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Aortic Valve Replacement with Rapid Deployment Surgical Bioprosthesis as Compared to Conventional Bioprosthesis via Full Sternotomy
e91
Abstracts
Conclusion: The Pioneer sternal cabling system appears to facilitate early extubation after adult cardiac surgery, but it does not reduce the rate of deep sternal infection. http://dx.doi.org/10.1016/j.hlc.2015.12.014 SCIENTIFIC SESSION 6: TRANSFUSION 17th Nov (TUE) 15:55 - 16:05 Clinical Application of ECMO Support in Heart Transplantation Shoei-Shen Wang National Taiwan University Hospital, Taiwan Purpose: We evaluate the effect of extracorporeal membrane oxygenation (ECMO) support on the recipients waiting for heart transplantation (HT) and the influence of survival after HT at National Taiwan University Hospital (NTUH). Methods: In Taiwan the first HT was performed at NTUH in 1987. From 2005 to 2014, 1510 patients underwent ECMO support including 90 patients bridging to HT and 102 patients after HT, while HT were performed in 237 patients during that 10-year period at NTUH. The ECMO was instituted when the patient suffered from persistent low output despite large dose catecholamine infusion with inotropic equivalent over 50 microgram/kg/min or cardiopulmonary resuscitation (CPR). The main indication for HT was congestive heart failure with maximal VO2 < 10 mL/kg/min, or intractable heart failure with maximal VO2 < 14 mL/kg/min. The commonest aetiology for HT was dilated cardiomyopathy, and the second was ischaemic cardiomyopathy. The age ranged from 4 months to 74 years with male predominant. Results: We found that ECMO was effective for CPR (ECPR) or short-term support. Those patients with pulmonary or renal dysfunction, systemic infection, or high creatinine kinase or lactate level had worse progress. The 1-year and 5-year survival of HT recipients with good renal and pulmonary function were 97.7% and 80.2% respectively. The 1-year and 5-year survival for patients bridged with ECMO were 80.9% and 69.7% respectively at NTUH. Conclusion: Although ECMO is effective for CPR or shortterm support, the patients bridged with ECMO had worse 1year and 5-year survival after heart transplantation. http://dx.doi.org/10.1016/j.hlc.2015.12.015 SCIENTIFIC SESSION 7: AORTIC VALVE SURGERY 17th Nov (TUE) 17:50 - 18:00 Aortic Valve Replacement with Rapid Deployment Surgical Bioprosthesis as Compared to Conventional Bioprosthesis via Full Sternotomy Andrew Smith, William Shi *, Andrew Newcomb, Philip Davis St Vincent’s Hospital, Melbourne, VIC, Australia
Purpose: Rapid-deployment aortic valve replacement (RD-AVR) is becoming more popular in recent years. There are limited studies comparing RD-AVR to cAVR and no studies where both these valves are inserted via a full sternotomy. Methodology: From 2008 to 2015, 597 patients underwent isolated aortic valve replacement CABG at a single centre. During this period, 41 (7%) patients received RD-AVR and 556 (93%) received cAVR. Of the patients receiving RD-AVR, surgical access was via full median sternotomy in 98% of patients. Propensity-score matching yielded 41 matched pairs. Intra and post-operative outcomes were compared. Results: The RD-AVR group had shorter aortic cross clamp (RD-AVR: 71.132.7 mins vs cAVR: 105.842.4 mins, P<0.01) and cardiopulmonary bypass (RD-AVR: 9541.5 mins vs cAVR: 134.346.9 mins, P<0.01) times. There was no difference in hospital mortality (RDAVR: 2% vs cAVR 2%, P>0.99). RD-AVR patients required shorter mean ventilation (RD-AVR: 16.525.2 hrs vs cAVR: 63130.6 hrs, P<0.01) and intensive care admission times (RD-AVR: 51.145.4 hrs vs cAVR: 108157.4 hrs, P=0.03). RD-AVR also had reduced rates of new postoperative atrial arrhythmias (RD-AVR: 20% vs cAVR: 49%, P=0.02). Total length of postoperative hospital stay was similar (RD-AVR: 9.64.5 days vs cAVR: 14.914.4 days, P<0.09). Haemodynamic performance for the RD-AVR was satisfactory. Conclusion: Our findings support the safety and efficacy of RD-AVR. RD-AVR allows for shorter cross clamp and cardiopulmonary times. RD-AVR may result in improved in-hospital outcomes. Further studies are required to establish any long-term benefits over conventional AVR. http://dx.doi.org/10.1016/j.hlc.2015.12.016 SCIENTIFIC SESSION 8: HEART FAILURE AND TRANSPLANTATION 18th Nov (WED) 09:50 - 10:00 Destination VAD’s in Australia and New Zealand David McGiffin The Alfred Hospital, Melbourne, VIC, Australia Mechanical circulatory support using implanted ventricular assist devices or the artificial heart (currently a rare procedure) has an increasing role in the management of patients with end-stage heart disease. The role of ventricular assist devices is classified on an intent strategy – bridge to transplantation, destination therapy, bridge to candidacy and bridge to recovery. Due to the dynamic nature of heart failure, patients may transition between groups. Approximately 50% of patients coming to cardiac transplantation in Australia have a left ventricular assist device. The two most frequently implanted devices in Australia are the Heartmate II and HeartWare. Currently destination therapy is not approved in Australia and the principle reason is the lack of a compelling cost effectiveness argument for its use compared with medical treatment for heart failure in patients ineligible for cardiac ransplantation. Although ventricular
Abstracts
Conclusion: The Pioneer sternal cabling system appears to facilitate early extubation after adult cardiac surgery, but it does not reduce the rate of deep sternal infection. http://dx.doi.org/10.1016/j.hlc.2015.12.014 SCIENTIFIC SESSION 6: TRANSFUSION 17th Nov (TUE) 15:55 - 16:05 Clinical Application of ECMO Support in Heart Transplantation Shoei-Shen Wang National Taiwan University Hospital, Taiwan Purpose: We evaluate the effect of extracorporeal membrane oxygenation (ECMO) support on the recipients waiting for heart transplantation (HT) and the influence of survival after HT at National Taiwan University Hospital (NTUH). Methods: In Taiwan the first HT was performed at NTUH in 1987. From 2005 to 2014, 1510 patients underwent ECMO support including 90 patients bridging to HT and 102 patients after HT, while HT were performed in 237 patients during that 10-year period at NTUH. The ECMO was instituted when the patient suffered from persistent low output despite large dose catecholamine infusion with inotropic equivalent over 50 microgram/kg/min or cardiopulmonary resuscitation (CPR). The main indication for HT was congestive heart failure with maximal VO2 < 10 mL/kg/min, or intractable heart failure with maximal VO2 < 14 mL/kg/min. The commonest aetiology for HT was dilated cardiomyopathy, and the second was ischaemic cardiomyopathy. The age ranged from 4 months to 74 years with male predominant. Results: We found that ECMO was effective for CPR (ECPR) or short-term support. Those patients with pulmonary or renal dysfunction, systemic infection, or high creatinine kinase or lactate level had worse progress. The 1-year and 5-year survival of HT recipients with good renal and pulmonary function were 97.7% and 80.2% respectively. The 1-year and 5-year survival for patients bridged with ECMO were 80.9% and 69.7% respectively at NTUH. Conclusion: Although ECMO is effective for CPR or shortterm support, the patients bridged with ECMO had worse 1year and 5-year survival after heart transplantation. http://dx.doi.org/10.1016/j.hlc.2015.12.015 SCIENTIFIC SESSION 7: AORTIC VALVE SURGERY 17th Nov (TUE) 17:50 - 18:00 Aortic Valve Replacement with Rapid Deployment Surgical Bioprosthesis as Compared to Conventional Bioprosthesis via Full Sternotomy Andrew Smith, William Shi *, Andrew Newcomb, Philip Davis St Vincent’s Hospital, Melbourne, VIC, Australia
Purpose: Rapid-deployment aortic valve replacement (RD-AVR) is becoming more popular in recent years. There are limited studies comparing RD-AVR to cAVR and no studies where both these valves are inserted via a full sternotomy. Methodology: From 2008 to 2015, 597 patients underwent isolated aortic valve replacement CABG at a single centre. During this period, 41 (7%) patients received RD-AVR and 556 (93%) received cAVR. Of the patients receiving RD-AVR, surgical access was via full median sternotomy in 98% of patients. Propensity-score matching yielded 41 matched pairs. Intra and post-operative outcomes were compared. Results: The RD-AVR group had shorter aortic cross clamp (RD-AVR: 71.132.7 mins vs cAVR: 105.842.4 mins, P<0.01) and cardiopulmonary bypass (RD-AVR: 9541.5 mins vs cAVR: 134.346.9 mins, P<0.01) times. There was no difference in hospital mortality (RDAVR: 2% vs cAVR 2%, P>0.99). RD-AVR patients required shorter mean ventilation (RD-AVR: 16.525.2 hrs vs cAVR: 63130.6 hrs, P<0.01) and intensive care admission times (RD-AVR: 51.145.4 hrs vs cAVR: 108157.4 hrs, P=0.03). RD-AVR also had reduced rates of new postoperative atrial arrhythmias (RD-AVR: 20% vs cAVR: 49%, P=0.02). Total length of postoperative hospital stay was similar (RD-AVR: 9.64.5 days vs cAVR: 14.914.4 days, P<0.09). Haemodynamic performance for the RD-AVR was satisfactory. Conclusion: Our findings support the safety and efficacy of RD-AVR. RD-AVR allows for shorter cross clamp and cardiopulmonary times. RD-AVR may result in improved in-hospital outcomes. Further studies are required to establish any long-term benefits over conventional AVR. http://dx.doi.org/10.1016/j.hlc.2015.12.016 SCIENTIFIC SESSION 8: HEART FAILURE AND TRANSPLANTATION 18th Nov (WED) 09:50 - 10:00 Destination VAD’s in Australia and New Zealand David McGiffin The Alfred Hospital, Melbourne, VIC, Australia Mechanical circulatory support using implanted ventricular assist devices or the artificial heart (currently a rare procedure) has an increasing role in the management of patients with end-stage heart disease. The role of ventricular assist devices is classified on an intent strategy – bridge to transplantation, destination therapy, bridge to candidacy and bridge to recovery. Due to the dynamic nature of heart failure, patients may transition between groups. Approximately 50% of patients coming to cardiac transplantation in Australia have a left ventricular assist device. The two most frequently implanted devices in Australia are the Heartmate II and HeartWare. Currently destination therapy is not approved in Australia and the principle reason is the lack of a compelling cost effectiveness argument for its use compared with medical treatment for heart failure in patients ineligible for cardiac ransplantation. Although ventricular