conducted a retrospective cohort analysis using the CDC WONDER database from 1999 to 2023, focusing on adults aged >25 years with malignancies. Deaths were identified using international classification of disease 10 (ICD-10) codes for instances where both sepsis and malignant neoplasms were listed as causes of death. Age-adjusted mortality rates (AAMR) per 100,000 population were extracted, and temporal trends were analyzed using Joinpoint regression to calculate the annual percentage change (APC) and its weighted average, the average annual percentage change (AAPC). Results were stratified to evaluate temporal, gender-based, racial, and geographic disparities in mortality. Results: From 1999 to 2023, a total of 684,930 sepsis-related deaths were recorded among adults with malignancies. Over this period, the AAMR increased significantly from 12.06 to 14.21, with an AAPC of 0.86 (95% CI: 0.74 to 1.06). Males had a higher overall AAMR (15.09) compared to females (9.91), but females experienced a sharper increase over time (23.77% vs. 9.56%). Non-Hispanic (NH) Black or African Americans had the highest AAMR (18.98), followed by NH American Indian or Alaska Natives (11.59) and NH Whites (11.35), while NH Asians/Pacific Islanders exhibited the lowest rate (10.24). Geographic disparities were significant, with state-specific AAMRs ranging from 24.62 in the District of Columbia to 7.50 in Montana. States in the top 90 th percentile included Mississippi, Rhode Island, West Virginia, New Jersey, and the District of Columbia, while those in the bottom 10 th percentile included Montana, Oregon, Idaho, and Wisconsin. Regionally, the Northeast had the highest AAMR (12.65), followed by the South (12.49) and West (11.69), with the Midwest exhibiting the lowest rate (11.08). Conclusions: This nationwide analysis highlights a concerning rise in sepsis-related mortality among patients with malignancies over the past 25 years, with females, NH Blacks and residents of the Northeastern region emerging as the most vulnerable populations. These findings underscore the need for prompt implementation of targeted strategies designed to overcome these disparities.