Abstracts angiography. Of these, assessments of the renal arteries were performed in 26 of the 27 patients, and assessments of the iliac arteries wer...

46KB Sizes 0 Downloads 135 Views


angiography. Of these, assessments of the renal arteries were performed in 26 of the 27 patients, and assessments of the iliac arteries were performed in 19 of the 27 patients. Renal FMD was identified on catheter angiography in 17/26 patients, but was only identified on CT angiography in 4/26 patients. Iliac FMD was identified in 13/19 patients with catheter angiography, but was only identified in 1/19 patients on CT angiography. Of the 23/27 patients with extracardiac (renal or iliac) FMD identified on catheter angiography, only 4 of these patients was found to have FMD on CT angiography (sensitivity of 17.4%). CONCLUSION: Although CT angiography is noninvasive, it was poorly sensitive in diagnosing renal or iliac FMD when compared to the gold-standard catheter angiography. Further prospective studies should be performed to confirm our findings. 196 QUALITY OF LIFE AND FRAILTY FOLLOWING TRANSCATHETER AORTIC VALVE IMPLANTATION P Gouda, C Paterson, S Meyer, M Shanks, C Butler, D Taylor, B Tyrrell, RC Welsh Edmonton, Alberta BACKGROUND:

Transcather aortic valve implantation (TAVI) is an established alternative to surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis and increased surgical risk. Frailty is a critical clinical metric that heart teams assess to select TAVI over SAVR. To date there has been limited data assessing frailty assessed sequentially over time in TAVI patients and the relationship of frailty to quality of life measurements. METHODS/RESULTS: From June 2012 to June 2015, 159 consecutive patients underwent TAVI. Of these, 65 had undergone sequential frailty testing and completed quality of life questionnaires pre-TAVI and one-month post-TAVI. In this cohort, the mean age was 85.5 +/- 6.25 years, 56.9% were male and mean body mass index was 27.8+/- 5.0. Mean baseline ejection fraction (EF) was 55.4% +/- 10.3 and mean post-TAVI EF was 57.9% +/- 6.8. At baseline participants reported an activities of daily living disability mean score of 3.22 +/- 2.1, with a mean improvement of 1.0 +/- 2.5 at one month. Participants scored their overall baseline wellbeing at a mean of 58.8% +/19.2, which increased to 71.4% +/- 14.8 at one month. Using the Minnesota Quality of Life questionnaire, patients reported a baseline mean score of 52.3% +/- 23.0 for physical components and 13.0% +/- 18.4 for emotional components, which improved to 21.2% +/- 18.8 and 2.6% +/- 6.0 respectively. Frailty measured by hand grip strength did not improve with a mean of 24.5 +/- 7.8 at baseline, which decreased to 23.7 +/- 7.3 at on month. The walk test had modest improvement with 50.0% passing the walk test at baseline 50.0% and 55.6% at one month. CONCLUSION: Consistent with known data, patients who have undergone TAVI report consistent improvements in quality of life one-month post-TAVI using a variety of instruments to evaluate quality of life. However, measurements of frailty using handgrip and walk test as a surrogates for frailty, had no significant short-term improvements in frailty. Understanding


frailty and its impact on patient selection and outcomes is critical and warrants further consideration. 197 TRANSFEMORAL ACURATE-NEOTM SELFEXPANDING TRANSCATHETER AORTIC VALVE IMPLANTATION: FIRST NORTH AMERICAN EXPERIENCE R Bagur, PJ Teefy, B Kiaii, P Diamantouros, MW Chu London, Ontario BACKGROUND:

Transcatheter aortic valve implantation (TAVI) has become a therapeutic alternative for patients presenting with severe symptomatic aortic stenosis and considered at highsurgical risk. Paravalvular leak (PVL), conduction disorders and coronary obstruction remain unresolved procedure-related complications. The aim of this manuscript was to report the first North American experience with the ACURATE-neoTM aortic bioprosthesis and its ACURATE-TFTM delivery system (Symetis S.A., Ecublens, Switzerland). TM METHODS: Transfemoral ACURATE-neo aortic valve implantation was performed in 17 patients. Clinical and echocardiographic assessment was performed at baseline, post-procedure and at least 30 days. Outcomes were assessed according to valvular academic research consortium (VARC-2) criteria. RESULTS: The mean age was 83.57.1 years with a mean logistic-EuroSCORE-II of 5.13.0% and Society of Thoracic Surgeons score of 4.92.3%. Device success was achieved in all patients. Notably, the mean distance between the aortic-annulus and the left main coronary artery ostium was 13.42.7 mm, and 8 (47%) patients had <12 mm. At 30-day, there were no deaths, conversions to surgery or major procedure-related complications. New-pacemaker implantation was required in 6.3% of patients. ACURATE-neoTMimplantation resulted in a significant reduction in mean transvalvular gradient (51.116.5 mmHg to 10.45.8 mmHg, P<0.0001) and increase in effective-orifice area (0.640.15 cm2 to 1.780.38 cm2, P<0.0001) at hospitaldischarge. Paravalvular-leak was absent in 4 patients, trace in 6 patients and mild in 7 patients. Hospital discharge occurred at a mean of 7.14.8 days, and all patients were in NYHA class I-II at a mean follow-up of 6.02.3 months. CONCLUSION: The present initial North American experience shows that the ACURATE-neoTM aortic bioprosthesis was safely and successfully implanted by transfemoral approach. The special design of this newer-generation device affords a stable and predictable implantation, representing a reasonable alternative to reduce the risk of coronary obstruction while achieving optimal hemodynamic performance with a relatively low rate of PPI. 198 PROCEDURAL AND CLINICAL OUTCOMES AFTER TRANSCATHETER IMPACT OF THE LEARNING CURVE ON PRAORTIC VALVE IMPLANTATION Z Frikha, A El hammiri, C Naim, JB Masson, JF Gobeil, LM Stevens, N Noiseux, J Potvin Montréal, Québec