Early Echocardiographic Outcomes in Mitral Valve Repair for Myxomatous Mitral Regurgitation – A Single Centre Experience

Early Echocardiographic Outcomes in Mitral Valve Repair for Myxomatous Mitral Regurgitation – A Single Centre Experience

466 2012 ANZSCTS Annual Scientific Meeting ABSTRACTS creatinine were associated with longer hours (>24 h) of mechanical ventilation, ICU stay and lo...

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466

2012 ANZSCTS Annual Scientific Meeting

ABSTRACTS

creatinine were associated with longer hours (>24 h) of mechanical ventilation, ICU stay and low cardiac output syndrome compared to the other groups. Group >100% rise of serum creatinine were associated with significant increase stroke (Adjusted HR 5.40 and 95% CI (1.90–15.34), multiorgan failure with adjusted HR 6.33and 95% CI (2.43–16.49). Increase of perioperative serum creatinine above 50% give higher chance to have postoperative renal failure adjusted HR 8.98 and 95% CI (3.96–20.37) increase to Adjusted HR 35.32 and 95% CI (16.79–74.31) in >100% group. Analysis of serum creatinine change showed that a 47% increase was the best predictor of renal failure after cardiac surgery, with 86.76% specificity and 64.89% sensitivity. Conclusions: An increase of perioperative serum creatinine in cardiac surgery was consistently associated with higher postoperative mortality and increase risk of most major morbidity outcomes. Efforts to identify patients with high risk of impaired renal function and preserve renal function before and during cardiac surgery may yield benefits for patients in the future. http://dx.doi.org/10.1016/j.hlc.2013.03.027 2012 Poster Presentation/Panel 2 Early Echocardiographic Outcomes in Mitral Valve Repair for Myxomatous Mitral Regurgitation – A Single Centre Experience

Heart, Lung and Circulation 2013;22:455–489

ease resection was used in 30% and neochords in 66%. A remodelling annuloplasty band or ring was used in 90.8% and 7.3% respectively. Results: Postoperative MR was ≤trivial in 86.4% and ≤mild in 99%. LV size was significantly improved with a normal LV size in 77.2% compared with 27.2% preoperatively. For isolated posterior leaflet repair, resection was associated with significantly improved postoperative MR compared with neochords (≤trivial, 92.5 vs 86.2%) as well as a higher proportion with a normal postoperative LVEF (84.9 vs 75.4%). A preoperative dilated LV (≥mod) was associated with increased pulmonary hypertension (≥mod 47.8 vs 20.7%) and postoperative LV dysfunction (LVEF < 60%, 70.2 vs 88.7%), but no difference in residual MR. Patients also undergoing TV repair were more likely to have significant preoperative TR (>mod 41.9 vs 4%), pulmonary hypertension (>mod 54.8 vs 21.7%), LV dysfunction (LVEF < 60% 9.7 vs 4%) and dilatation (>mod 67.7 vs 46.9%). Postoperatively however there was no difference in LV function, size, or degree of MR between those with TV repair and those without. Discussion: This series shows very good early results with minimal residual MR and improved LV size. Patients undergoing associated TV repair were more likely to have an impaired and dilated LV preoperatively but this did not translate into worse outcomes. http://dx.doi.org/10.1016/j.hlc.2013.03.028

Levi Bassin 1,∗ , Beatrix Weiss 1,2 , Damian Gimpel 2 , Paul Gilhooly 2 , Riley Smith 2 , Zakir Akhunji 1 , Peter Grant 1 , Hugh Wolfenden 1

2012 Poster Presentation/Panel 3

1 Department

Krish Chaudhuri ∗ , Ros Woodfine, Paula Richardson, Svatka Micik, Craig Jurisevic, James Edwards, Rob Stuklis, Mike Worthington

of Cardiothoracic Surgery, Prince of Wales Hospital and Prince of Wales Private Hospital, Sydney, Australia 2 Faculty of Medicine, University of Notre Dame, Sydney, Australia Introduction: Mitral valve repair has been the preferred method for treating myxomatous mitral valve disease at our institution since the 1980s. This and an active Echocardiography department has resulted in early referral for patients with grade III and IV mitral regurgitation (MR). A variety of repair techniques have been used with a trend to more neochordal repairs than resection. We have undertaken a review of our recent results with a focus on LV function, repair techniques, and tricuspid disease. Methods: We reviewed the pre- and postoperative (one week) echocardiograms of 206 consecutive patients (age 66.2 ± 12.1 years) that underwent mitral valve repair for myxomatous degeneration at our unit from 2007 to 2012. Additional procedures included tricuspid valve repair in 31 (15.1%), coronary surgery in 46 (22.3%), aortic valve replacement in 12 (5.8%), redo sternotomy in 12 (5.8%), and redo mitral repair in seven (3.4%). Posterior, anterior, or bi-leaflet prolapse/flail was present in 75.0%, 4.3%, and 20.7% respectively. Preoperative LV function was normal (LVEF >60%) in 95.1% and LV size was normal or mildly dilated in 27.2% and 50.0% respectively. Preoperative TR >moderate was present in 9.7%. Pulmonary hypertension >moderate was present in 26.7%. For posterior leaflet dis-

Reporting of Clinical Risk Incidents in a Cardiothoracic Surgical Unit

D’Arcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, Australia Introduction: Internationally, various systems have been used in clinical governance models to assess clinical risk management [1]. The Australian Incident Management System (AIMS) was previously used for reporting clinical risk incidents at the Royal Adelaide Hospital up until May 31st 2011. From June 1st 2011, the Safety Learning System (SLS) was adopted and led to increased reports due to ease of access by all hospital personnel. Herein we report the nature and type of incidents with the SLS that occurred in a Cardiothoracic Unit, encompassing the operating theatre, a dedicated Cardiothoracic Intensive Care Unit (ICU) and the ward. Methods: All qualitative reported risk incidents were retrieved from the SLS Database from 1st June 2011 until 16th September 2012. Incidents were categorized according to 1 of 11 types and their severity was deemed by assigning a Severity Assessment Code (SAC). The SAC ranges from 1 to 4, with 1 representing an extreme risk incident and 4 a low risk incident. Statistical analysis was performed to ascertain differences in the type and sever-