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Concomitant Epicardial Left Ventricular Lead Implantation in Cardiac Surgical Patients with Impaired Cardiac Function
2012 ANZSCTS Annual Scientific Meeting
461
accomplished during open-heart surgery and should be considered prior to operation.
PLT from 11% to 39%, one or more FFP from 11% to 48% and one or more cryoprecipitate from 1% to 20%. Similar variation was still present when the analysis was limited to isolated first-time CABG. Hospital-characteristics, including state or territory, private versus public and teaching versus non-teaching, were not associated with variation in transfusion rates. Discussion: Wide variation in transfusion of all components and large volume RBC was identified, even after adjustment for patient, hospital and procedural characteristics known to influence transfusion. There remain many areas where the evidence-base to inform the use of blood products is lacking, and further clinical studies are required.
Fabiano Viana ∗ , John Troupis, Andrew Cochrane, Cliff Choong, Randall Moshinsky, Adrian Pick, Aubrey Almeida, Jacob Goldstein, Julian Smith
http://dx.doi.org/10.1016/j.hlc.2013.03.017
Monash Medical Centre, Southern Health and Monash University, Melbourne, Australia
Monday 12 November – Session 2/1640 – 1650 Concomitant Epicardial Left Ventricular Lead Implantation in Cardiac Surgical Patients with Impaired Cardiac Function P. Conaglen 1,2,∗ , L. Shan 1 , D. Webb 1 , E. Buratto 1 , P. Davis 1 , M. Yii 1 , I. Nixon 1 , A. Rosalion 1 , A. Newcomb 1,2 1 Department of Cardiothoracic Surgery, St. Vincent’s Hospital, Melbourne, Australia 2 Department of Surgery, The University of Melbourne, Australia
Introduction: Epicardial left ventricular (LV) lead implantation for bi-ventricular pacing (Bi-V) has advantages over the transvenous approach that can be exploited for patients with impaired cardiac function undergoing cardiac surgery. We investigated the benefit of concomitant prophylactic LV lead implantation and subsequent lead performance after receiving a Bi-V device. Methods: 4846 patients underwent cardiac surgery between January 2001 and December 2011. 783 patients (66.1 ± 11.0 years) with poor LV function, defined as grade 4 estimated ejection fraction or echocardiographic ejection fraction <30%, were offered concomitant LV lead implantation according to surgeon preference. Lead performance data was collected by device interrogation after connection of a Bi-V device. Nineteen patients were excluded due to missing data (total n = 764). Statistical analysis was performed by Chi-sqaure test. Results: An LV lead was implanted in 134 patients (17.5%) of which 28 (20.9%) subsequently received a Bi-V device. The median time-period from LV lead implantation to connection of a Bi-V device was 32.5 [1–2162] days. At the time of Bi-V device connection, pacing threshold (1.53 ± 0.60) and impedance (474.0 ± 189.3) were satisfactory. Significantly fewer patients received a Bi-V device (n = 3) if they did not have an LV lead implanted at the time of surgery (0.005% vs 20.9%, p < 0.0001). Discussion: A significant proportion of patients may benefit from concomitant prophylactic LV lead implantation and avoid a second major procedure. Subsequent lead performance after connection of a Bi-V device appears satisfactory. Epicardial LV lead placement is easily
http://dx.doi.org/10.1016/j.hlc.2013.03.018 Monday 12 November – Session 2/1650 – 1700 Four Dimensional (4D) Chest Computed Tomography (CT) Imaging for Re-Entry Risk Assessment in Re-Do Sternotomy
Introduction: Re-do cardiac surgery can be associated with an increased risk of morbidity and mortality, often related to intraoperative injury [1]. A recent evidence based review concluded that adequate preoperative imaging using CT is essential for optimum planning of re-do cardiac surgery [2]. Although conventional CT is an optimal imaging modality for anatomical detail, this imaging technique has not been widely recognised as useful in assessment of the presence or absence of functional tethering of structures. We present the world’s first experience in utilisation of 4D CT for re-entry risk assessment in re-do sternotomy. Methods: We utilised the wide field of view CT unit with 320 detectors, each detector 0.5 mm, with consequent 16 cm of superior to inferior coverage in one tube rotation, without table movement. The acquisition of images was performed in two cycles of full inspiration and expiration. A volume data set was obtained every one sixth of a second, which consequently provided multi dimensional image reconstruction. After loading the data set into a workstation, we were able to assess for the presence of differential motion between the sternum and adjacent structures. Pre-operative images were compared to intraoperative surgical findings. Results: In a preliminary study of 12 cases, we correctly identified any evidence of tethering to the sternum of anterior cardiac structures, the aorta or previous bypass grafts. This enabled surgeons to meticulously plan the re-entry, including making decisions about the potential cannulation sites or the utilisation of cardiopulmonary bypass prior to sternotomy. Preoperative imaging correlated well with intraoperative findings and there were no re-entry related injuries in these patients. Discussion: 4D CT allows for improved risk stratification and planning of surgical strategy to reduce the potential re-entry risk in patients coming for re-do operations, an innovation due to the highly specific and unique construction of the 320 slice, multidetector CT scanner.
Reference [1] Roselli EE, Pettersson GB, Blackstone EH, Brizzio ME, Houghtaling PL, Hauck R, Burke JM, Lytle BW. Adverse events during
ABSTRACTS
Heart, Lung and Circulation 2013;22:455–489
461
accomplished during open-heart surgery and should be considered prior to operation.
PLT from 11% to 39%, one or more FFP from 11% to 48% and one or more cryoprecipitate from 1% to 20%. Similar variation was still present when the analysis was limited to isolated first-time CABG. Hospital-characteristics, including state or territory, private versus public and teaching versus non-teaching, were not associated with variation in transfusion rates. Discussion: Wide variation in transfusion of all components and large volume RBC was identified, even after adjustment for patient, hospital and procedural characteristics known to influence transfusion. There remain many areas where the evidence-base to inform the use of blood products is lacking, and further clinical studies are required.
Fabiano Viana ∗ , John Troupis, Andrew Cochrane, Cliff Choong, Randall Moshinsky, Adrian Pick, Aubrey Almeida, Jacob Goldstein, Julian Smith
http://dx.doi.org/10.1016/j.hlc.2013.03.017
Monash Medical Centre, Southern Health and Monash University, Melbourne, Australia
Monday 12 November – Session 2/1640 – 1650 Concomitant Epicardial Left Ventricular Lead Implantation in Cardiac Surgical Patients with Impaired Cardiac Function P. Conaglen 1,2,∗ , L. Shan 1 , D. Webb 1 , E. Buratto 1 , P. Davis 1 , M. Yii 1 , I. Nixon 1 , A. Rosalion 1 , A. Newcomb 1,2 1 Department of Cardiothoracic Surgery, St. Vincent’s Hospital, Melbourne, Australia 2 Department of Surgery, The University of Melbourne, Australia
Introduction: Epicardial left ventricular (LV) lead implantation for bi-ventricular pacing (Bi-V) has advantages over the transvenous approach that can be exploited for patients with impaired cardiac function undergoing cardiac surgery. We investigated the benefit of concomitant prophylactic LV lead implantation and subsequent lead performance after receiving a Bi-V device. Methods: 4846 patients underwent cardiac surgery between January 2001 and December 2011. 783 patients (66.1 ± 11.0 years) with poor LV function, defined as grade 4 estimated ejection fraction or echocardiographic ejection fraction <30%, were offered concomitant LV lead implantation according to surgeon preference. Lead performance data was collected by device interrogation after connection of a Bi-V device. Nineteen patients were excluded due to missing data (total n = 764). Statistical analysis was performed by Chi-sqaure test. Results: An LV lead was implanted in 134 patients (17.5%) of which 28 (20.9%) subsequently received a Bi-V device. The median time-period from LV lead implantation to connection of a Bi-V device was 32.5 [1–2162] days. At the time of Bi-V device connection, pacing threshold (1.53 ± 0.60) and impedance (474.0 ± 189.3) were satisfactory. Significantly fewer patients received a Bi-V device (n = 3) if they did not have an LV lead implanted at the time of surgery (0.005% vs 20.9%, p < 0.0001). Discussion: A significant proportion of patients may benefit from concomitant prophylactic LV lead implantation and avoid a second major procedure. Subsequent lead performance after connection of a Bi-V device appears satisfactory. Epicardial LV lead placement is easily
http://dx.doi.org/10.1016/j.hlc.2013.03.018 Monday 12 November – Session 2/1650 – 1700 Four Dimensional (4D) Chest Computed Tomography (CT) Imaging for Re-Entry Risk Assessment in Re-Do Sternotomy
Introduction: Re-do cardiac surgery can be associated with an increased risk of morbidity and mortality, often related to intraoperative injury [1]. A recent evidence based review concluded that adequate preoperative imaging using CT is essential for optimum planning of re-do cardiac surgery [2]. Although conventional CT is an optimal imaging modality for anatomical detail, this imaging technique has not been widely recognised as useful in assessment of the presence or absence of functional tethering of structures. We present the world’s first experience in utilisation of 4D CT for re-entry risk assessment in re-do sternotomy. Methods: We utilised the wide field of view CT unit with 320 detectors, each detector 0.5 mm, with consequent 16 cm of superior to inferior coverage in one tube rotation, without table movement. The acquisition of images was performed in two cycles of full inspiration and expiration. A volume data set was obtained every one sixth of a second, which consequently provided multi dimensional image reconstruction. After loading the data set into a workstation, we were able to assess for the presence of differential motion between the sternum and adjacent structures. Pre-operative images were compared to intraoperative surgical findings. Results: In a preliminary study of 12 cases, we correctly identified any evidence of tethering to the sternum of anterior cardiac structures, the aorta or previous bypass grafts. This enabled surgeons to meticulously plan the re-entry, including making decisions about the potential cannulation sites or the utilisation of cardiopulmonary bypass prior to sternotomy. Preoperative imaging correlated well with intraoperative findings and there were no re-entry related injuries in these patients. Discussion: 4D CT allows for improved risk stratification and planning of surgical strategy to reduce the potential re-entry risk in patients coming for re-do operations, an innovation due to the highly specific and unique construction of the 320 slice, multidetector CT scanner.
Reference [1] Roselli EE, Pettersson GB, Blackstone EH, Brizzio ME, Houghtaling PL, Hauck R, Burke JM, Lytle BW. Adverse events during
ABSTRACTS
Heart, Lung and Circulation 2013;22:455–489