Miami Heart Research Institute

Right ventricular failure after left ventricular assist device implantation is associated with significant morbidity and mortality. The use of percutaneous right ventricular assist devices for treatment in this clinical situation is increasing, but these devices are prone to migration with limited options for revision or repositioning. We describe a case of a patient whose device was repositioned safely using a balloon-assisted tracking technique with a peripheral angioplasty balloon, analogous to the technique developed to advance catheters past radial artery stenoses in coronary interventions.

474 Background: Metastatic non–clear cell renal cell carcinoma (nccRCC) is a rare, heterogeneous disease historically underrepresented in trials. Over the past two decades, systemic therapies including tyrosine kinase inhibitors (TKIs), immune checkpoint inhibitors (IO), and IO/TKI combinations have expanded, but their impact on survival in nccRCC remains poorly defined. Methods: We included patients diagnosed with metastatic nccRCC between 2004-2020 from National Cancer Database. We stratified patients based on therapy eras: pre-TKI, TKI, IO, and IO–TKI. We utilized Kaplan-Meier analysis and Cox proportional hazard models to study overall survival (OS)in patients with nccRCC. Results: We included 2,753 patients diagnosed with metastatic nccRCC from the NCDB. Among patients with nccRCC, those who did not receive systemic therapy had a median survival of 3.29 months (95% CI: 2.99–3.55 months). In contrast, patients who received systemic therapy had a longer median survival of 7.62 months (95% CI: 7.26–7.98 months). At 6 months, patients who did not receive systemic therapy had a survival probability of 32.9% (95% CI: 29.9–35.9%). By 12 months, survival declined further to 16.9% (95% CI: 14.7–19.5%). In contrast, patients who received systemic therapy demonstrated significantly better outcomes. At 6 months, survival probability was 62.1% (95% CI: 59.5–64.6%), and at 12 months, survival remained 27.6% (95% CI: 25.3–30.0%). Patients who received systemic therapy had 18% less risk of death compared to patients who did not receive systemic therapy. Additionally, each subsequent year of diagnosis had HR of 0.96 (95% CI: 0.95–0.97, p = 0.00) compared to previous year. Conclusions: Patients with metastatic nccRCC who received systemic therapy lived longer than those who did not (median 7.6 vs 3.3 months; ~18% lower mortality risk). Year-over-year survival gains (HR 0.96; p<0.001) align with wider use of TKIs, IO, and IO–TKI regimens. Given persistently modest survival, prioritizing enrollment in subtype-specific trials and ensuring timely access to active combinations should be central to care. Cox proportional hazards model evaluating factors associated with overall survival among patients with metastatic nccRCC. Variable Comparator HR (95% CI) P-value Age ≥65 years vs <65 years 1.02 (0.91–1.13) 0.78 Private insurance vs Uninsured 0.78 (0.60–1.01) 0.06 Non-academic facility vs Academic 1.13 (1.04–1.23) <0.001 Comorbidity ≥1 vs 0 1.07 (0.98–1.17) 0.13 Distance ≥50 miles vs <50 miles 0.87 (0.79–0.96) <0.001 Poor/Undifferentiated grade vs Well/Moderate 1.72 (1.50–1.97) <0.001 Cytoreductive nephrectomy: Yes vs No 0.46 (0.41–0.53) <0.001 Each Year of diagnosis vs Previous Year 0.96 (0.95–0.97) <0.001 Systemic therapy: Yes vs No 0.82 (0.76–0.89) <0.001

Abstract BACKGROUND Chimeric antigen receptor (CAR) T cell therapy is under investigation for glioblastoma (GBM), with early-phase trials reporting varied toxicity profiles. While CAR-T has demonstrated potential in hematologic malignancies, its safety in GBM remains incompletely characterized. This study meta-analyzes adverse event profiles, including cytokine release syndrome (CRS), neurological events, and overall toxicity in GBM. METHODS A systematic search was conducted through May 30, 2025, using PubMed, Cochrane Library, and conference proceedings from ASCO, SNO, ESMO, and AACR. Eligible studies were clinical trials of CAR-T therapy in GBM reporting CRS, neurological events, or any grade adverse events. Pooled incidence rates were calculated using a random-effects model. Heterogeneity was assessed using the I² statistic, with values of 0–25% considered low, 26–50% moderate, and >50% high. Between-study variance was estimated using the Q-profile method with Hartung-Knapp adjustment. RESULTS Twelve phase I trials (N=147) were analyzed. The median age was 55 years (IQR: 42.8–60.5), and 35.3% of participants were female. Dose escalation strategies were reported in 46% of studies, while the remaining 54% used fixed or predefined dosing. Routes of CAR-T administration included intravenous (46%), intraventricular (23%), intracavitary (15%), and multiple or combined routes (15%). The median time from diagnosis to CAR-T infusion was 12.0 months (IQR: 11.05–15.0). The pooled incidence of CRS was 20.3% (95% CI: 3.7%–63.0%; I²=72.8%). Neurological events occurred in 41.0% of patients (95% CI: 22.4%–62.6%; I²=59.8%). The overall rate of any-grade adverse events was 59.5% (95% CI: 46.5%–71.2%; I²=35.0%). Median follow-up was 8.9 months (IQR: 6.3–22.8). CONCLUSIONS Adverse events are frequently observed in early-phase CAR-T trials for GBM, with considerable variability in CRS and neurotoxicity rates. These findings highlight the need for optimized dosing strategies, delivery routes, and toxicity mitigation approaches as CAR-T continues to advance in neuro-oncology.

Abstract BACKGROUND Isocitrate dehydrogenase mutant (IDHm) low-grade gliomas have a slow growing phase, but eventually become aggressive tumors. To delay long-term toxic effects of chemoradiation, low-risk patients are monitored after surgery. Traditionally, patients >40 were considered high-risk, however, this remains controversial. Recent promising results with the IDHm-inhibitor vorasidenib sparking debate, challenging age-based risk stratification. We evaluated survival relative to age and molecular data. METHODS 598 IDHm astrocytoma grades 2-3 and 288 IDHm oligodendroglioma grades 2-3 were analyzed by NGS and WTS at Caris Life Sciences (Phoenix, AZ). Samples were stratified by age at diagnosis (12-26y, 27-40y, 41-60y, and >60y). Overall survival was obtained from insurance claims data and analyzed using Kaplan-Meier and Cox proportional hazards models. Comparisons in survival were made between 27-40y and 41-60y given larger sample size. Multivariate regression analysis included radiotherapy, temozolomide, and mutation status as covariates. RESULTS IDHm astrocytomas age distribution was 12-26y, n=74 (12.4%); 27-40y, n=271 (45.3%); 41-60y, n=205 (34.3%); and >60y, n=48 (8.0%). Univariate analysis showed that 27-40y patients had shorter survival (HR=1.63, 95% CI:1.07–2.50, p=0.022). However, after multivariate analysis, age was not associated with survival (HR =1.02, 95% CI:0.74-1.4, p=0.912). In contrast, TP53 (HR=4.0, 95%CI:1.43-11.24, p=0.008– mutation rate=95.4%) and TERT-promoter (HR=10.36, 95% CI:4.05-26.45, p<0.0001– mutation rate=9.0%) mutations were independently associated with poorer survival. IDHm oligodendrogliomas age distribution was 12-26y, n=18 (5.5%); 27-40y, n=76 (23.2%); 41-60y, n=137 (41.8%); and >60y, n=57 (17.4%). Univariate and multi-variate analysis did not show any association between age and survival (HR =0.94, 95% CI:0.48-1.83, p=0.912, and HR =1.33, 95% CI:0.81-2.19, p=0.248, respectively). However, KRAS mutations were independently associated with poorer survival (HR=4.36, 95% CI:1.12-16.92, p=0.033- mutation rate=3%). CONCLUSIONS While age (27-40y vs. 41-60y) was not associated with survival, genetic alterations such as KRAS (oligodendroglioma), TP53 and TERT mutations (astrocytoma) were independently associated with poorer survival.

Cardiovascular disease (CVD) remains the leading cause of mortality globally. While coronary artery calcium (CAC) scoring is the current gold standard for detecting subclinical atherosclerosis, recent research has highlighted breast arterial calcification (BAC), often incidentally identified on screening mammograms, as a potential non-invasive marker of CVD risk. BAC has been significantly associated with an increased risk of adverse cardiovascular outcomes, including ischemic and hemorrhagic stroke, peripheral vascular disease, and heart failure. This systematic review comprises 14 studies aimed at better understanding the association between the presence of BAC and CAC. The studies consisted of 5,249 women who underwent both BAC and CAC scoring, primarily post-menopausal, with an average age of 57.8 years. The time interval between BAC and CAC assessment ranged from same-day imaging to 2.94 years (mean: 16.2 months; median: 12 months). Across all studies, a consistent positive correlation was observed between the presence of BAC and CAC. Notably, women with both BAC and CAC tended to be older and exhibited a higher burden of coronary artery stenosis, an increased number of affected vessels, and more extensive calcification distribution. The pooled sensitivity, specificity, positive predictive value, and negative predictive value of BAC for detecting CAC were 38.9%, 88%, 73%, and 57.2%, respectively. These findings suggest that the presence of BAC may serve as a useful tool for supporting the presence of CAC in at-risk patients. Given its accessibility, cost-effectiveness, and high specificity, BAC holds promise as a screening adjunct for early CVD detection in women. Standardized guidelines are needed to support radiologists in the consistent reporting of BAC on mammograms and to inform primary care providers on appropriate follow-up and cardiovascular screening for patients with positive BAC findings.