Background: Catheter ablation is an effective treatment for ventricular tachycardia (VT), albeit the decision to undergo this procedure is often influenced by underlying comorbidities. The present study aims at evaluating the effects of chronic kidney disease (CKD) on clinical outcomes of VT ablation. Methods: We identified 7,212 patients who presented between 2016-2018 and underwent catheter ablation for VT. Their clinical data were retrospectively accrued from the national readmission database (NRD) using the corresponding diagnosis codes. We compared clinical outcomes between patients with chronic kidney disease (CKD-group) and patients without. Odds ratios (OR) for the primary and secondary outcomes were calculated, and multivariable regression analysis was utilized to adjust for confounding variables. Results: Compared with patients without CKD, patients in CKD-group were older (mean age 67.9 vs. 60.5 years, P <0.01), had a longer mean length of stay (8.73 vs. 5.69 days, P <0.01), and higher in-hospital mortality (OR 2.24, 95% confidence interval (CI) (1.29-3.88), P<0.01). CKD-group patients had increased risk of developing acute kidney injury (10% vs. 8.6%, P<0.01) and 30-day readmission rate due to VT (OR 1.77, 95% CI (1.17-2.69), P<0.01). Conclusion: In patients with CKD, VT ablation is associated with worse clinical outcomes in-hospital mortality and 30-day readmission rate. This significantly influences the decision-making prior to performing this procedure.

Purpose: Diffuse mega-aorta is challenging. Prior studies have raised concerns regarding the safety of the open two-stage elephant trunk (ET) approach for extensive thoracic aortic aneurysm (TAA), specifically in regard to inter-stage mortality. This study evaluates the safety of the two-stage ET approach for management of extensive TAA. Methods: Between 2003–2018, 152 patients underwent a Stage I ET procedure by a single surgeon (mean age 64.5±14.8). Second stage ET procedure was planned in 60 patients (39.4%) and to-date has been performed in 54 patients (90%). (In the remaining patients, the elephant trunk was prophylactic for the long-term, with no plan for near-term utilization). Results: In-hospital mortality after the Stage I procedure was 3.3% (5/152). In patients planned for Stage II, the median inter-stage interval was 5 weeks (range: 0-14). Of the remaining six patients with planned, but uncompleted Stage II procedures, five patients expired from various causes in the interval period (inter-stage mortality of 8.3%). There were no cases of aortic rupture in the inter-stage interval. Stage II was completed in 58 patients (including 4 unplanned) with 30-day morality of 10.3% (6/58). Seven patients developed strokes after Stage II (12%), and three patients (5.1%) developed paraplegia. Conclusions: The overall mortality, including Stage I, inter-stage interval, and Stage II was 18.6%. This cumulative mortality for the open two-staged ET approach for treatment of extensive TAA is acceptable for aortic disease of this severity. Fear of inter-stage rupture should not preclude the aggressive Two-Stage approach to management of extensive TAA.