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Systematic review of percutaneous coronary intervention and transcatheter aortic valve implantation for concomitant aortic stenosis and coronary artery disease
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Abstracts
stroke (6 vs. 0%); prolonged ventilation > 24 hrs (41 vs. 16%); and pneumonia (24 vs. 9%). Median ICU length of stay was longer for the frail patients (44 vs. 27 hrs). There was one inhospital death in the frail group and none in the non-frail group (6 vs. 0%). The majority of non-frail patients discharged directly home (78%) compared to frail patients (53%). The incidence of 30 day readmission to hospital was also higher in the frail patients (18 vs. 7%). Conclusions: Patients identified as frail by the Fried criteria experience more post-operative complications and are less likely to be discharged directly home from hospital. The Fried criteria can be used to define a group of patients that are at greater risk of poor early outcomes following cardiac surgery. References [1] Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001;56:M146–56. [2] Afilalo J, Alexander KP, Mack MJ, Maurer MS, Green P, Allen LA, et al. Frailty assessment in the cardiovascular care of older adults. J Am Coll Cardiol 2014;63(8):747–62.
http://dx.doi.org/10.1016/j.hlc.2014.12.142 Results of a small centre arterial switch program - the perth experience Charles Jenkinson *, Kelly Holmes, David Andrews Children’s Cardiac Centre, Princess Margaret Hospital, Perth, Australia * Corresponding author. Introduction: Transposition of the Great Arteries is a complex congenital cardiac disorder that “baffled” a generation of great surgeons, including Blalock, Rashkind, Bailey, Senning, and Mustard. It was not until the Jatene Repair in 1975, followed by modifications by Lecompte in 1982, that long term survival with excellent outcomes was made possible. We present the results of the Arterial Switch Operation undertaken in a small paediatric cardiac surgical unit, with all cases operated by a single surgeon. Results are then compared against international databases, as well as the metaanalysis we have conducted of international peerreviewed literature (see presentation titled Twenty-Five Years Of Arterial Switch Operations - A meta-analysis). Methods: A prospectively collected database of all paediatric cardiac surgical cases was used to identify all patients undergoing Arterial Switch Operation at Princess Margaret Hospital from 20 February 2001 to 3 June 2008. Data were collected on pathology, morbidity, and mortality. Results: There were 44 cases of Transposition of the Great Arteries treated with Arterial Switch Operation in the history of our unit, all undertaken in the above-mentioned timeframe. In 32 cases (72.7%), the ventricular septum was intact. Coronary abnormalities were present in 9 cases (20.5%). There were three deaths in the series (mortality rate of 6.8%), of which only one was in the intact ventricular septum group. In this patient, there was a concomitant coronary artery abnormality. There were six cases (13.6%) of re-exploration for bleeding, two runs of extracorporeal membranous oxygenation (4.5%), five neurological events (11.3%), and seven patients required haemofiltration (15.9%).
Discussion: The Arterial Switch Operation presents many challenges to the cardiac surgical team. Our results show statistical comparability to both the European Assocation for Cardio-Thoracic Surgery Congenital Database, as well as our meta-analysis. Achieving good results in the Arterial Switch Operation requires excellent teamwork between a multi-skilled group of people, however good results are possible in centres such as ours, and should be strived for. http://dx.doi.org/10.1016/j.hlc.2014.12.143 Systematic review of percutaneous coronary intervention and transcatheter aortic valve implantation for concomitant aortic stenosis and coronary artery disease Christopher Cao 1,2*, Sohaib Virk 1, David Tian 1, Zakir Akhunji 2, Tristan D. Yan 1,3 1
The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia 2 Department of Cardiothoracic Surgery, Prince of Wales Hospital, Randwick, Australia 3 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia * Corresponding author. Introduction: Co-existing coronary artery disease (CAD) is common in patients with severe aortic stenosis (AS). Although transcatheter aortic valve implantation (TAVI) has emerged as a feasible alternative to surgical aortic valve replacement (SAVR) for high-risk patients with AS, the optimal treatment of CAD in patients undergoing TAVI remains unclear. Combined PCI and TAVI have been performed in selected institutions, but clinical outcomes remain uncertain. The present systematic review aimed to assess the safety and efficacy of combined PCI and TAVI for patients with severe AS and CAD. Methods: An electronic search was conducted on six databases to identify all relevant studies and the outcomes were statistically summarised. The primary endpoints included 30-day mortality and 12-month survival. Secondary endpoints were measured according to the Valve Academic Research Consortium criteria. Results: From seven studies involving 363 patients, periprocedural mortality was 8.8%. At 30-days, pooled incidences of stroke, vascular complications and major bleeding were 2.9%, 5.4% and 16.3%, respectively. Acute renal failure developed in 3.8% of patients, 2.7% had myocardial infarction and 19.9% required a permanent pacemaker. Overall survival at 1- and 2-years was 81.2% and 73.8%, respectively. Discussion: PCI and TAVI can be performed for high-risk patients with severe AS and CAD. However, their perioperative mortality may be higher than those with isolated AS who require TAVI alone. Mid-term outcomes are more encouraging, but longer follow-up is needed in future studies. Results of this study serve as an important benchmark to compare with surgical outcomes of patients who undergo SAVR and coronary artery bypass graft surgery. http://dx.doi.org/10.1016/j.hlc.2014.12.144
Abstracts
stroke (6 vs. 0%); prolonged ventilation > 24 hrs (41 vs. 16%); and pneumonia (24 vs. 9%). Median ICU length of stay was longer for the frail patients (44 vs. 27 hrs). There was one inhospital death in the frail group and none in the non-frail group (6 vs. 0%). The majority of non-frail patients discharged directly home (78%) compared to frail patients (53%). The incidence of 30 day readmission to hospital was also higher in the frail patients (18 vs. 7%). Conclusions: Patients identified as frail by the Fried criteria experience more post-operative complications and are less likely to be discharged directly home from hospital. The Fried criteria can be used to define a group of patients that are at greater risk of poor early outcomes following cardiac surgery. References [1] Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001;56:M146–56. [2] Afilalo J, Alexander KP, Mack MJ, Maurer MS, Green P, Allen LA, et al. Frailty assessment in the cardiovascular care of older adults. J Am Coll Cardiol 2014;63(8):747–62.
http://dx.doi.org/10.1016/j.hlc.2014.12.142 Results of a small centre arterial switch program - the perth experience Charles Jenkinson *, Kelly Holmes, David Andrews Children’s Cardiac Centre, Princess Margaret Hospital, Perth, Australia * Corresponding author. Introduction: Transposition of the Great Arteries is a complex congenital cardiac disorder that “baffled” a generation of great surgeons, including Blalock, Rashkind, Bailey, Senning, and Mustard. It was not until the Jatene Repair in 1975, followed by modifications by Lecompte in 1982, that long term survival with excellent outcomes was made possible. We present the results of the Arterial Switch Operation undertaken in a small paediatric cardiac surgical unit, with all cases operated by a single surgeon. Results are then compared against international databases, as well as the metaanalysis we have conducted of international peerreviewed literature (see presentation titled Twenty-Five Years Of Arterial Switch Operations - A meta-analysis). Methods: A prospectively collected database of all paediatric cardiac surgical cases was used to identify all patients undergoing Arterial Switch Operation at Princess Margaret Hospital from 20 February 2001 to 3 June 2008. Data were collected on pathology, morbidity, and mortality. Results: There were 44 cases of Transposition of the Great Arteries treated with Arterial Switch Operation in the history of our unit, all undertaken in the above-mentioned timeframe. In 32 cases (72.7%), the ventricular septum was intact. Coronary abnormalities were present in 9 cases (20.5%). There were three deaths in the series (mortality rate of 6.8%), of which only one was in the intact ventricular septum group. In this patient, there was a concomitant coronary artery abnormality. There were six cases (13.6%) of re-exploration for bleeding, two runs of extracorporeal membranous oxygenation (4.5%), five neurological events (11.3%), and seven patients required haemofiltration (15.9%).
Discussion: The Arterial Switch Operation presents many challenges to the cardiac surgical team. Our results show statistical comparability to both the European Assocation for Cardio-Thoracic Surgery Congenital Database, as well as our meta-analysis. Achieving good results in the Arterial Switch Operation requires excellent teamwork between a multi-skilled group of people, however good results are possible in centres such as ours, and should be strived for. http://dx.doi.org/10.1016/j.hlc.2014.12.143 Systematic review of percutaneous coronary intervention and transcatheter aortic valve implantation for concomitant aortic stenosis and coronary artery disease Christopher Cao 1,2*, Sohaib Virk 1, David Tian 1, Zakir Akhunji 2, Tristan D. Yan 1,3 1
The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia 2 Department of Cardiothoracic Surgery, Prince of Wales Hospital, Randwick, Australia 3 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia * Corresponding author. Introduction: Co-existing coronary artery disease (CAD) is common in patients with severe aortic stenosis (AS). Although transcatheter aortic valve implantation (TAVI) has emerged as a feasible alternative to surgical aortic valve replacement (SAVR) for high-risk patients with AS, the optimal treatment of CAD in patients undergoing TAVI remains unclear. Combined PCI and TAVI have been performed in selected institutions, but clinical outcomes remain uncertain. The present systematic review aimed to assess the safety and efficacy of combined PCI and TAVI for patients with severe AS and CAD. Methods: An electronic search was conducted on six databases to identify all relevant studies and the outcomes were statistically summarised. The primary endpoints included 30-day mortality and 12-month survival. Secondary endpoints were measured according to the Valve Academic Research Consortium criteria. Results: From seven studies involving 363 patients, periprocedural mortality was 8.8%. At 30-days, pooled incidences of stroke, vascular complications and major bleeding were 2.9%, 5.4% and 16.3%, respectively. Acute renal failure developed in 3.8% of patients, 2.7% had myocardial infarction and 19.9% required a permanent pacemaker. Overall survival at 1- and 2-years was 81.2% and 73.8%, respectively. Discussion: PCI and TAVI can be performed for high-risk patients with severe AS and CAD. However, their perioperative mortality may be higher than those with isolated AS who require TAVI alone. Mid-term outcomes are more encouraging, but longer follow-up is needed in future studies. Results of this study serve as an important benchmark to compare with surgical outcomes of patients who undergo SAVR and coronary artery bypass graft surgery. http://dx.doi.org/10.1016/j.hlc.2014.12.144