PM118 Predictors of Early Discharge After Trans-Femoral Transcatheter Aortic Valve Implantation

PM111 Mitral Valve Perforation Among Patients Seen At The Uganda Heart Institute: A Series of Twelve Cases Twalib O. Aliku*1, Emmy Okello2, Sulaiman Lubega3, Peter Lwabi3 1 Paediatrics and Child Health, Gulu University, Gulu, 2Adult Cardiology, 3Paediatric Cardiology, Uganda Heart Institute, Kampala, Uganda Introduction: Mitral valve perforation is a rare complication of infective endocarditis that is associated with significant morbidity, especially in those receiving inadequate therapy. In Africa few centres routinely perform valve surgeries. Objectives: We describe the clinical presentation and outcomes of patients with echocardiographically diagnosed mitral valve perforations that have not undergone valve surgery. Methods: We reviewed the clinical and echocardiographic data of patients diagnosed to have mitral valve perforation and on medical followed up at the Uganda Heart Institute paediatric cardiology division from July 2011 to August 2013. Results: A total of 12 patients were diagnosed to have mitral valve perforation, 9 being female. The age range was from 15 months to 26 years. None had had previous cardiac surgery, chest trauma or cardiac catheterization procedure. A suspected clinical diagnosis of infective endocarditis was present in five patients prior to initial echocardiography evaluation. All patients were treated for a febrile illness prior to referral. A positive blood culture was present in only one patient. Two patients had no predisposing heart lesion; one had subaortic membrane causing severe left ventricular outflow obstruction and mild aortic regurgitation, while nine patients had underlying rheumatic heart disease. Mitral valve perforation was attributable to infective endocarditis in 11 patients who met the Dukes Criteria, while the twelfth patient had severe aortic regurgitation that could also cause mitral valve perforation. Only four patients had visible vegetations; in 3 patients the vegetations were on the mitral valve leaflets and in the other patient on the aortic valve. Five patients (42%) died within two months of diagnosis. Five of the survivors have had repeated admissions to hospital for worsening heart failure, including one with recurrence of infective endocarditis while the other two have NYHA class II heart failure symptoms. Conclusion: Rheumatic heart disease is a major underlying cause of infective endocarditis and mitral valve perforation in our setting. Many patients with mitral valve perforation have high immediate mortality and significant morbidity without valve surgery. Disclosure of Interest: None Declared PM116 First Utilization of the Paieon’s C-THV Guiding System for Transcatheter Aortic Valve Implantation (TAVI) in an Australian Setting Matias Yudi*1, Khoa Phan1, Nigel Lewis1, Eliza Teo1, Matthew Brooks1, Caitlin Cheshire1, James Wong1, Subodh Joshi1, Vanessa Ogden1, Ronen Gurvitch1 1 Cardiology Department, Royal Melbourne Hospital, Melbourne, Australia Introduction: Accurate device positioning during transcatheter aortic valve implantation (TAVI) is essential for optimal results. Recent advances in multimodality imaging have resulted in adjuvant positioning tools beyond traditional fluoroscopy and echocardiography. Paieon’s C-THV system is a real-time image acquisition and processing system designed to facilitate Edwards-SAPIEN TAVI. The system focuses on four aspects: obtaining optimal projection, ideal valve diameter selection, accurate positioning for deployment and post-implantation analysis. Objectives: Our aim was validation and evaluation of the Paieon C-THV system. Methods: We describe the first twenty-two patients in Australia who underwent EdwardSAPIEN-XT TAVI using the Paieon’s C-THV system in conjunction with fluoroscopy, aortography and echocardiography. Results: Twenty-two high risk patients underwent TAVI utilizing the Paieon C-THV guiding system. The mean age was 85
5 years, the mean STS score was 7.5%
2.7%, 74% were female and 82% had TAVI via transfemoral access. Fourteen (64%) patients required a 23mm valve. In conjunction with aortography and fluoroscopy, the C-THV system was used to aid optimal deployment. The aorta-LV partition was calculated prior to deployment and visually correlated with the actual deployment in 21 of 22 cases. The Paieon C-THV system was found to be a useful adjunct, correctly determining the implant depth, 3-D implant projections and minimizing the use of contrast media. There were no cases of valve embolization and no cases requiring a second valve implant secondary to malposition. Conclusion: The Paieon C-THV system was successfully used for the first time in an Australian setting as an adjunctive real time imaging modality to optimise TAVI. It can successfully predict and guide valve positioning and appears to simplify the procedure. Disclosure of Interest: None Declared

GHEART Vol 9/1S/2014

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March, 2014

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POSTER/2014 WCC Posters

PM117 Predictors of Prolonged Hospital Stay Following Transcatheter Aortic Valve Implantation Matias Yudi*1, Khoa Phan1, Nigel Lewis1, James Wong1, Vanessa Ogden1, Subodh Joshi1, Roderic Warren1, Marco Larobina1, John Goldblatt1, Ronen Gurvitch1 1 Cardiology Department, Royal Melbourne Hospital, Melbourne, Australia Introduction: Transcatheter Aortic Valve Implantation (TAVI) is an alternative to traditional aortic valve replacement in high-risk surgical patients. One of the proposed advantages of TAVI is reduced post-procedural length of stay. Length of hospitalization has an important role in determining the economic viability of this relatively new procedure. Objectives: To determine the predictors of prolonged hospitalization (more than 4 days) in patients undergoing TAVI in a single institution. Methods: The first fifty patients undergoing successful TAVI with Edward Sapien-XT valves at Royal Melbourne Hospital were included in this analysis. Patients were divided into two groups depending on their length of stay, with the early group discharged within 4 days and the prolonged group discharged thereafter. Clinical, echocardiographic, procedural and post-procedural characteristics were evaluated and compared between the groups. Results: Of the fifty patients included, 18 (32%) underwent either a trans-apical (17) or trans-aortic (1) TAVI. 36% of patients were discharged within 4 days, all of which underwent trans-femoral TAVI. Patients with prolonged hospital stay, when compared to the early discharge group, were more likely to have non-femoral approach (56% vs 0%, p <0.01), be admitted directly to ICU post-procedure (78% vs 11%, p <0.01) and require blood transfusions (31% vs 0%, p¼0.02). They also had higher pre-procedural RVSP (40mmHg vs 22mmHg, p¼0.01) and lower post-procedural ejection fraction (54% vs 59%, p¼0.02). Conclusion: In the early experience of a new TAVI program at a major tertiary centre, early discharge was only achieved in patients with a trans-femoral approach. Associations with prolonged stay include transapical or direct aortic approach, direct admission to ICU, requirement for blood transfusion, and a higher pre-procedural RVSP. Disclosure of Interest: None Declared PM118 Predictors of Early Discharge After Trans-Femoral Transcatheter Aortic Valve Implantation Khoa Phan1, Matias Yudi*1, Nigel Lewis1, James Wong1, Subodh Joshi1, Roderic Warren1, Vanessa Ogden1, Marco Larobina1, John Goldblatt1, Ronen Gurvitch1 1 Cardiology Department, Royal Melbourne Hospital, Melbourne, Australia Introduction: Transcatheter aortic valve implantation (TAVI) performed via the transfemoral approach has consistently been associated with earlier hospital discharge when compared to the trans-aortic and trans-apical approaches. Furthermore, increased operator experience and improvements in technology have also led to a decrease in post-procedural hospital stay. Objectives: We aim to determine predictors of early discharge (within 4 days of procedure) in patients who underwent trans-femoral TAVI. Methods: Patients undergoing trans-femoral TAVI with Edward Sapien XT valves at Royal Melbourne Hospital were included in this analysis. Patients were divided into two groups: the early discharge group (discharged within 4 days) and the delayed discharge group (discharged after 4 days). Clinical, echocardiographic, procedural and post-procedural characteristics were evaluated and a comparison between the groups was undertaken. Results: Of the thirty-two patients included, 18 (56%) were discharged within 4 days of the procedure. There were no statistical differences between the early and delayed discharge groups with respect to age (83.7
4.6 vs 84.9
4.6 years, p¼0.45), STS score (6.7%
3.5% vs 8.4%
3.1%, p¼0.12), BMI (27.2
5.5 vs 26.4
4.5, p¼0.64) and eGFR (66.1
19.4 vs 55.8
22.3, p¼0.64). Patients who were discharged early had significantly less pulmonary hypertension (17% vs 57%, p<0.01) and less moderate-to-severe mitral regurgitation at baseline (33% vs 75%, p¼0.03). Post-procedure, the early discharge group were significantly less likely to be in the intensive care unit (6% vs 39%, p¼0.02) and receive blood transfusions (0% vs 36%, p¼ 0.02). Conclusion: In the early experience of a relatively new TAVI program at a major tertiary centre, early discharge was achieved in a more than half of patients who underwent transfemoral TAVI. Potential predictors of early discharge may include lower pulmonary pressures, mild/trivial mitral regurgitation and direct transfer to a general cardiology ward post procedure as opposed to ICU. Disclosure of Interest: None Declared PM119 Initial Results of Percutaneous Trans-Septal Balloon Aortic Valvuloplasty Using Inoue Balloon In High Risk Aortic Stenosis Nobuhito Yagi*1, Tetsuya Asato1, Ryosyu Taira1, Asako Fukuyama1, Jun Nakazato1, Takanori Takahashi1, Minoru Wake1, Kazuhito Hirata1 1 Department of Internal Medicine, Division of Cardiology, Okinawa Chubu Hospital, Uruma, Japan Introduction: Many inoperable patients with severe aortic stenosis (AS) are not eligible for transcatheter aortic valve replacement (TAVR) in Japan. Objectives: The aim of this study was to evaluate the role of antegrade trans-septal percutaneous balloon aortic valvuloplasty (BAV) in this setting.

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POSTER ABSTRACTS

p<0.001) and PLR level of >117.78 yielded an AUC value of 0.707 (CI 95%: 0.6360.777, sensitivity: 70%, specificity: 58%; p< 0.001). Multivariate analysis showed that increased PLR and inadeaquate anticoagulation were independent predictors for thrombosis in patients with PVT. Conclusion: This was the first study that evaluated NLR and PLR in patients with PVT. PVT patients had increased NLR, PLR and CRP levels when compared with subjects with normofunctional prosthesis. Furthermore, multivariate analysis showed that increased PLR was an independent predictor for thrombosis in patients with PVT. Further studies are needed to confirm these findings. Disclosure of Interest: None Declared