Left Atrial Appendage Occlusion Utilising the Amplatzer Cardiac Plug

Methods: Subjects greater than one year post implantation of a balloon expandable aortic valve underwent MDCT. Geometry of the stent frame was assessed for circularity, minimum (Dmin ) and maximum (Dmax ) external diameter and expansion ratio at three levels: ventricular, mid and aortic. Circularity was defined as an eccentricity index (EI) of less than 0.1 (EI = 1 − Dmin /Dmax ) and expansion ratio as a percentage of the measured short axis derived area divided by the expected area. Results: Thirty-seven patients underwent MDCT at an average 2.7 years (987 days) post implantation (range 1.0–4.0 years) including 26 Edward Sapien, six Sapien XT and five Cribier Edwards valves. 110 of 111 (99%) segments in the 37 valves were circular. The was no difference in circularity between valve type (p = 0.66) or from the ventricular to aortic aspect of the frame (p = 0.54). The mean external diameter of the 23 and 26 mm valves was 23.4 ± 1.0 mm and 25.9 ± 0.9 mm, respectively. The average expansion ratio was 104.1 ± 7.5% with a significant increase from the ventricular to aortic level (100.7% vs 108.5%, p = <0.001). There were no cases of stent frame fracture. Conclusion: Balloon expandable aortic valves have excellent rates of circularity and maintain full expansion without stent frame fracture late following implantation, thus supporting long term stent durability. doi:10.1016/j.hlc.2011.05.331 329 Left Atrial Appendage Occlusion Utilising the Amplatzer Cardiac Plug G. Young 1,∗ , V. Paul 2 , P. Disney 1 , R. Clugston 2 , X. Xu 2 , S. Worthley 1 1 Adelaide 2 Royal

Cardiology, Australia Perth Hospital, Australia

Introduction: Left atrial appendage (LAA) occlusion may be an alternative to long term warfarin therapy for prevention of embolic complications in patients with AF. Methods: We report on 29 consecutive patients undergoing LAA occlusion using the Amplatzer Cardiac Plug (ACP) at the Royal Adelaide and Royal Perth Hospitals. General anaesthesia was used with combined fluoroscopic and trans-oesophageal echo (TOE) guidance. The ACP was delivered to the LAA via a guiding sheath following transseptal puncture. Results: In total 29 patients (M:F = 21:8, median age 75 years) were screened between June 2010 and February 2011. Indication was AF with a mean CHADS score of 3.4 and a bleeding complication with warfarin in 25 patients and embolic CVA on warfarin in two. In two patients the procedure was cancelled due to the presence of LAA thrombus on the TOE. In all remaining 27 patients the ACP was deployed without complication. The mean procedure and fluoroscopy times were 84 (±27) min and 18 (±8) minutes, respectively. In all but one patient a single occluder was used. Two groin haematomas and one minor oesophageal injury were the only procedural com-

Abstracts CSANZ Abstracts 2011

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plications, importantly there were no cases of pericardial effusion or tamponade. Procedural TOE echo has shown complete occlusion of the LAA in all cases and no thrombus at follow TOE. Conclusions: LAA occlusion with the ACP can be performed safely and expeditiously and may be a viable alternative to long term warfarin therapy. doi:10.1016/j.hlc.2011.05.332 330 Lesion Guided Strategy for the Use of Bare Metal Stents in Large Coronary Vessels P. Fahmy ∗ , M. Leung, W. Ahmar, P. Sinha, C. Roufaeil, K. Sinha, I. Meredith, Y. Malaiapan MonashHeart/Monash Medical Centre, Australia Background: Although drug eluting stents (DES) have revolutionised percutaneous coronary intervention (PCI), the use of bare metal stents (BMS) remains important in some lesion subsets like large coronary vessels. However, there is limited Australian data on the efficacy of BMS in large coronary vessels (LCV). Aim: To determine the efficacy of BMS in LCV. Methods: Patients who had LCV PCI were compared with those who had medium calibre coronary vessels (MCV) PCI. Definition: LCV—vessels that required stents > 4 mm. MCV—vessels that required stents 33.75 mm in diameter. Data was collected from institutional database retrospectively and major adverse cardiac events (MACE) were recorded by telephone call. Results: In 1310 patients, there were 398(30%) LCV (age 62 ± 15, 77% male) and 930(70%) MCV (age 61 ± 14, 77% male). Baseline clinical characteristics, lesion complexities (B2/C—66% LCV vs 62% MCV) were similar. The indication for PCI was ST elevation myocardial infarction in 43 vs 35%; P = 0.003 and unstable angina/NSTEMI in 34 vs 33%, P = NS. Right coronary artery and saphenous vein graft comprised 61 vs 42%; and 6 vs 2% respectively; both P < 0.001. Bare metal stents were used in 75 vs 45%; P < 0.001. Procedural success and final TIMI 3 flow were 93 vs 93% and 95 vs 94%, respectively, P = NS for both. MACE at a mean follow up of 1105 ± 416 days (85% follow up achieved): TLR/TVR—5 vs 7% P = NS, recurrent angina—5 vs 12%; P = 0.001, and all cause mortality—3 vs 1%; P = 0.05. Conclusion: Lesion guided use of BMS in LCV resulted in similar safety and efficacy when compared to a more conventional lesion guided use of DES in MCV. doi:10.1016/j.hlc.2011.05.333

ABSTRACTS

Heart, Lung and Circulation 2011;20S:S1–S155