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Impact of Discontinuation of Antiplatelet Therapy Prior to Isolated Valve and Combined Coronary Artery Bypass Graft and Valve Procedures on Short and Intermediate Term Outcomes
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SHORT ORAL PRESENTATIONS 1: ADULT CARDIAC 16th Nov (MON) 13:50 - 13:55 Impact of Discontinuation of Antiplatelet Therapy Prior to Isolated Valve and Combined Coronary Artery Bypass Graft and Valve Procedures on Short and Intermediate Term Outcomes James Meneguzzi *, Philip Hayward, Matthew Kilpin, Ying Yan Zhu, Atsuo Doi, Christopher Reid, Lavinia Tran, Julian Smith The University of Melbourne, Melbourne, VIC, Australia Purpose:This study aims to identify the optimal timing for administration of aspirin in isolated valve or combined CABG and valve surgery to minimise risk of perioperative morbidity and mortality. Methods: From a prospectively compiled database collected by the Australian and New Zealand Society of Cardiac and Thoracic Surgeons we identified 8,294 patients undertaking isolated valve or combined CABG and valve procedures while discontinuing aspirin. Time points for cessation of antiplatelet therapy were categorised as follows: <2 days, 3-7 days or >7 days preoperatively. We evaluated the association of adverse in-hospital events and intermediate term survival in each time category. Results: Discontinuing aspirin 3-7 days from surgery decreased rates of returning to theatre (HR=0.560, p=0.002) reduced ICC losses (HR=0.757, p=0.000) and red blood cell and platelet transfusions (HR=0.719, p=0.000 and HR=0.604, p=0.000 respectively) compared to patients continuing aspirin until <2 days from the procedure. Stopping aspirin <2 days from surgery increased risk of reoperation for bleeding (HR=2.076, p=0.001), returning to theatre (HR=1.781, p=0.000), ICC drain losses (HR=1.337, p=0.000) and transfusion demands for red blood cells (HR=1.381, p=0.000) and platelets (HR=1.450, p=0.000) when compared to those discontinuing aspirin >7 days from surgery. Aspirin cessation <2 days from procedure does not confer a survival benefit when compared to discontinuation >2 days from surgery. Conclusion: Late discontinuation of aspirin before isolated valve or combined coronary artery bypass graft and valve procedures results in greater rates of bleeding and transfusion requirements without an improvement in short- and intermediate-term survival. http://dx.doi.org/10.1016/j.hlc.2015.12.028 SHORT ORAL PRESENTATIONS 1: ADULT CARDIAC 16th Nov (MON) 13:20 - 13:25 Minimally Invasive Aortic Valve Surgery - Our Early Experience Charles Jenkinson *, Pragnesh Joshi, Lucas Sanders, Louis Okiwelu, Lakshmeesh Shetty, Jurgen Passage Sir Charles Gairdner Hospital, Perth, WA, Australia
Abstracts
Purpose: Our institution has recently started a minimally invasive aortic valve program with surgical approach via hemisternotomy. We hypothesise that this approach will reduce postoperative complications and length of stay, whilst not compromising the safety and efficacy of traditional aortic valve surgery via full sternotomy. We present our early results, and discuss our approach and techniques, including the use of one-shot crystalloid cardioplegia, and the ability to conduct complex aortic surgery via this approach. Methodology: A retrospective analysis of data from both the ANZCTS Database submissions for our hospital, and data collected prospectively within our unit were carried out to identify patients undergoing minimally invasive aortic surgery since inception this year. Baseline characteristics were then collected for each patient, and outcomes data were examined. These were compared to a cohort of patients from our unit who underwent standard aortic valve and aortic interventions, for parameters including Major Adverse Cardiac Events, Return to Theatre, Blood Transfusion, and Length of Stay. Results: 16 patients were identified as undergoing hemisternotomy for aortic valve surgery in the study period. One patient underwent aortic root replacement by modified Bengal Procedure. From this group there were no conversions to full sternotomy, and we saw no incidences of death, stroke, re-exploration, or deep sternal wound infection. Conclusion: Minimally invasive aortic valve surgery is in its infancy within our department. However our early results are encouraging, and we continue to pursue this technique. http://dx.doi.org/10.1016/j.hlc.2015.12.029 SHORT ORAL PRESENTATIONS 1: ADULT CARDIAC 16th Nov (MON) 13:25 - 13:30 Real-world 2-Year Outcomes from an Australasian High Risk Aortic Stenosis Service Ben Dunne *, Darren Tan, Daniel Chu, Victor Yau, Gerald Yong, Robert Larbalestier Fiona Stanley Hospital, Perth, WA, Australia Purpose: The purpose of this study was to examine the real-world outcomes of the treatment approaches available through an Australasian High-Risk Aortic Stenosis Service. Methodology: A retrospective review of all patients referred to the Western Australian High Risk Aortic Stenosis Service was performed. Patients were analysed according to the intervention received. The 4 groups were – Surgical, Transfemoral TAVI, Transapical TAVI and Medical therapy (including BAV). All patients were followed for 2 years to ensure accurate 2-year data. The primary endpoints were survival and rehospitalisation for cardiac reasons. Results: 391 patients were followed for 2 years post-procedure or post-referral if no procedure was performed. 2year survival was 91.9% (Surgical), 80.5% (Transfemoral), 70% (Transapical) and 49.5% (Medical). In those surviving to 2 years, freedom from rehospitalisation was 89.8% (Surgical), 89.9% (Transfemoral), 100% (Transapical) and 50.5% (Medical).
SHORT ORAL PRESENTATIONS 1: ADULT CARDIAC 16th Nov (MON) 13:50 - 13:55 Impact of Discontinuation of Antiplatelet Therapy Prior to Isolated Valve and Combined Coronary Artery Bypass Graft and Valve Procedures on Short and Intermediate Term Outcomes James Meneguzzi *, Philip Hayward, Matthew Kilpin, Ying Yan Zhu, Atsuo Doi, Christopher Reid, Lavinia Tran, Julian Smith The University of Melbourne, Melbourne, VIC, Australia Purpose:This study aims to identify the optimal timing for administration of aspirin in isolated valve or combined CABG and valve surgery to minimise risk of perioperative morbidity and mortality. Methods: From a prospectively compiled database collected by the Australian and New Zealand Society of Cardiac and Thoracic Surgeons we identified 8,294 patients undertaking isolated valve or combined CABG and valve procedures while discontinuing aspirin. Time points for cessation of antiplatelet therapy were categorised as follows: <2 days, 3-7 days or >7 days preoperatively. We evaluated the association of adverse in-hospital events and intermediate term survival in each time category. Results: Discontinuing aspirin 3-7 days from surgery decreased rates of returning to theatre (HR=0.560, p=0.002) reduced ICC losses (HR=0.757, p=0.000) and red blood cell and platelet transfusions (HR=0.719, p=0.000 and HR=0.604, p=0.000 respectively) compared to patients continuing aspirin until <2 days from the procedure. Stopping aspirin <2 days from surgery increased risk of reoperation for bleeding (HR=2.076, p=0.001), returning to theatre (HR=1.781, p=0.000), ICC drain losses (HR=1.337, p=0.000) and transfusion demands for red blood cells (HR=1.381, p=0.000) and platelets (HR=1.450, p=0.000) when compared to those discontinuing aspirin >7 days from surgery. Aspirin cessation <2 days from procedure does not confer a survival benefit when compared to discontinuation >2 days from surgery. Conclusion: Late discontinuation of aspirin before isolated valve or combined coronary artery bypass graft and valve procedures results in greater rates of bleeding and transfusion requirements without an improvement in short- and intermediate-term survival. http://dx.doi.org/10.1016/j.hlc.2015.12.028 SHORT ORAL PRESENTATIONS 1: ADULT CARDIAC 16th Nov (MON) 13:20 - 13:25 Minimally Invasive Aortic Valve Surgery - Our Early Experience Charles Jenkinson *, Pragnesh Joshi, Lucas Sanders, Louis Okiwelu, Lakshmeesh Shetty, Jurgen Passage Sir Charles Gairdner Hospital, Perth, WA, Australia
Abstracts
Purpose: Our institution has recently started a minimally invasive aortic valve program with surgical approach via hemisternotomy. We hypothesise that this approach will reduce postoperative complications and length of stay, whilst not compromising the safety and efficacy of traditional aortic valve surgery via full sternotomy. We present our early results, and discuss our approach and techniques, including the use of one-shot crystalloid cardioplegia, and the ability to conduct complex aortic surgery via this approach. Methodology: A retrospective analysis of data from both the ANZCTS Database submissions for our hospital, and data collected prospectively within our unit were carried out to identify patients undergoing minimally invasive aortic surgery since inception this year. Baseline characteristics were then collected for each patient, and outcomes data were examined. These were compared to a cohort of patients from our unit who underwent standard aortic valve and aortic interventions, for parameters including Major Adverse Cardiac Events, Return to Theatre, Blood Transfusion, and Length of Stay. Results: 16 patients were identified as undergoing hemisternotomy for aortic valve surgery in the study period. One patient underwent aortic root replacement by modified Bengal Procedure. From this group there were no conversions to full sternotomy, and we saw no incidences of death, stroke, re-exploration, or deep sternal wound infection. Conclusion: Minimally invasive aortic valve surgery is in its infancy within our department. However our early results are encouraging, and we continue to pursue this technique. http://dx.doi.org/10.1016/j.hlc.2015.12.029 SHORT ORAL PRESENTATIONS 1: ADULT CARDIAC 16th Nov (MON) 13:25 - 13:30 Real-world 2-Year Outcomes from an Australasian High Risk Aortic Stenosis Service Ben Dunne *, Darren Tan, Daniel Chu, Victor Yau, Gerald Yong, Robert Larbalestier Fiona Stanley Hospital, Perth, WA, Australia Purpose: The purpose of this study was to examine the real-world outcomes of the treatment approaches available through an Australasian High-Risk Aortic Stenosis Service. Methodology: A retrospective review of all patients referred to the Western Australian High Risk Aortic Stenosis Service was performed. Patients were analysed according to the intervention received. The 4 groups were – Surgical, Transfemoral TAVI, Transapical TAVI and Medical therapy (including BAV). All patients were followed for 2 years to ensure accurate 2-year data. The primary endpoints were survival and rehospitalisation for cardiac reasons. Results: 391 patients were followed for 2 years post-procedure or post-referral if no procedure was performed. 2year survival was 91.9% (Surgical), 80.5% (Transfemoral), 70% (Transapical) and 49.5% (Medical). In those surviving to 2 years, freedom from rehospitalisation was 89.8% (Surgical), 89.9% (Transfemoral), 100% (Transapical) and 50.5% (Medical).