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Transapical Redo-Aortic Valve in Valve Implantation With Left Main Protection Strategy
Abstracts
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Transapical Redo-Aortic Valve in Valve Implantation With Left Main Protection Strategy Prakash Ludhani, Dr ∗ , Tanveer Ahmad, Dr, Jane Hallam, Dr, Ronen Gurvitch, Dr, John Goldblatt, Dr, James Tatotulis, Dr Royal Melbourne Hospital, Melbourne, VIC, Australia Transcatheter aortic valve implantation (TAVI) is mostly preferred for high-risk symptomatic group of patients with severe aortic stenosis. Surgical management of elderly patients with severe stenosis of bioprosthetic aortic valve (originally implanted 2005), coronary artery disease and porcelain aorta requiring redo-aortic valve replacement (AVR) with coronary artery bypass is not only associated with high morbidity and mortality but is challenging and requires accurate pre-planning. We report a successful combine transapical valve in valve implantation (TA-TAVI) with off pump coronary artery bypass grafting. Keywords: Bioprosthetic valve-stenosis; valve in valve implantation; Transapical; Off pump coronary artery by pass grafting; Porcelain aorta http://dx.doi.org/10.1016/j.hlc.2017.03.074 3D Vats - What is the Evidence? Felicity Mcivor, Dr Griffith University, Brisbane, QLD, Australia Purpose: Video-assisted thoracoscopic surgery (VATS) decreases perioperative morbidity and length of hospital stay compared with thoracotomy. Conventional VATS uses twodimensional (2D) video display systems, but a significant limitation is poor depth perception, as operators must rely on 2D images to work in a three-dimensional (3D) space. 3D displays were introduced to overcome the challenge of operating with limited depth perception. The purpose of this review was to explore the impact of 3D vision on surgical performance in VATS. Method: Relevant literature was identified through systematic searches of PubMed/MEDLINE, EMBASE and CENTRAL databases. Boolean logic was used to combine variations of the phrases “video-assisted thoracoscopic surgery” and “three-dimensional” in key word searching. Pre-determined inclusion and exclusion criteria were applied to select studies. Data extraction and analysis were conducted in a standardised manner across all studies and results were reported in the narrative form. Results: Database searching yielded 374 results. Four articles satisfied inclusion criteria. 689 patients undergoing lobectomy, segmentectomy, wedge resection or oesophagectomy were included across the four studies. All studies reported 3D VATS reduced operating time while achieving at least equivalent patient outcomes. However, side effects such as nausea were reported in ancillary members of the surgical team in two studies. No study controlled for the potential confounders of operator stereoacuity, crosstalk conditions or equipment heterogeneity.
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Conclusion: Further research controlling for potential confounders is required to determine the true effect of 3D vision in VATS. http://dx.doi.org/10.1016/j.hlc.2017.03.075 A Meta-Analysis of the Efficacy of Allopurinol in Reducing the Incidence of Myocardial Infarction (MI) Aarya Murali, Miss ∗ , Sean Morrison, Mr, Joseph Moxon, Dr, Jonathan Golledge, Prof James Cook University, Brisban, QLD, Australia Purpose: Myocardial infarction (MI) continues to be a leading cause of morbidity and mortality. Recent studies have suggested a novel cardioprotective role for allopurinol. This reviews aims to assess the efficacy of allopurinol in reducing the incidence of MI. Methodology: MEDLINE, Scopus, Web of Science, and Cochrane Library databases were searched for randomised controlled trials (RCT) examining the efficacy of allopurinol in reducing the incidence of MI. Reference lists of included studies were also hand-searched. Data extraction and quality assessment were performed by two independent reviewers. RevMan 5.3 was used to perform formal tests of heterogeneity, fixed-effects meta-analysis and leave-one-out sensitivity analyses. Results: 1034 citations were screened; only six studies satisfied the inclusion criterion. Published between 1988 and 1995, all of these studies examined the cardioprotective efficacy of allopurinol in the setting of coronary artery bypass graft (CABG) surgery. Perioperative MI was reported in 2 (1.77%) of 113 patients randomised to allopurinol and 14 (12.07%) of 116 control patients. Quality assessment revealed that methods of randomisation, allocation concealment and blinding were inconsistently reported. Fixed-effects meta-analysis (I2 = 0%) identified a statistically significant, reduced incidence of MI (RR 0.21, 95% CI: 0.06, 0.70, p-value = 0.01) in allopurinol patients. In leave-one-out sensitivity analyses, the treatment effect became non-significant with the removal of one of the studies. Conclusion: Based on limited evidence from small RCTs, allopurinol appears to decrease the incidence of perioperative MI following CABG. Further research is required to confirm these findings. http://dx.doi.org/10.1016/j.hlc.2017.03.076 Huge Anterior Mediastinal Teratoma: A Case Report Jose Martinelli Nadal, Dr ∗ , Robert Xu, Dr, Jason Varzaly, Dr, Tovi Vo, Dr, Victor Aguirre, Dr, Michael Worthington, Mr Royal Adelaide Hospital, Adelaide, SA, Australia Introduction: Teratomas are the most common type of germ cell tumour in the anterior mediastinum. They are of equal distribution in both males and females with a peak incidence in young adults. Less than one per cent are malignant,
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Transapical Redo-Aortic Valve in Valve Implantation With Left Main Protection Strategy Prakash Ludhani, Dr ∗ , Tanveer Ahmad, Dr, Jane Hallam, Dr, Ronen Gurvitch, Dr, John Goldblatt, Dr, James Tatotulis, Dr Royal Melbourne Hospital, Melbourne, VIC, Australia Transcatheter aortic valve implantation (TAVI) is mostly preferred for high-risk symptomatic group of patients with severe aortic stenosis. Surgical management of elderly patients with severe stenosis of bioprosthetic aortic valve (originally implanted 2005), coronary artery disease and porcelain aorta requiring redo-aortic valve replacement (AVR) with coronary artery bypass is not only associated with high morbidity and mortality but is challenging and requires accurate pre-planning. We report a successful combine transapical valve in valve implantation (TA-TAVI) with off pump coronary artery bypass grafting. Keywords: Bioprosthetic valve-stenosis; valve in valve implantation; Transapical; Off pump coronary artery by pass grafting; Porcelain aorta http://dx.doi.org/10.1016/j.hlc.2017.03.074 3D Vats - What is the Evidence? Felicity Mcivor, Dr Griffith University, Brisbane, QLD, Australia Purpose: Video-assisted thoracoscopic surgery (VATS) decreases perioperative morbidity and length of hospital stay compared with thoracotomy. Conventional VATS uses twodimensional (2D) video display systems, but a significant limitation is poor depth perception, as operators must rely on 2D images to work in a three-dimensional (3D) space. 3D displays were introduced to overcome the challenge of operating with limited depth perception. The purpose of this review was to explore the impact of 3D vision on surgical performance in VATS. Method: Relevant literature was identified through systematic searches of PubMed/MEDLINE, EMBASE and CENTRAL databases. Boolean logic was used to combine variations of the phrases “video-assisted thoracoscopic surgery” and “three-dimensional” in key word searching. Pre-determined inclusion and exclusion criteria were applied to select studies. Data extraction and analysis were conducted in a standardised manner across all studies and results were reported in the narrative form. Results: Database searching yielded 374 results. Four articles satisfied inclusion criteria. 689 patients undergoing lobectomy, segmentectomy, wedge resection or oesophagectomy were included across the four studies. All studies reported 3D VATS reduced operating time while achieving at least equivalent patient outcomes. However, side effects such as nausea were reported in ancillary members of the surgical team in two studies. No study controlled for the potential confounders of operator stereoacuity, crosstalk conditions or equipment heterogeneity.
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Conclusion: Further research controlling for potential confounders is required to determine the true effect of 3D vision in VATS. http://dx.doi.org/10.1016/j.hlc.2017.03.075 A Meta-Analysis of the Efficacy of Allopurinol in Reducing the Incidence of Myocardial Infarction (MI) Aarya Murali, Miss ∗ , Sean Morrison, Mr, Joseph Moxon, Dr, Jonathan Golledge, Prof James Cook University, Brisban, QLD, Australia Purpose: Myocardial infarction (MI) continues to be a leading cause of morbidity and mortality. Recent studies have suggested a novel cardioprotective role for allopurinol. This reviews aims to assess the efficacy of allopurinol in reducing the incidence of MI. Methodology: MEDLINE, Scopus, Web of Science, and Cochrane Library databases were searched for randomised controlled trials (RCT) examining the efficacy of allopurinol in reducing the incidence of MI. Reference lists of included studies were also hand-searched. Data extraction and quality assessment were performed by two independent reviewers. RevMan 5.3 was used to perform formal tests of heterogeneity, fixed-effects meta-analysis and leave-one-out sensitivity analyses. Results: 1034 citations were screened; only six studies satisfied the inclusion criterion. Published between 1988 and 1995, all of these studies examined the cardioprotective efficacy of allopurinol in the setting of coronary artery bypass graft (CABG) surgery. Perioperative MI was reported in 2 (1.77%) of 113 patients randomised to allopurinol and 14 (12.07%) of 116 control patients. Quality assessment revealed that methods of randomisation, allocation concealment and blinding were inconsistently reported. Fixed-effects meta-analysis (I2 = 0%) identified a statistically significant, reduced incidence of MI (RR 0.21, 95% CI: 0.06, 0.70, p-value = 0.01) in allopurinol patients. In leave-one-out sensitivity analyses, the treatment effect became non-significant with the removal of one of the studies. Conclusion: Based on limited evidence from small RCTs, allopurinol appears to decrease the incidence of perioperative MI following CABG. Further research is required to confirm these findings. http://dx.doi.org/10.1016/j.hlc.2017.03.076 Huge Anterior Mediastinal Teratoma: A Case Report Jose Martinelli Nadal, Dr ∗ , Robert Xu, Dr, Jason Varzaly, Dr, Tovi Vo, Dr, Victor Aguirre, Dr, Michael Worthington, Mr Royal Adelaide Hospital, Adelaide, SA, Australia Introduction: Teratomas are the most common type of germ cell tumour in the anterior mediastinum. They are of equal distribution in both males and females with a peak incidence in young adults. Less than one per cent are malignant,