Percutaneous Closure of Secundum Atrial Septal Defects: Success Rates in Patients with Moderate-Large versus Very Large Defects

S148 ABSTRACTS

350 Percutaneous Balloon Aortic Valvuloplasty is a Safe and Effective Bridging Procedure to Transcatheter Aortic Valve Replacement D. Murdoch 1,2,∗ , J. Hunter 1,2 , A. Incani 1,2 , O. Raffel 1,2 , C. Aroney 1,2 , D. Walters 1,2 1 The 2 The

Heart, Lung and Circulation 2013;22:S126–S266

CSANZ 2013 Abstracts

Prince Charles Hospital, Australia University of Queensland, Australia

Introduction: Transcatheter aortic valve replacement (TAVR) is a less invasive option for the treatment of severe aortic valve stenosis (AS) in patients who are at high surgical risk. Balloon aortic valvuloplasty has been used both to bridge patients with severe AS to TAVR and to aid in the selection of patients for TAVR. We evaluate the safety and efficacy of this approach. Methods: Patients undergoing both PBAV and TAVR at The Prince Charles Hospital, between 2008 and 2013 were analysed. Demographic, co-morbidity and functional status data was collected. Procedure dates, outcomes and complications were noted. Emergency department admissions were recorded one year before PBAV and prior to TAVR. Results: Fifty-nine patients were identified, mean age 84.4 years. Ninety-three percent had NYHA Class III or IV dyspnoea. Thirty-nine percent had impaired left ventricular function. Mean peak aortic valve gradient was 53 mmHg (IQR 39–61) pre-valvuloplasty and 24 mmHg (IQR 16–31) post valvuloplasty. No immediate complications occurred. Thirty-day complications were haematoma (two), pseudoaneurysm (one), acute kidney injury (two), bacteraemia (one) and DVT (one). No strokes occurred. Mean time from PBAV to TAVR was 230 days. Seven patients underwent re-do PBAV at a mean interval of 353 days. Emergency department admissions were significantly less between PBAV and TAVR than in the one-year prior (0.55 vs 1.56, p = 0.002). Conclusion: PBAV is an effective treatment for this symptomatic population undergoing evaluation for TAVR. Mean peak aortic valve gradient reduction was 29 mmHg, with significantly fewer emergency admissions after the procedure. Complications were uncommon, with haematoma and kidney injury most frequently encountered. http://dx.doi.org/10.1016/j.hlc.2013.05.352 351 Percutaneous Closure of Secundum Atrial Septal Defects: Success Rates in Patients with Moderate-Large versus Very Large Defects G. Romanelli, R. Harper, N. Nerlekar ∗ , P. Mottram MonashHEART, Southern Health, Australia Background: Percutaneous closure of moderate sized atrial septal defects (ASD) has been demonstrated to

be safe and effective. However, feasibility for very large (>30 mm) defects is less clear, particularly when an aortic rim of septal tissue is absent. Methods: The study includedpatients referred for percutaneous ASD closure with maximal ASD diameter ≥20 mm at pre-procedural transoesophageal echocardiography. Patients were grouped according to presence of moderate-large (20–30 mm), or very large (>30 mm) ASD size. Procedural success was defined by successful device deployment and absence of complications. Results: Forty-four patients (median 40 yrs, range 12–85yrs, 77% female) with maximal ASD diameter 29.2 ± 7.5 mm were included. Twenty-six had moderatelarge ASDs (24 ± 3.4 mm); 18 had very large ASDs (37.0 ± 4.2 mm). Aortic rim was absent in 24 patients, and small in 20 patients (4.7 ± 2.9 mm). Percutaneous defect closure was successful in 36 of 44 patients (82%). Procedural success was 100% in moderate-large group and 56% in very large ASD group. If patients with ASD ≥40 mm were excluded (n = 7), success rate in remainder of very large ASD group (diameter 31–39 mm) was 91%. A single complication (device migration) occurred in a patient with a 40 mm defect and absent aortic rim. The presence of aortic rim of septum did not appear to be related to procedural success in either group. Conclusion: The vast majority of moderate-large ASDs (20–39 mm) can be successfully closed percutaneously with a low complication rate. However, procedural success is poor when attempting closure of extreme defects (≥40 mm), regardless of whether an aortic rim of septal tissue or present or absent. http://dx.doi.org/10.1016/j.hlc.2013.05.353 352 Peri-Procedural Anticoagulation and Coronary Angiography: Should Warfarin be Discontinued? T. Wang ∗ , T. Snow, T. Watson, J. Stewart, M. Webster, P. Ruygrok Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand Background: Current recommendation for anticoagulated patients referred for coronary angiography is to interrupt their anticoagulation regime and aim for an INR <1.8 on the day of the procedure. Recent studies have shown however that the benefits for continuing warfarin peri-procedurally may outweigh its risks. We reviewed the outcomes of both approaches in a local coronary angiography cohort. Method: Patients normally on warfarin and undergoing coronary angiography over a three-year period at Auckland were identified. We collected their characteristics and outcomes including bleeding and thromboembolism at 30 days from clinical records. Results: A total of 230 (9.8%) patients of 2345 undergoing cardiac catheterisation were taking warfarin regularly, and 75 of whom did not discontinue warfarin for the procedure. Mean age was 67.0 ± 12.5 years and 65.7% (151) were