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Balloon aortic valvuloplasty (BAV): Waikato Hospital experience
Abstract
357 Australian multi-centre experience with bioresorbable vascular scaffolds in “real-world” coronary disease twelve-month outcomes D. Robaei 1,3,5,∗ , L. Back 1 , S. Atique 2 , R. Tan 2,4 , S. Ooi 1,5 , R. Giles 1 , A. Farshid 2,4 , M. Pitney 1,3,5 , N. Jepson 1,5 1 Eastern
Heart Clinic, Prince of Wales Hospital, Randwick, Sydney, NSW, Australia 2 Canberra Hospital, Canberra, ACT, Australia 3 Sutherland Heart Clinic, Sutherland Hospital, Caringbah, Sydney, NSW, Australia 4 Australian National University, Canberra, ACT, Australia 5 University of New South Wales, Randwick, Sydney, NSW, Australia Aim: To evaluate the safety and efficacy of the Absorb bioresorbable vascular scaffold (BVS) out to 12 months in a wide range of lesion subsets. Methods and Results: Data from 3 Australian centres was collected prospectively - 231 Absorb BVS scaffolds were implanted in 154 patients (76% male, mean age 61). ACS was the indication for PCI in 48%. Diabetes mellitus was present in 19%. A mean of 1.5 scaffolds were implanted/patient (range 1-5). Target vessel was LAD in 45%, RCA in 36%, LCX in 17%, SVG in 1% and LMS in 1%. Multi-vessel BVS was performed in 12%. Lesion complexity was 10% type A, 33% type B1, 30% type B2 and 27% type C. Pre-dilation was performed for all and post-dilation in 90%. Mean scaffold diameter was 2.9mm and mean scaffold length was 18.9mm. Intra-coronary imaging was utilised in 14%. Anti-platelet therapy on discharge was aspirin in 100%, clopidogrel in 71%, prasugrel in 28% and ticagrelor in 1%. Procedural success was achieved in 100% and device success was achieved in 99.1% (2 scaffold delivery failures). Peri-procedural myocardial infarction occurred in 3% of cases. The rate of mortality during follow-up was 0.6%, myocardial infarction 2%, TLR 3%, TVR 5%, scaffold thrombosis 1.2% (0.6% definite, 0.6% probable), and MACE 4% (n=6). Conclusion: Absorb BVS implantation in a cohort of real world patients was both safe and efficacious with very high rates of procedural success and low clinical event rates at 12 months when used to treat a wide spectrum of coronary lesions. http://dx.doi.org/10.1016/j.hlc.2015.06.358
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358 Balloon aortic valvuloplasty (BAV): Waikato Hospital experience K. Sree Raman, S. Pasupati, R. Nair Waikato Hospital, New Zealand Introduction: The advent of TAVI has seen resurgence in BAV for both bridging and palliation of patients with symptomatic severe aortic stenosis(AS). Objectives: We report our experience with the first 250 BAVs at Waikato Hospital, New Zealand. Methods: All patients who had a BAV were followed retrospectively. Results: 250 procedures were performed in 240 patients with 1 patient undergoing 2 redo BAVs. There were no lost to follow-up. Mean age was 81±8, 65% were men. Mean logistic EUROSCORE was 25%±17%. 20% had a concomitant coronary intervention. Post BAV aortic mean gradient and valve area improved from 48±15 to 31±11mmHg (p<0.0001) and 0.7±0.2 to 1.0±0.3cm2 (p<0.0001). VARC major vascular complication, stroke and bleeding occurred in 2%, 0.4% and 1.2% respectively. Disabling bleeding was 0.4%. Intra-procedural and 30day mortality was 0.8% and 9% respectively. Median NYHA class improved from 3 to 1 (p<0.0001). Patients (n=89) with reduced ejection fraction (EF) (EF <50%); 69% improved (≥ 5%), 25% had no change and 10% worsened post BAV. In patients with significant mitral regurgitation (MR, n=93), 45% improved sufficiently post BAV to avoid mitral valve replacement. These lead to 36% of patients being bridged (sAVR 24%, TAVI 76%) with 4% receiving (mean days 438) redo BAV. AS related admissions dropped from 1±1 to 0±1 (p<0.0001) in the 6 months pre and post BAV. Conclusion: In a high-risk cohort BAV can be performed safely to bridge to definitive therapy. It is useful to assess cardiac reserve, improvement in MR and functional status to decide on sAVR or TAVI. As a palliative procedure it reduces hospital admissions and improves quality of life over a year. http://dx.doi.org/10.1016/j.hlc.2015.06.359 359 Balloon aortic valvuloplasty: contemporary single centre experience in the TAVI era T. Ford 1,∗ , K. Nguyen 1 , M. Pitney 1,2 , D. Friedman 1,2 , A. Lau 1,2 , R. Giles 1,2 , R. Allan 1,2 , N. Jepson 1,2 1 Prince of Wales Hospital, Sydney, NSW, Australia 2 Eastern Heart Clinic, Sydney, NSW, Australia
Background: We report our recent experience with balloon aortic valvuloplasty (BAV) including indications, procedural data, complications and 30-day mortality. Methods: Forty consecutive adult patients with severe symptomatic AS underwent 44 retrograde femoral BAV procedures from August 2012 to March 2014. Indications for BAV included: palliation of symptoms (81%); bridge to TAVI (11%);
357 Australian multi-centre experience with bioresorbable vascular scaffolds in “real-world” coronary disease twelve-month outcomes D. Robaei 1,3,5,∗ , L. Back 1 , S. Atique 2 , R. Tan 2,4 , S. Ooi 1,5 , R. Giles 1 , A. Farshid 2,4 , M. Pitney 1,3,5 , N. Jepson 1,5 1 Eastern
Heart Clinic, Prince of Wales Hospital, Randwick, Sydney, NSW, Australia 2 Canberra Hospital, Canberra, ACT, Australia 3 Sutherland Heart Clinic, Sutherland Hospital, Caringbah, Sydney, NSW, Australia 4 Australian National University, Canberra, ACT, Australia 5 University of New South Wales, Randwick, Sydney, NSW, Australia Aim: To evaluate the safety and efficacy of the Absorb bioresorbable vascular scaffold (BVS) out to 12 months in a wide range of lesion subsets. Methods and Results: Data from 3 Australian centres was collected prospectively - 231 Absorb BVS scaffolds were implanted in 154 patients (76% male, mean age 61). ACS was the indication for PCI in 48%. Diabetes mellitus was present in 19%. A mean of 1.5 scaffolds were implanted/patient (range 1-5). Target vessel was LAD in 45%, RCA in 36%, LCX in 17%, SVG in 1% and LMS in 1%. Multi-vessel BVS was performed in 12%. Lesion complexity was 10% type A, 33% type B1, 30% type B2 and 27% type C. Pre-dilation was performed for all and post-dilation in 90%. Mean scaffold diameter was 2.9mm and mean scaffold length was 18.9mm. Intra-coronary imaging was utilised in 14%. Anti-platelet therapy on discharge was aspirin in 100%, clopidogrel in 71%, prasugrel in 28% and ticagrelor in 1%. Procedural success was achieved in 100% and device success was achieved in 99.1% (2 scaffold delivery failures). Peri-procedural myocardial infarction occurred in 3% of cases. The rate of mortality during follow-up was 0.6%, myocardial infarction 2%, TLR 3%, TVR 5%, scaffold thrombosis 1.2% (0.6% definite, 0.6% probable), and MACE 4% (n=6). Conclusion: Absorb BVS implantation in a cohort of real world patients was both safe and efficacious with very high rates of procedural success and low clinical event rates at 12 months when used to treat a wide spectrum of coronary lesions. http://dx.doi.org/10.1016/j.hlc.2015.06.358
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358 Balloon aortic valvuloplasty (BAV): Waikato Hospital experience K. Sree Raman, S. Pasupati, R. Nair Waikato Hospital, New Zealand Introduction: The advent of TAVI has seen resurgence in BAV for both bridging and palliation of patients with symptomatic severe aortic stenosis(AS). Objectives: We report our experience with the first 250 BAVs at Waikato Hospital, New Zealand. Methods: All patients who had a BAV were followed retrospectively. Results: 250 procedures were performed in 240 patients with 1 patient undergoing 2 redo BAVs. There were no lost to follow-up. Mean age was 81±8, 65% were men. Mean logistic EUROSCORE was 25%±17%. 20% had a concomitant coronary intervention. Post BAV aortic mean gradient and valve area improved from 48±15 to 31±11mmHg (p<0.0001) and 0.7±0.2 to 1.0±0.3cm2 (p<0.0001). VARC major vascular complication, stroke and bleeding occurred in 2%, 0.4% and 1.2% respectively. Disabling bleeding was 0.4%. Intra-procedural and 30day mortality was 0.8% and 9% respectively. Median NYHA class improved from 3 to 1 (p<0.0001). Patients (n=89) with reduced ejection fraction (EF) (EF <50%); 69% improved (≥ 5%), 25% had no change and 10% worsened post BAV. In patients with significant mitral regurgitation (MR, n=93), 45% improved sufficiently post BAV to avoid mitral valve replacement. These lead to 36% of patients being bridged (sAVR 24%, TAVI 76%) with 4% receiving (mean days 438) redo BAV. AS related admissions dropped from 1±1 to 0±1 (p<0.0001) in the 6 months pre and post BAV. Conclusion: In a high-risk cohort BAV can be performed safely to bridge to definitive therapy. It is useful to assess cardiac reserve, improvement in MR and functional status to decide on sAVR or TAVI. As a palliative procedure it reduces hospital admissions and improves quality of life over a year. http://dx.doi.org/10.1016/j.hlc.2015.06.359 359 Balloon aortic valvuloplasty: contemporary single centre experience in the TAVI era T. Ford 1,∗ , K. Nguyen 1 , M. Pitney 1,2 , D. Friedman 1,2 , A. Lau 1,2 , R. Giles 1,2 , R. Allan 1,2 , N. Jepson 1,2 1 Prince of Wales Hospital, Sydney, NSW, Australia 2 Eastern Heart Clinic, Sydney, NSW, Australia
Background: We report our recent experience with balloon aortic valvuloplasty (BAV) including indications, procedural data, complications and 30-day mortality. Methods: Forty consecutive adult patients with severe symptomatic AS underwent 44 retrograde femoral BAV procedures from August 2012 to March 2014. Indications for BAV included: palliation of symptoms (81%); bridge to TAVI (11%);