Thirty-Day Readmissions After Percutaneous Left Atrial Appendage Occlusion: Insights from the Nationwide Readmissions Database.

Percutaneous left atrial appendage occlusion (LAAO) provides a nonpharmacological alternative of preventing stroke in patients with non-valvular atrial fibrillation who are poor candidates for oral anticoagulation. Data on 30 day readmission measures following LAAO is limited. Index LAAO procedures and 30 day readmissions were identified using the Nationwide Readmissions Database (NRD) from 2016 to 2018. The rates and causes of 30 day readmissions were studied. Complex samples multivariable logistic regression models were used to identify predictors of 30 day readmission. Among 29,367 patients undergoing LAAO, the rates of 30 day readmissions were 9.2%. The most common overall cause of 30 day readmission was gastrointestinal bleeding (18.5%), followed by heart failure (13.1%), and infection (7.3%). Female gender (OR1.22; 95% CI 1.08-1.38), HF (OR 1.30; 95% CI 1.15-1.47), anemia (OR 1.37; 95% CI 1.11-1.68), chronic lung disease (OR 1.42; 95% CI 1.25-1.62), End stage renal disease (OR 2.75; 95% CI 2.13-3.55), Acute kidney injury (OR 1.66; 95% CI 1.25-2.20), bleeding/transfusion (OR 1.63; 95% CI 1.28-2.09) were found to be independent predictors of 30 days Readmission. The overall rate of 30 day readmission after LAAO was 9.2% with non-cardiac causes (gastrointestinal bleeding) being the most common. Reducing in-hospital complications and identifying optimal post procedural anticoagulation/antithrombotic regimen may help decrease readmissions following LAAO.

Control hydrogel-hyaluronic acid aggregation toward the design of biomimetic superlubricants.

Healthy synovial fluids (SFs) are complex fluids consisting of biopolymers, globule proteins, and lipids and regarded as superlubricants to provide nearly life-long low friction and wear protection of synovial joints in mammals. In this paper, we report that the intricate lubricious mixture can be simulated by the aggregation of hyaluronic acid (HA) and hydrogel particles in aqueous suspensions. In the HA aqueous suspensions added with synthetic polymer microgels, we have effectively captured the bulk rheological properties of healthy SFs. It is also confirmed by light scattering and fluorescence microscopic characterization that added hydrogel particles can enhance the HA network by hydrogel-mediated hydrogen bonding, leading to the fractal HA-hydrogel aggregating networks in aqueous suspensions. The potential application of HA-hydrogel particle aggregates as biomimetic superlubricants is supported by the comparable low friction at high load to that of healthy SFs.