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Five-Year Review of the Demographics and Clinical Outcomes of Aortic Valve (AV) Endocarditis at Auckland District Health Board (ADHB)
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Heart, Lung and Circulation 2011;20:376–419
Abstracts
ABSTRACTS
Patient characteristic’s and treatment options.
Number Age range RF only Rx Cryo only Rx Both Rx
All
Adult >16 yrs
Paediatric
241 7–78(45) 214 35 7
208 16–78(50) 197(94.7%) 11(5.2%) 3(1.4%)
33 7–16(10) 11(32.5%) 22(66.5%) 4(10%)
Procedural results and outcomes. Rx
Acute success Recurrence Complications
Follow up # Follow up duration
Adult – 95%
Paediatric – 100%
RFA
Cryoablation
RFA
Cryoablation
96% 3(3.5%) 2% (4) × complete heart block 95/208 2–16 months
93% 1(20%) None
94.1% 1(9%) None
92.6% 3(14%) None
17/38 2–12 months
Conclusion: Cryo-ablation for AVNRT can achieve comparable success rates to RFA, equitable procedural and fluoroscopy duration, with fewer or no complications and reasonable recurrence rates at follow up in adults. Early signs suggest a slightly higher recurrence risk for cryoablation in children. doi:10.1016/j.hlc.2011.03.026 Five-Year Review of the Demographics and Clinical Outcomes of Aortic Valve (AV) Endocarditis at Auckland District Health Board (ADHB) C. Deng ∗ , J. Pemberton Department of Cardiology, Auckland City Hospital, New Zealand Background: AV endocarditis is a serious condition with a significant proportion developing aortic root complications (ARC) and is associated with high mortality rates. Methods: Using data from clinical records, we reviewed the demographics, pre-existing valve type, causative organisms, the presence of ARC, need for surgery and mortality for patients with AV endocarditis at ADHB over a five-year period to September 2010. Results: 121 cases of AV endocarditis were identified; 83% male, 58% European, 28% Pacific Islanders, 12% Maori, the remainder Asian and Middle Eastern (2%). Native valve infections accounted for 53% of cases. Of these, 42% had a pre-existing valvular abnormality such as bicuspid or rheumatic valve. Forty-seven percent were prosthetic valve infection. ‘Normal’ valves accounted for 30% of all infection. Major causative organisms were: Streptococcus 35%, Staphylococcus 30%, Enterococcus 17% and culture negative 6%.
The prevalence of ARC was 29%. Twenty-five percent of prosthetic valve and 33% of native valve endocarditis (p-value 0.32). Fifty-nine percent of patients underwent surgical repair: 38% of patients without ARC compared to 91% with ARC. Three patients with ARC died prior to surgical intervention. There were 14 in-hospital deaths (12% mortality); 57% of these patients had a prosthetic valve. Five (14%) patients with ARC died, compared to 8 (9%) without root complications (p-value 0.43). Conclusion: AV endocarditis and ARC are serious infections with relatively high in-hospital mortality. Our study does not suggest an increase in the prevalence of ARC between different valve types. In-hospital mortality was not higher in the ARC group. doi:10.1016/j.hlc.2011.03.027 Acute Predict Cardiac Catheter Lab (CCL)—An Electronic Real-Time Audit, Quality Improvement Process in Middlemore Hospital CCL C. Flynn ∗ , J. White, S. Graham, A. McLachlan, A.J. Kerr, D. Scott, P. Kay Middlemore Hospital, New Zealand Background: The aim was to develop, within the existing Acute Predict electronic system, a system to comprehensively capture and report all CCL activity and in-hospital outcomes for patients undergoing coronary angiography. Methods: A working group developed, tested and implemented the electronic audit system in the CCL. CCL nurses enter data directly into the electronic templates on the day of coronary angiography. Data cross-populates with the Acute Predict acute coronary syndrome (ACS) data-set collected in the CCU thus reducing data entry duplication and improving data accuracy. In-hospital outcomes back-populates to the catheter lab record from the ACS forms completed by the CCU team. The system generates patient lists according to level of data completeness which are used to identify patients with incomplete in-hospital outcome data, then completed from the Electronic Discharge Summary. A standardised live report is available to all users both specifically to individual patients, and filtering by any data item in the data-set. A quality improvement group supports implementation and use of the data. Results: From mid-November 2010 to late-February 2011 all CCL patients (n = 232) had complete data capture, mean age 62 years, 65% male, 53% non-European, 63% in-patients, 79% were for suspected or known CHD, 82% had radial access, 66.7% had >50 stenosis in one or more vessels, 49% had EF assessed, 44 patients had PCI. Three patients died in-hospital and only one patient had a PCIrelated complication. Conclusion: The Acute Predict CCL system was easy to implement and provides ready access to reliable information to drive quality improvement. doi:10.1016/j.hlc.2011.03.028
Heart, Lung and Circulation 2011;20:376–419
Abstracts
ABSTRACTS
Patient characteristic’s and treatment options.
Number Age range RF only Rx Cryo only Rx Both Rx
All
Adult >16 yrs
Paediatric
241 7–78(45) 214 35 7
208 16–78(50) 197(94.7%) 11(5.2%) 3(1.4%)
33 7–16(10) 11(32.5%) 22(66.5%) 4(10%)
Procedural results and outcomes. Rx
Acute success Recurrence Complications
Follow up # Follow up duration
Adult – 95%
Paediatric – 100%
RFA
Cryoablation
RFA
Cryoablation
96% 3(3.5%) 2% (4) × complete heart block 95/208 2–16 months
93% 1(20%) None
94.1% 1(9%) None
92.6% 3(14%) None
17/38 2–12 months
Conclusion: Cryo-ablation for AVNRT can achieve comparable success rates to RFA, equitable procedural and fluoroscopy duration, with fewer or no complications and reasonable recurrence rates at follow up in adults. Early signs suggest a slightly higher recurrence risk for cryoablation in children. doi:10.1016/j.hlc.2011.03.026 Five-Year Review of the Demographics and Clinical Outcomes of Aortic Valve (AV) Endocarditis at Auckland District Health Board (ADHB) C. Deng ∗ , J. Pemberton Department of Cardiology, Auckland City Hospital, New Zealand Background: AV endocarditis is a serious condition with a significant proportion developing aortic root complications (ARC) and is associated with high mortality rates. Methods: Using data from clinical records, we reviewed the demographics, pre-existing valve type, causative organisms, the presence of ARC, need for surgery and mortality for patients with AV endocarditis at ADHB over a five-year period to September 2010. Results: 121 cases of AV endocarditis were identified; 83% male, 58% European, 28% Pacific Islanders, 12% Maori, the remainder Asian and Middle Eastern (2%). Native valve infections accounted for 53% of cases. Of these, 42% had a pre-existing valvular abnormality such as bicuspid or rheumatic valve. Forty-seven percent were prosthetic valve infection. ‘Normal’ valves accounted for 30% of all infection. Major causative organisms were: Streptococcus 35%, Staphylococcus 30%, Enterococcus 17% and culture negative 6%.
The prevalence of ARC was 29%. Twenty-five percent of prosthetic valve and 33% of native valve endocarditis (p-value 0.32). Fifty-nine percent of patients underwent surgical repair: 38% of patients without ARC compared to 91% with ARC. Three patients with ARC died prior to surgical intervention. There were 14 in-hospital deaths (12% mortality); 57% of these patients had a prosthetic valve. Five (14%) patients with ARC died, compared to 8 (9%) without root complications (p-value 0.43). Conclusion: AV endocarditis and ARC are serious infections with relatively high in-hospital mortality. Our study does not suggest an increase in the prevalence of ARC between different valve types. In-hospital mortality was not higher in the ARC group. doi:10.1016/j.hlc.2011.03.027 Acute Predict Cardiac Catheter Lab (CCL)—An Electronic Real-Time Audit, Quality Improvement Process in Middlemore Hospital CCL C. Flynn ∗ , J. White, S. Graham, A. McLachlan, A.J. Kerr, D. Scott, P. Kay Middlemore Hospital, New Zealand Background: The aim was to develop, within the existing Acute Predict electronic system, a system to comprehensively capture and report all CCL activity and in-hospital outcomes for patients undergoing coronary angiography. Methods: A working group developed, tested and implemented the electronic audit system in the CCL. CCL nurses enter data directly into the electronic templates on the day of coronary angiography. Data cross-populates with the Acute Predict acute coronary syndrome (ACS) data-set collected in the CCU thus reducing data entry duplication and improving data accuracy. In-hospital outcomes back-populates to the catheter lab record from the ACS forms completed by the CCU team. The system generates patient lists according to level of data completeness which are used to identify patients with incomplete in-hospital outcome data, then completed from the Electronic Discharge Summary. A standardised live report is available to all users both specifically to individual patients, and filtering by any data item in the data-set. A quality improvement group supports implementation and use of the data. Results: From mid-November 2010 to late-February 2011 all CCL patients (n = 232) had complete data capture, mean age 62 years, 65% male, 53% non-European, 63% in-patients, 79% were for suspected or known CHD, 82% had radial access, 66.7% had >50 stenosis in one or more vessels, 49% had EF assessed, 44 patients had PCI. Three patients died in-hospital and only one patient had a PCIrelated complication. Conclusion: The Acute Predict CCL system was easy to implement and provides ready access to reliable information to drive quality improvement. doi:10.1016/j.hlc.2011.03.028