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Mitral Valve Repair for Mitral Valve Prolapse: The Auckland Experience
578
Abstracts CSANZ 2013 NZ Abstracts
ABSTRACTS
Results: A representative sample of 332 patients admitted with ACS who had subsequent clinic follow-up with electronic recording of risk factors was identified. Seventy-six patients (23%) were smokers, 120 (36%) were ex-smokers and 136 (41%) were non-smoker at time of admission with ACS. Patients with STEMI were 25%, NSTEMI 63% and unstable angina 12%. By ethnicity there were 9% Maori, 21% Pacific, 19% Indian and 51% European/Other. Smokers had mean age of 51, with 77.6% male. At follow-up 50% of smokers remained current smokers with a median follow-up time of 121 days. Fifty-two percent of Maori, 62.5% of Pacific, 62.5% of Indian and 40% of European/Other patients continued to smoke (p < 0.39). Patients who remained smokers were more likely to have presented with STEMI than patients who had quit smoking at follow-up (p < 0.02). Conclusion: Half of current smokers still continue to smoke after ACS. Improved patient education and smoking cessation strategy are required to improve smoking cessation rates in this high-risk group of patients. http://dx.doi.org/10.1016/j.hlc.2013.04.071 67 Mitral Valve Repair for Mitral Valve Prolapse: The Auckland Experience J. Sathananthan 1,∗ , P. Raudkivi 2 , Andrew Kerr 1 1 Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand 2 Cardiothoracic Surgical Unit, Auckland City Hospital, Auckland, New Zealand
Background: Mitral valve prolapse (MVP) is a common cause of degenerative mitral regurgitation. Mitral valve (MV) repair has the benefit of avoiding anticoagulation and the long-term risks associated with prosthetic valves. We sought to assess trends and outcomes of mitral valve repair in our centre. Methods: Patients who underwent MV repair for MVP between January 2005 and December 2011 were included. 30-day mortality, severity of post repair regurgitation, need for repeat surgery and case volume by individual surgeons were assessed. Results: 265 patients had isolated mitral valve surgery with 120(45%) undergoing surgery for MVP. Eightynine(74%) patients with MVP had MV repair. Patients with posterior leaflet prolapse, bileaflet prolapse and anterior leaflet prolapse had MV repair rates of 91%, 48% and 21% respectively. Thirty-day mortality was 1% and six patients(6.7%) required MV replacement for failed repair, a mean of 195 days after failed repair. There were a total of 10 surgeons with three surgeons accounting for 65% of cases. Surgeons with a higher volume of MV repair (>10 cases) were more likely to repair the valve than replace it, compared with low volume surgeons(86% vs 58%, p < 0.01). Persistent severe mitral regurgitation and need for repeat surgery for failed MV repair did not vary between high and low volume surgeons (p < 0.40 and p < 0.66 respectively).
Heart, Lung and Circulation 2013;22:548–593
Conclusion: Mitral valve repair rather than replacement was the preferred approach at this single centre, particularly in those with posterior leaflet prolapse. Ideally higher volume operators should perform mitral valve repair, given their higher rate of repair than replacement. http://dx.doi.org/10.1016/j.hlc.2013.04.072 68 First Experience of Continuous High Dose Intravenous Frusemide in the Community for End Stage Heart Failure J. Scott ∗ , J. Chirnside, G. Sheppard Heart Failure Service, Cardio/Respiratory Integrated Specialist Services, Christchurch Hospital, Christchurch, New Zealand Background: End stage heart failure management in the community is complex with many experiencing poor quality of life and frequent admissions for symptom management. As patients deteriorate, fluid balance becomes precarious, complicated by worsening renal function and increasing diuretic resistance. Diuretic titration is an important aspect of symptom management and when diuretic resistant, evidence suggests continuous infusion is superior to intermittent. High dose continuous infusions have also shown to be more effective in the hospital setting and utilised frequently, however there have been few studies looking at outcomes of intravenous (IV) diuretics in the outpatient setting. Methods: We aimed to explore this method of frusemide delivery as a new management strategy and initially describe two case studies. Results: 63 yr old and 50 yr old males with end stage cardiomyopathy and multiple co-morbidities. Both had high admission rates and lengthy stays over the previous year and were discharged with continuous infusions to hospital level care facilities. 500–1000 mg doses were utilised with effective diuresis and improvement in symptoms. Conclusion: Observed positive impact physically and psychologically on patients and family with symptomatic improvement and achievement of patient goals in regard to end of life care, along with reduced admissions and length of stay. http://dx.doi.org/10.1016/j.hlc.2013.04.073 69 BNP Signal Peptide is Protective in Ischaemia Reperfusion Injury M. Siriwardena ∗ , C.J. Charles, M. Byers, A.M. Richards, C.J. Pemberton Christchurch Cardioendocrine Research Group, Christchurch School of Medicine, University of Otago, 21 St Asaph Street, Christchurch, New Zealand Background: Our group has previously provided evidence that B type natriuretic peptide signal peptide (BNPsp) is a novel early biomarker of cardiac ischaemia.
Abstracts CSANZ 2013 NZ Abstracts
ABSTRACTS
Results: A representative sample of 332 patients admitted with ACS who had subsequent clinic follow-up with electronic recording of risk factors was identified. Seventy-six patients (23%) were smokers, 120 (36%) were ex-smokers and 136 (41%) were non-smoker at time of admission with ACS. Patients with STEMI were 25%, NSTEMI 63% and unstable angina 12%. By ethnicity there were 9% Maori, 21% Pacific, 19% Indian and 51% European/Other. Smokers had mean age of 51, with 77.6% male. At follow-up 50% of smokers remained current smokers with a median follow-up time of 121 days. Fifty-two percent of Maori, 62.5% of Pacific, 62.5% of Indian and 40% of European/Other patients continued to smoke (p < 0.39). Patients who remained smokers were more likely to have presented with STEMI than patients who had quit smoking at follow-up (p < 0.02). Conclusion: Half of current smokers still continue to smoke after ACS. Improved patient education and smoking cessation strategy are required to improve smoking cessation rates in this high-risk group of patients. http://dx.doi.org/10.1016/j.hlc.2013.04.071 67 Mitral Valve Repair for Mitral Valve Prolapse: The Auckland Experience J. Sathananthan 1,∗ , P. Raudkivi 2 , Andrew Kerr 1 1 Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand 2 Cardiothoracic Surgical Unit, Auckland City Hospital, Auckland, New Zealand
Background: Mitral valve prolapse (MVP) is a common cause of degenerative mitral regurgitation. Mitral valve (MV) repair has the benefit of avoiding anticoagulation and the long-term risks associated with prosthetic valves. We sought to assess trends and outcomes of mitral valve repair in our centre. Methods: Patients who underwent MV repair for MVP between January 2005 and December 2011 were included. 30-day mortality, severity of post repair regurgitation, need for repeat surgery and case volume by individual surgeons were assessed. Results: 265 patients had isolated mitral valve surgery with 120(45%) undergoing surgery for MVP. Eightynine(74%) patients with MVP had MV repair. Patients with posterior leaflet prolapse, bileaflet prolapse and anterior leaflet prolapse had MV repair rates of 91%, 48% and 21% respectively. Thirty-day mortality was 1% and six patients(6.7%) required MV replacement for failed repair, a mean of 195 days after failed repair. There were a total of 10 surgeons with three surgeons accounting for 65% of cases. Surgeons with a higher volume of MV repair (>10 cases) were more likely to repair the valve than replace it, compared with low volume surgeons(86% vs 58%, p < 0.01). Persistent severe mitral regurgitation and need for repeat surgery for failed MV repair did not vary between high and low volume surgeons (p < 0.40 and p < 0.66 respectively).
Heart, Lung and Circulation 2013;22:548–593
Conclusion: Mitral valve repair rather than replacement was the preferred approach at this single centre, particularly in those with posterior leaflet prolapse. Ideally higher volume operators should perform mitral valve repair, given their higher rate of repair than replacement. http://dx.doi.org/10.1016/j.hlc.2013.04.072 68 First Experience of Continuous High Dose Intravenous Frusemide in the Community for End Stage Heart Failure J. Scott ∗ , J. Chirnside, G. Sheppard Heart Failure Service, Cardio/Respiratory Integrated Specialist Services, Christchurch Hospital, Christchurch, New Zealand Background: End stage heart failure management in the community is complex with many experiencing poor quality of life and frequent admissions for symptom management. As patients deteriorate, fluid balance becomes precarious, complicated by worsening renal function and increasing diuretic resistance. Diuretic titration is an important aspect of symptom management and when diuretic resistant, evidence suggests continuous infusion is superior to intermittent. High dose continuous infusions have also shown to be more effective in the hospital setting and utilised frequently, however there have been few studies looking at outcomes of intravenous (IV) diuretics in the outpatient setting. Methods: We aimed to explore this method of frusemide delivery as a new management strategy and initially describe two case studies. Results: 63 yr old and 50 yr old males with end stage cardiomyopathy and multiple co-morbidities. Both had high admission rates and lengthy stays over the previous year and were discharged with continuous infusions to hospital level care facilities. 500–1000 mg doses were utilised with effective diuresis and improvement in symptoms. Conclusion: Observed positive impact physically and psychologically on patients and family with symptomatic improvement and achievement of patient goals in regard to end of life care, along with reduced admissions and length of stay. http://dx.doi.org/10.1016/j.hlc.2013.04.073 69 BNP Signal Peptide is Protective in Ischaemia Reperfusion Injury M. Siriwardena ∗ , C.J. Charles, M. Byers, A.M. Richards, C.J. Pemberton Christchurch Cardioendocrine Research Group, Christchurch School of Medicine, University of Otago, 21 St Asaph Street, Christchurch, New Zealand Background: Our group has previously provided evidence that B type natriuretic peptide signal peptide (BNPsp) is a novel early biomarker of cardiac ischaemia.