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Outcomes After Transcatheter Pulmonary Valve (Melody) Implantation in a Tertiary Australian Centre
Abstracts
Methods: All OHCA patients were identified over 26 months via hospital admission/discharge coding and internal linking with Victorian cardiac outcomes registry. Results: 110 arrest patients were identified presenting between 01/07/2013 to 01/09/2015, 72 meet the OHCA definition as per Utstein criteria for non EMS witnessed OHCA. 45(62.5%) of patients died. Baseline characteristics were similar between survivors and non-survivors. 21(29%) patients were female. 47 patients (65%) had out-of-hospital ventricular fibrillation arrest. Survival was significantly improved in this group compared to presenting with a non-shockable rhythm (51% vs 12%, p <0.01). Regarding post resuscitation measures, 68% of patients were treated with temperature management, 54% underwent coronary angiogram and 31% of patients underwent PCI. 83% of patients had cardiogenic shock. Mean time to return of spontaneous circulation (ROSC) was longer in patients who died 33±19minutes vs 22±13minutes; p=0.007. Lower initial pH (7.05±0.24 vs 7.18±0.09, p<0.005), higher initial lactate (8.5±4.3 vs 4.8±2.9, p<0.005) and lower admission eGFR (53±20 vs 71±21, p=0.001) and cardiogenic shock (93% vs 67%, p=0.007) were all associated with death. Conclusions: In this 26-month study of OHCA patients, those who presented with PEA or asystole, longer ROSC, lower pH, higher lactate, poorer renal function and shock had a strong association with mortality in hospital. http://dx.doi.org/10.1016/j.hlc.2016.06.432 431 Outcome of Transradial Versus Transfemoral Intervention in Acute Coronary Syndromes N. Sinhal, C. Allada, M. Rahman, S. O’Connor, A. Farshid ∗ Canberra Hospital, Canberra, Australia Objectives: Our aim was to assess the safety and efficacy of transradial (TRI) versus transfemoral intervention (TFI) in acute coronary syndromes (ACS). Methods: We analysed demographic, procedural and outcome data on consecutive patients who underwent PCI for ACS during 2012-2015. The primary outcomes were Major Adverse Cardiovascular Events (MACE) defined as death, myocardial infarction, target lesion revascularisation and stroke, and Net Adverse Clinical Events (NACE), defined as MACE or major bleeding. Results: A total of 2014 patients underwent PCI, 1385 (68%) TFI, 639 (32%) TRI. Mean age was 65.6 years in TFI and 62.1 years in TRI (P<0.0001) with more females in the TFI group (25% v 20%, p=0.0033). Prevalence of diabetes was 24% in TFI v 23% in TRI, (p=0.56). Prevalence of multivessel disease was similar (51.8% in TRI versus 48.4% in TFI, p=0.16) but there was more multivessel PCI in TRI (15.7% versus. 10.6%, p=0.004). STEMI as indication for PCI was more common in TFI (50% v 44%, p<0.0001), whereas NSTEMI was more prevalent in TRI (39% in TFI v 46% in TFI, p<0.0001). Procedural success was comparable (TRI 98.75% versus TFI 97.84%, p=0.09). During 12 months follow up, incidence of MACE was 11.0% in TFI and 5.6% in TRI groups (P<0.0001). Incidence of NACE was 13.5% and 5.9% respectively (p<0.0001). On
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multivariate cox regression analysis, femoral access was an independent predictors of higher MACE as well as age >70, cardiogenic shock, cardiac arrest, and diabetes. Conclusions: In patients with ACS, transradial PCI was associated with a lower incidence of MACE and NACE. http://dx.doi.org/10.1016/j.hlc.2016.06.433 432 Outcomes After Transcatheter Pulmonary Valve (Melody) Implantation in a Tertiary Australian Centre R. Markham 1,2,∗ , A. Challa 1,2 , S. Kyranis 1,2 , A. Mandala 1 , J. Hanna 1 , J. Latona 1 , R. Gluer 1,2 , C. Mengel 1 , N. Gaikwad 1 , E. Shaw 1 , M. Vaishnav 1 , A. Kahrom 1 , S. Hliang 1 , D. Murdoch 1,2 , K. Poon 1,2 , T. Malpas 1 , C. Hamilton-Craig 1,2 , D. Walters 1,2 1 Heart
and Lung Institute, The Prince Charles Hospital, Brisbane, Australia 2 University of Queensland, Brisbane, Australia Background: Transcatheter Pulmonary Valve Implantation (TPVI) with the Melody® transcatheter pulmonary valve (TPV) is a less invasive strategy to manage adults with previously operated congenital heart disease and pulmonary valve dysfunction. Aim: To describe procedural and clinical outcomes at last follow-up after TPVI. Methods: All patients who underwent TPVI with Melody® TPV at The Prince Charles Hospital between Jan 2009 and Feb 2016 had admission and follow-up data prospectively entered into a standardised registry. Results: 17 patients underwent TPVI, mean age of 33.7 years (range: 15-60). Congenital heart disease was present in all patients: tetralogy of Fallot (58.9%), truncus arteriosus (5.8%), Ross procedure (17.4%), transposition of great arteries (5.8%), pulmonary atresia (12.1%). Indication for valve implantation was pulmonary stenosis (64.7%), pulmonary regurgitation (11.7%) and dual pathology (23.5%). Pre-stenting with an uncovered CP stent, followed by successful TPV implantation occurred in all patients (100% procedural success). Mean procedure time was 120 minutes (range: 86-169). Invasively measured right ventricular systolic pressure reduced from 68±26 mmHg to 43±14 mmHg (p<0.0001). All six patients with primary pulmonary regurgitation (Grade ≥2) had no pulmonary regurgitation post procedure. The only recorded procedural complication was one case of balloon rupture in a heavily calcified conduit. Mean follow-up was 28.8 months (range: 0.5-69.6). At last recorded follow-up there was one hospitalisation for heart failure and two decrements in RVEF. There were no deaths, infective endocarditis, re-intervention or stent fractures. Conclusion: Our data confirms the safety and effectiveness of TPVI with the Melody® TPV in contemporary Australian practice. http://dx.doi.org/10.1016/j.hlc.2016.06.434
Methods: All OHCA patients were identified over 26 months via hospital admission/discharge coding and internal linking with Victorian cardiac outcomes registry. Results: 110 arrest patients were identified presenting between 01/07/2013 to 01/09/2015, 72 meet the OHCA definition as per Utstein criteria for non EMS witnessed OHCA. 45(62.5%) of patients died. Baseline characteristics were similar between survivors and non-survivors. 21(29%) patients were female. 47 patients (65%) had out-of-hospital ventricular fibrillation arrest. Survival was significantly improved in this group compared to presenting with a non-shockable rhythm (51% vs 12%, p <0.01). Regarding post resuscitation measures, 68% of patients were treated with temperature management, 54% underwent coronary angiogram and 31% of patients underwent PCI. 83% of patients had cardiogenic shock. Mean time to return of spontaneous circulation (ROSC) was longer in patients who died 33±19minutes vs 22±13minutes; p=0.007. Lower initial pH (7.05±0.24 vs 7.18±0.09, p<0.005), higher initial lactate (8.5±4.3 vs 4.8±2.9, p<0.005) and lower admission eGFR (53±20 vs 71±21, p=0.001) and cardiogenic shock (93% vs 67%, p=0.007) were all associated with death. Conclusions: In this 26-month study of OHCA patients, those who presented with PEA or asystole, longer ROSC, lower pH, higher lactate, poorer renal function and shock had a strong association with mortality in hospital. http://dx.doi.org/10.1016/j.hlc.2016.06.432 431 Outcome of Transradial Versus Transfemoral Intervention in Acute Coronary Syndromes N. Sinhal, C. Allada, M. Rahman, S. O’Connor, A. Farshid ∗ Canberra Hospital, Canberra, Australia Objectives: Our aim was to assess the safety and efficacy of transradial (TRI) versus transfemoral intervention (TFI) in acute coronary syndromes (ACS). Methods: We analysed demographic, procedural and outcome data on consecutive patients who underwent PCI for ACS during 2012-2015. The primary outcomes were Major Adverse Cardiovascular Events (MACE) defined as death, myocardial infarction, target lesion revascularisation and stroke, and Net Adverse Clinical Events (NACE), defined as MACE or major bleeding. Results: A total of 2014 patients underwent PCI, 1385 (68%) TFI, 639 (32%) TRI. Mean age was 65.6 years in TFI and 62.1 years in TRI (P<0.0001) with more females in the TFI group (25% v 20%, p=0.0033). Prevalence of diabetes was 24% in TFI v 23% in TRI, (p=0.56). Prevalence of multivessel disease was similar (51.8% in TRI versus 48.4% in TFI, p=0.16) but there was more multivessel PCI in TRI (15.7% versus. 10.6%, p=0.004). STEMI as indication for PCI was more common in TFI (50% v 44%, p<0.0001), whereas NSTEMI was more prevalent in TRI (39% in TFI v 46% in TFI, p<0.0001). Procedural success was comparable (TRI 98.75% versus TFI 97.84%, p=0.09). During 12 months follow up, incidence of MACE was 11.0% in TFI and 5.6% in TRI groups (P<0.0001). Incidence of NACE was 13.5% and 5.9% respectively (p<0.0001). On
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multivariate cox regression analysis, femoral access was an independent predictors of higher MACE as well as age >70, cardiogenic shock, cardiac arrest, and diabetes. Conclusions: In patients with ACS, transradial PCI was associated with a lower incidence of MACE and NACE. http://dx.doi.org/10.1016/j.hlc.2016.06.433 432 Outcomes After Transcatheter Pulmonary Valve (Melody) Implantation in a Tertiary Australian Centre R. Markham 1,2,∗ , A. Challa 1,2 , S. Kyranis 1,2 , A. Mandala 1 , J. Hanna 1 , J. Latona 1 , R. Gluer 1,2 , C. Mengel 1 , N. Gaikwad 1 , E. Shaw 1 , M. Vaishnav 1 , A. Kahrom 1 , S. Hliang 1 , D. Murdoch 1,2 , K. Poon 1,2 , T. Malpas 1 , C. Hamilton-Craig 1,2 , D. Walters 1,2 1 Heart
and Lung Institute, The Prince Charles Hospital, Brisbane, Australia 2 University of Queensland, Brisbane, Australia Background: Transcatheter Pulmonary Valve Implantation (TPVI) with the Melody® transcatheter pulmonary valve (TPV) is a less invasive strategy to manage adults with previously operated congenital heart disease and pulmonary valve dysfunction. Aim: To describe procedural and clinical outcomes at last follow-up after TPVI. Methods: All patients who underwent TPVI with Melody® TPV at The Prince Charles Hospital between Jan 2009 and Feb 2016 had admission and follow-up data prospectively entered into a standardised registry. Results: 17 patients underwent TPVI, mean age of 33.7 years (range: 15-60). Congenital heart disease was present in all patients: tetralogy of Fallot (58.9%), truncus arteriosus (5.8%), Ross procedure (17.4%), transposition of great arteries (5.8%), pulmonary atresia (12.1%). Indication for valve implantation was pulmonary stenosis (64.7%), pulmonary regurgitation (11.7%) and dual pathology (23.5%). Pre-stenting with an uncovered CP stent, followed by successful TPV implantation occurred in all patients (100% procedural success). Mean procedure time was 120 minutes (range: 86-169). Invasively measured right ventricular systolic pressure reduced from 68±26 mmHg to 43±14 mmHg (p<0.0001). All six patients with primary pulmonary regurgitation (Grade ≥2) had no pulmonary regurgitation post procedure. The only recorded procedural complication was one case of balloon rupture in a heavily calcified conduit. Mean follow-up was 28.8 months (range: 0.5-69.6). At last recorded follow-up there was one hospitalisation for heart failure and two decrements in RVEF. There were no deaths, infective endocarditis, re-intervention or stent fractures. Conclusion: Our data confirms the safety and effectiveness of TPVI with the Melody® TPV in contemporary Australian practice. http://dx.doi.org/10.1016/j.hlc.2016.06.434