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Percutaneous Septal Occluder Devices for the Closure of Patent Foramen Ovale
S174
Abstracts
Heart, Lung and Circulation 2008;17S:S1–S209
ABSTRACTS
major adverse events during angiography in our cardiac catheterisation laboratory. Method: Review of medical records and prospectively collected complication forms in all consecutive patients who underwent diagnostic coronary angiography at Waikato hospital between 01.01.2000 and 31.12.2007. Results: A total of 8482 patients (mean age 60.2 ± 10.6 years, 63% men) had coronary angiography during this period. Six percent of these patients also underwent coronary bypass graft angiography. Arterial access site was femoral in 99% with closure devices were used in 2% patients. Complication rates were as follows: Event
% (n = 8482)
Myocardial infarction
0.05
Cerebrovascular accidents
0.40
Vascular access complications
0.33
Contrast reaction
0.30
Haemodynamic complications
0.06
Mortality
0.06
Overall major complication rate was 1.2% (12:1000). Incidence of radio-contrast induced nephropathy could not be assessed as the renal functions were not checked in all the patients post angiography. Conclusion: Coronary angiography at Waikato hospital carries a small but definite risk. Complication rates over an 8-year period are comparable with published data. doi:10.1016/j.hlc.2008.05.413 413 Percutaneous Septal Occluder Devices for the Closure of Patent Foramen Ovale Naylin Bissessor 1 , Rohan Jayasinghe 1 , Lisa Hourigan 2 , Greg Scalia 2 , Darryl Burstow 2 , Con Aroney 2 , Darren Walters 2,∗ 1 Cardiology
Unit, Gold Coast Hospital, Gold Coast, Queensland, Australia; 2 Cardiology Program, The Prince Charles Hospital, Brisbane, Queensland, Australia Transcatheter closure of patent foramen ovale (PFO) has rapidly evolved as the preferred management strategy for the prevention of recurrent cerebrovascular events in patients with cryptogenic stroke and presumed paradoxical embolus. There is limited outcome data in patients treated with this therapy particularly for the newer devices. Methods: Data from medical records, catheter and echocardiography laboratory databases on 70 procedures performed between September 2003 and Jan 2008 was collected prospectively. Results: The cohort consisted of 70 patients mean age 43.6 years (range 19–77) of whom 51% were male. The indications for closure were cryptogenic cerebrovascular accident (CVA) or transient ischaemic accident (TIA) in 64 (91%), cryptogenic ST elevation myocardial infarction 1 (1.4%), peripheral emboli 2 (2.8%), refractory migraine (1.4%), decompression sickness (1.4%) and orthodeoxia (1.4%). All patients had demonstrated right to left shunting
on bubble study. Fifty three percentage of the procedures were guided by intracardiac echocardiography (ICE), 39% by transoesophageal echocardiography (TOE) and remainder by transthoracic echo alone. Devices used were Amplatzer PFO Occluder (AGA) (sizes 18–35 mm) in 49 (70%) and more recently the Premere device (St. Jude) in 21 (30%). In hospital complications consisted of one significant groin haematoma with skin infection. At a median of 11 months follow up (range 1 month to 4.3 years) most patients had no residual shunt (95.7%) whilst the remaining patients had trivial residual shunt. No patients experienced further CVA/TIAs or paradoxical embolic events during follow up. Conclusion: PFOs can be closed percutaneously with a low rate of significant residual shunting and very few complications. Recurrent index events are uncommon at medium term (up to 4 years) follow up. doi:10.1016/j.hlc.2008.05.414 414 Complications of Percutaneous Coronary Interventions (PCI) in the Real-World: The Waikato Hospital experience Namal Wijesinghe ∗ , Christopher Nunn, Cherian Sebastian, Spencer Heald, Hugh McAlister, Gerard Devlin Waikato Hospital, Hamilton, New Zealand Background: PCI is a very effective treatment for symptomatic coronary artery disease with a recognised complication rate. Overseas experience suggests this has improved in recent years. Limited data is available in New Zealand. We describe PCI-related adverse outcomes at Waikato hospital. Method: Review of medical records and prospectively collected complication forms of all consecutive patients who had PCI at Waikato hospital between 01.01.2000 and 31.12.2007. Patients who had angioplasty for acute ST elevation myocardial infarction were excluded. Results: A total of 4120 patients (mean age: 61.9 ± 9.6 years, 73% men) had PCI during this period. Arterial access site was achieved via the femoral artery in 97%. Haemostasis was secured with closure devices in 2% of patients. Event
% (n = 4120)
ST-elevation myocardial infarction
0.2
Non ST-elevation myocardial infarction
0.34
Repeat intervention during same admission
0.14
Cerebrovascular accidents
0.14
Vascular access complications
0.46
Contrast reaction
0.23
Urgent coronary bypass surgery
0.17
Non-urgent coronary bypass surgery
0.03
Cardiac tamponade
0.06
Other bleeding requiring blood transfusion
0.2
Mortality
0.3
Overall major complication rate was 2.27% (23:1000). Incidence of radio-contrast induced nephropathy could not be
Abstracts
Heart, Lung and Circulation 2008;17S:S1–S209
ABSTRACTS
major adverse events during angiography in our cardiac catheterisation laboratory. Method: Review of medical records and prospectively collected complication forms in all consecutive patients who underwent diagnostic coronary angiography at Waikato hospital between 01.01.2000 and 31.12.2007. Results: A total of 8482 patients (mean age 60.2 ± 10.6 years, 63% men) had coronary angiography during this period. Six percent of these patients also underwent coronary bypass graft angiography. Arterial access site was femoral in 99% with closure devices were used in 2% patients. Complication rates were as follows: Event
% (n = 8482)
Myocardial infarction
0.05
Cerebrovascular accidents
0.40
Vascular access complications
0.33
Contrast reaction
0.30
Haemodynamic complications
0.06
Mortality
0.06
Overall major complication rate was 1.2% (12:1000). Incidence of radio-contrast induced nephropathy could not be assessed as the renal functions were not checked in all the patients post angiography. Conclusion: Coronary angiography at Waikato hospital carries a small but definite risk. Complication rates over an 8-year period are comparable with published data. doi:10.1016/j.hlc.2008.05.413 413 Percutaneous Septal Occluder Devices for the Closure of Patent Foramen Ovale Naylin Bissessor 1 , Rohan Jayasinghe 1 , Lisa Hourigan 2 , Greg Scalia 2 , Darryl Burstow 2 , Con Aroney 2 , Darren Walters 2,∗ 1 Cardiology
Unit, Gold Coast Hospital, Gold Coast, Queensland, Australia; 2 Cardiology Program, The Prince Charles Hospital, Brisbane, Queensland, Australia Transcatheter closure of patent foramen ovale (PFO) has rapidly evolved as the preferred management strategy for the prevention of recurrent cerebrovascular events in patients with cryptogenic stroke and presumed paradoxical embolus. There is limited outcome data in patients treated with this therapy particularly for the newer devices. Methods: Data from medical records, catheter and echocardiography laboratory databases on 70 procedures performed between September 2003 and Jan 2008 was collected prospectively. Results: The cohort consisted of 70 patients mean age 43.6 years (range 19–77) of whom 51% were male. The indications for closure were cryptogenic cerebrovascular accident (CVA) or transient ischaemic accident (TIA) in 64 (91%), cryptogenic ST elevation myocardial infarction 1 (1.4%), peripheral emboli 2 (2.8%), refractory migraine (1.4%), decompression sickness (1.4%) and orthodeoxia (1.4%). All patients had demonstrated right to left shunting
on bubble study. Fifty three percentage of the procedures were guided by intracardiac echocardiography (ICE), 39% by transoesophageal echocardiography (TOE) and remainder by transthoracic echo alone. Devices used were Amplatzer PFO Occluder (AGA) (sizes 18–35 mm) in 49 (70%) and more recently the Premere device (St. Jude) in 21 (30%). In hospital complications consisted of one significant groin haematoma with skin infection. At a median of 11 months follow up (range 1 month to 4.3 years) most patients had no residual shunt (95.7%) whilst the remaining patients had trivial residual shunt. No patients experienced further CVA/TIAs or paradoxical embolic events during follow up. Conclusion: PFOs can be closed percutaneously with a low rate of significant residual shunting and very few complications. Recurrent index events are uncommon at medium term (up to 4 years) follow up. doi:10.1016/j.hlc.2008.05.414 414 Complications of Percutaneous Coronary Interventions (PCI) in the Real-World: The Waikato Hospital experience Namal Wijesinghe ∗ , Christopher Nunn, Cherian Sebastian, Spencer Heald, Hugh McAlister, Gerard Devlin Waikato Hospital, Hamilton, New Zealand Background: PCI is a very effective treatment for symptomatic coronary artery disease with a recognised complication rate. Overseas experience suggests this has improved in recent years. Limited data is available in New Zealand. We describe PCI-related adverse outcomes at Waikato hospital. Method: Review of medical records and prospectively collected complication forms of all consecutive patients who had PCI at Waikato hospital between 01.01.2000 and 31.12.2007. Patients who had angioplasty for acute ST elevation myocardial infarction were excluded. Results: A total of 4120 patients (mean age: 61.9 ± 9.6 years, 73% men) had PCI during this period. Arterial access site was achieved via the femoral artery in 97%. Haemostasis was secured with closure devices in 2% of patients. Event
% (n = 4120)
ST-elevation myocardial infarction
0.2
Non ST-elevation myocardial infarction
0.34
Repeat intervention during same admission
0.14
Cerebrovascular accidents
0.14
Vascular access complications
0.46
Contrast reaction
0.23
Urgent coronary bypass surgery
0.17
Non-urgent coronary bypass surgery
0.03
Cardiac tamponade
0.06
Other bleeding requiring blood transfusion
0.2
Mortality
0.3
Overall major complication rate was 2.27% (23:1000). Incidence of radio-contrast induced nephropathy could not be