Multivessel Coronary Intervention During Primary Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction. A Review of Consecutive Cases

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Heart, Lung and Circulation 2010;19S:S1–S268

Abstracts

ABSTRACTS

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337

Microcirculatory Resistance Can be Calculated without the Need for Wedge Pressure Measurements in the Presence of Epicardial Stenosis

Novel Use of a Melody Percutaneous Pulmonary Valve in the Tricuspid Valve Position—First Reported Experience

Yong 1,∗ ,

Ho 2 ,

A. M. Fearon 2 , M. Ng 1

C.

Chawantanpipat 1 ,

M.

Shah 2 ,

W.

1 Department of Cardiology, Royal Prince Alfred Hospital, Syd-

ney, Australia 2 Department of Cardiology, Stanford University Medical Cen-

tre, Palo Alto, United States Due to a pending patent, the text of this abstract has been withheld from publication. doi:10.1016/j.hlc.2010.06.1002 336 Multivessel Coronary Intervention During Primary Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction. A Review of Consecutive Cases E. Mckay ∗ , V. Chen University of Otago, New Zealand Background: Practice guidelines recommend revascularisation of culprit artery only during primary percutaneous coronary intervention (PCI) for acute ST elevation myocardial infarction (STEMI) (Level of evidence C). There is some divergence of opinion about appropriate management of multivessel coronary disease (MVCD) found during STEMI, appropriateness of multivessel coronary intervention (MVCI), and the clinical evidence. Methods: Retrospective review of consecutive primary and rescue STEMI PCI cases for a single operator between July 2006 and November 2009. Results: 102 cases were identified, mean follow-up 21.8 months. Mean age 62.7 years ±sd 11.9, 69/102 (68%) male, 17/102 (17%) rescue PCIs. 56/102 patients had single vessel disease; 14/56 (25%) transfers, 6/56 (10.7%) shock. Of 56 cases with single vessel disease, 2/56 (3.6%) died (1 shock, 1 hypoxic brain injury), 6/56 (10.7%) suffered target vessel revascularisation (TVR) (5 bare stent restenosis, 1 stent thrombosis). Of 46 patients with MVCD disease, 28/46 (60.9%) underwent culprit only PCI. 18/46 underwent MVCI (39.1%); 3/18 transfers (16.7%), 5/18 (27.8%) shock. 6/18 patients had 2 vessel PCI for triple vessel disease, 12/18 patients had complete revascularisation for 2 vessel disease. 2/18 (11.1%) patients with MVCI had TVR from ISR, 1/18 (5.6%) died (from shock). Conclusion: Contrary to guidelines, a sizeable proportion of cases with MVCD underwent MVCI during index STEMI PCI. Observed outcomes were similar to other subgroups, particularly patients with single vessel disease. We conclude that selected cases of MVCD can probably be safely treated with MVCI with potential advantages to the patient and institution logistics. doi:10.1016/j.hlc.2010.06.1003

P. Roberts 1,∗ , M. Wilson 2 , M. Valelly 2 , B. Bailey 2 , D. Celermajer 2 1 The 2 The

Children’s Hospital at Westmead, Australia Royal Prince Alfred Hospital, Australia

Background: A 30-year-old female with severe oedema and effort intolerance had undergone tricuspid valve replacement (27 mm bioprosthesis) 9 years previously for endocarditis complicating intravenous drug use. Echocardiography showed severe tricuspid valve stenosis with calcified leaflets. The desire for children and cervical neoplasia meant a second surgical bioprosthesis would require later re-replacement via a 3rd sternotomy when she may have young children; a mechanical valve with warfarinisation also had significant fetal and maternal pregnancy risks. Methods and procedure: No published literature on the use of percutaneous valves in the tricuspid position was identified. Personal communication identified 2 previous cases of percutaneous Melody valve use in the tricuspid position. Ethics approval for off-label use and informed consent were obtained. The internal diameter of the previous bioprosthesis was known to be 20 mm. Under general anaesthetic percutaneous right internal jugular access was used to place a wire in the right pulmonary artery. Predilation with a 22 mm balloon located the waist. Markers on the bioprosthetic valve struts and the balloon waist allowed accurate positioning and a Melody valve was deployed on a 22 mm Ensemble delivery system. Fluoroscopy and transoesophageal ultrasound showed the valve stent to be well positioned with mild regurgitation. The mean trans-valvar gradient was reduced from 13 to 3mmHg acutely. The day following the procedure she felt symptomatically much improved. Conclusion: We believe this is the 3rd case in the world of a Melody valve successfully deployed in the tricuspid position. Acknowledgements: Dr Evan Zahn. doi:10.1016/j.hlc.2010.06.1004 338 One-Year Experience with Transcatheter Aortic Valve Insertion [TAVI] via Transarterial Approach in a New Zealand Public Hospital S. Pasupati 1,∗ , G. Devlin 1 , M. Liang 1 , R. Fisher 1 , A. ElGamel 2 , N. Kejriwal 2 1 Department

of Cardiology, Waikato hospital, Hamilton, New Zealand 2 Department of Cardiothoracic Surgery, Waikato Hospital, Hamilton, New Zealand Background: Transcatheter aortic valves have been implanted in New Zealand since August 2008 for severe, symptomatic aortic stenosis in patients consid-