Comprehensive Haemodynamic Description of Prosthetic Valve Function by Transthoracic Echocardiography in 171 Normal Mitral Valve Prostheses

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Abstracts CSANZ 2012 Abstracts

Heart, Lung and Circulation 2012;21:S143–S316

ABSTRACTS

662

663

Australian and New Zealand Source Registry: Edwards Sapien Transcatheter Aortic Valve ReplacementOutcomes at 1 Year

Body Mass Index Predicts Postoperative Atrial Fibrillation: Results of a Contemporary Meta-Analysis

Walters 1,∗ ,

Sinhal 2 ,

Barron 3 ,

Pasupati 4 ,

A. D. S. D. S. Thambar 5 , G. Yong 6 , N. Jepson 7 , R. Bhindi 8 , J. Bennetts 2 , R. Larbalestier 6 , A. Clarke 1 , P. Brady 8 , H. Wolfenden 7 , A. James 5 , A. El Gamel 4 , P. Jansz 3 , D. Chew 2 1 The

Prince Charles Hospital Brisbane, Australia Medical Center, Australia 3 St Vincents Sydney, Australia 4 Waikato Hospital, New Zealand 5 John Hunter Hospital Newcastle, Australia 6 Royal Perth Hospital, Australia 7 Prince of Wales Hospital Sydney, Australia 8 Royal North Shore Hospital Sydney, Australia 2 Flinders

Background: Transcatheter aortic valve replacement (TAVR) may be considered for those with severe aortic stenosis who are inoperable or at high risk for surgical replacement. Methods: This study enrolled 132 subjects at eight centres between 12/2008 and 12/2010. Inclusion criteria included severe symptomatic aortic valve disease, symptomatic degenerative aortic stenosis (AVA ≤ 0.8 cm2 ), logistic Euroscore > 20% or STS > 10%, agreement between surgeon and cardiologist that the patient not suitable for open surgery due to high risk. Results: A total of 132 were enrolled and one patient was excluded prior to the procedure and one patient crossed over from transapical (TA) to the transfemoral (TF) group. The cohort consisted of 67 TF and 63 transapical (TA) implants. The mean age 83.7 years (TF) and 81.9 years (TA), female 34.3% (TF) 61.9% (TA), logistic Euroscore 27.1% (TF) 29.1% (TF) with procedural success (successful implant without conversion to surgery or death) of 92.5% (TF) 87.3% (TA) (p = 0.32). One year outcomes were not significantly different between TF and TA implants. These included mortality of 13.4% (TF) 20.6% (TA) (p = 0.09), stroke 3% (TF) and 4.8% (TA) (p = 0.39), pacemaker 4.5% (TF) 7.9% (TA) (p = 0.23), and VARC major vascular complication of 4.5% (TF) 6.4% (TA) (p = 0.41). Conclusion: TAVR with the Edwards Sapien device is safe and effective therapy by TA or TF route. A high procedural success rate was achieved with acceptable survival to one year for a patient group at high risk for open surgery. http://dx.doi.org/10.1016/j.hlc.2012.05.673

C. Wong ∗ , A. Brooks, M. Sun, D. Lau, T. Sullivan, D. Leong, K. Roberts-Thomson, G. Wittert, P. Sanders Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Australia Background: It is not clear whether body mass index (BMI) is associated with a greater incidence of postoperative atrial fibrillation (AF). Methods: Electronic databases were searched for published studies up until December 2011. Studies were included if they assessed the incidence of postcardiac surgery AF in relation to BMI. Data were pooled using random effects meta-analysis where appropriate. When data were reported as a series of dose-specific relative risks compared to a reference BMI category, these were transformed into risk estimates per unit of BMI via the Hartemink method to allow pooling. Results: Twenty-seven studies were identified. One study was not considered for pooled analysis due to already-included reports from the same institution. Nine studies did not report sufficient data to convert categorical to continuous relative risks. Of the remaining studies, pooled analysis of twelve studies reporting HR data revealed a significant association between BMI and incident postoperative AF (OR per unit of BMI 1.035 [95 CI% 1.029–1.042]). Conclusions: For every unit increase in BMI, there is a 3.5% increased risk of developing postoperative AF. These findings raise the possibility that preoperative weight loss may reduce the incidence of postoperative AF. http://dx.doi.org/10.1016/j.hlc.2012.05.674 664 Comprehensive Haemodynamic Description of Prosthetic Valve Function by Transthoracic Echocardiography in 171 Normal Mitral Valve Prostheses H. Samardhi ∗ , C. West, J. Chan, G. Scalia, D. Burstow The Prince Charles Hospital, Australia Introduction: Comprehensive data on prosthetic valve haemodynamics obtained by transthoracic echocardiography (TTE) in a large patient cohort with normal mitral valve prostheses (MVR) is limited. Establishment of normal ranges for all haemodynamic parameters is vital for identification of prosthetic valve dysfunction. Methods: TTE derived parameters in 171 patients with normal MVR confirmed by a recent transoesophageal echocardiogram were analysed. One hundred and nine patients had a mechanical prosthesis (ATS = 73, St Jude = 36) and 62 patients had a bioprosthesis (Mosaic = 39, Perimount = 23).

Abstracts CSANZ 2012 Abstracts

Results: The normal range data for the individual subtypes are shown below as medians (interquartile range). P values obtained using ANOVA. Valve type ATS (n = 73) St Jude (n = 36) Mosaic (n = 39) Perimount (n = 23) P value

Mitral E Velocity (cm/s) 164 (51) 174 (44.5) 190 (49.6) 165 (50) 0.010

MVR VTI (cm) 33 (9) 33.5 (14.6) 43.6 (12.7) 37 (8.6) <0.001

minute for 60 min after the addition of tissue factor and tissue plasminogen activator to plasma.

Mean gradient (mmHg) 4.1 (2.2) 4.4 (3.2) 6.2 (3.7) 5.1 (3.2) 0.003

Conclusions: This study establishes normal values for a comprehensive range of TTE derived MVR haemodynamic parameters. Valve subtypes have unique normal ranges which should enhance the clinical detection of prosthetic valve dysfunction. http://dx.doi.org/10.1016/j.hlc.2012.05.675 665 Current Level IA Evidence for Radial Artery versus Saphenous Vein in Coronary Artery Bypass Graft Surgery: A Meta-analysis of Randomised Controlled Trials C. Cao 1 , P. Bannon 1 , S. Munkholm-Larsen 1 , T. Yan 1 , S. Ang 2,∗ 1 The

Baird Institute for Applied Heart and Lung Surgical Research, Sydney, Australia 2 St George Hospital, Sydney, Australia Due to confidentiality reasons, the text of this abstract has been withheld from publication.

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PHT (cm/s) 69.4 (27) 69.3 (32) 79.5 (35.7) 83 (42.2) 0.075

LVOTd (cm)

EOA (cm2 )

MVR Index

2.2 (0.3) 2.2 (0.2) 2.2 (0.4) 2.3 (0.2) 0.97

2.3 (0.8) 2.0 (0.6) 1.9 (0.75) 2.1 (0.6) 0.012

1.75 (0.44) 1.87 (0.37) 2.03 (0.74) 2.0 (0.42) <0.001

Results: Pre-operative coagulation potentials (OCP) for both CABG and OPCAB were significantly elevated compared with healthy controls. OCP after CABG was elevated on post-operative days 3, 5, 10 relative to pre-operative baseline (d3 22.86%, d5 25.29%, d10 13.16%, all p < 0.05). OCP was significantly elevated in OPCAB on day 3 and 10 (d3 14.52%, d10 15.73%, both p < 0.05). Fibrinolysis potential (OFP) was impaired in CABG until day 10 (d1 −58.5%, d10 −7.58%, all p < 0.05) and to day 5 after OPCAB (d1 −22.9%, d5 12.3%, all p < 0.05). OCP for both groups at 6 weeks was lower than pre-operative values. Discussion: Patients undergoing CABG and OPCAB remain in a pro-thrombotic state, with increased OCP and decreased OFP, until at least post-operative day 10, recovering by 6 weeks. The first 6 weeks after surgery appear to be at greatest risk for thrombotic events. http://dx.doi.org/10.1016/j.hlc.2012.05.677 667

666 Early and Late Coagulation and Fibrinolysis After CABG and OPCAB J. Edelman 1,2,∗ , C. Reddel 2 , J. Fraser 3 , P. Bannon 1 , L. Kritharides 2 , J. Curnow 2,4 , M. Vallely 1 1 The Baird Institute, Cardiothoracic Surgical Unit, Royal Prince

Alfred Hospital, The University of Sydney, Australia 2 ANZAC Research Institute, Australia 3 Critical Care Research Group, The Prince Charles Hospital, Australia 4 Department of Haematology, Concord Hospital, Australia Introduction: A fine balance between the systems of coagulation and fibrinolysis after CABG is required to prevent complications of hypocoagulation (bleeding) or pro-thrombosis (stroke and graft failure). The assay of overall haemostatic potential (OHP) permits simultaneous evaluation of fibrinolysis and coagulation, and has never been utilised to assess the activity of these processes beyond the peri-operative period. Methods: Platelet-free plasma was isolated preoperatively, and on days 1, 3, 5, 10, 6 weeks and 6 months post-operatively from patients undergoing CABG (n = 30) and OPCAB (n = 30) for stable angina. Fibrin time curves are generated by measuring absorption of 405 nm each

Early Outcome of Isolated Tricuspid Valve Surgery at a Tertiary Referral Centre M. Premaratne ∗ , D. Wong, G. Cranney, G. Mathur, H. Wolfenden, P. Grant, Z. Akhunji Prince of Wales Hospital, Melbourne, Australia Background: Management of isolated tricuspid regurgitation (TR) is difficult due to progressive right heart failure and ultimately ineffective medical therapy. Surgical correction rates for isolated tricuspid regurgitation have historically been low due to high mortality rates reported in the literature. We report our institution’s experience with tricuspid valve surgery in a high-risk cohort. Methods: Database collection on cardiac surgery is collected prospectively at our institution. We reviewed procedural details between January 1998 and February 2012. Follow-up was obtained through review of electronic and paper medical records. Patients with concomitant mitral valve surgery were excluded. Results: Thirty-one patients were included. Sixty-five percent female, mean age 60 years. Indications were; functional TR 21, endocarditis 5, Ebstein’s anomaly 2, Carcinoid syndrome 1, concomitant aortic valve surgery 2. Procedures were; Tricuspid annuloplasty 19, bioprosthetic TV replacements (TVR) 11 and mechanical TVR 1. Preop functional NYHA class IV symptoms were present in 84%. Pre-op transthoracic echocardiogram (TTE) find-

ABSTRACTS

Heart, Lung and Circulation 2012;21:S143–S316