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Radiation Exposure During Percutaneous Treatment of Structural Heart Disease
Abstracts CSANZ 2012 Abstracts
S171
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Radiation Exposure During Percutaneous Treatment of Structural Heart Disease
Rates of Procedural Success in Percutaneous Coronary Intervention via the Radial Artery is Similar During Emergency Cases When Compared with Non-emergency Cases
J. Boland 1,∗ , B. Love 2 , D. Muller 3 1 St.
Vincent’s Hospital, Sydney, Australia 2 St. Vincent’s Private Hospital, Sydney, Australia 3 St. Vincent’s Hospital and St. Vincent’s Private Hospital, Sydney, Australia Background: Interventional cardiology has progressed from treating coronary arteries to correcting structural heart disease. There is concern over increased radiation exposure during prolonged percutaneous structural heart interventions. Aim: To compare differences in outcome, procedure time and radiation exposure between percutaneous coronary (PCI) and structural heart interventions (SHI). Methods: Data from 407 consecutive coronary interventions performed in 2011 were compared with 45 mitral valvuloplasties, 51 aortic valvuloplasties, 51 aortic valve replacements, 55 patent foramen ovale closures, 26 septal defect closures, 12 left atrial appendage closures and 3 Mitraclip procedures performed between July 2008 and Jan 2012. For all procedures, mean age was 68.1 ± 15.9 (range18–96 y); mean weight was 78.4 ± 17.1 (range 36–161 kg); 62% were male. Results: Analysis of procedure time (mean = 80.1 ± 24.3 min, range 35-185 min PCI vs 80.3 ± 50.1 min, range 11.9-454.0 min SHI, P = NS), fluoroscopy time (mean = 13.0 ± 9.9 min, range 1.3–113.3 min PCI vs 15.8 ± 11.9 min, range 0–63.2 min SHI, P < 0.01), and total radiation exposure (mean = 117.4 ± 92.5 Gy/cm2 , range 6.9–606.5 PCI vs 52.9 ± 60.2 Gy/cm2 , range 0–373.0 SHI, P < 0.0001) indicates that, although case times can be higher for SHI, radiation exposure is lower than for PCI. There were 29/407 failed PCI; there were 7/243 failed SHI with one death. Conclusion: Despite potentially longer case times, percutaneous structural heart interventions result in lower radiation exposure than coronary interventions. This is due primarily to increased use of transoesophageal echocardiography over fluoroscopy or cineangiography for structural heart interventions. The overall success rate for structural interventions is encouraging and justifies continued application of new techniques, particularly for inoperable patients, the aged and the infirm. http://dx.doi.org/10.1016/j.hlc.2012.05.425
J. Murphy, G. Figtree, M. Ward, R. Bhindi, R. Kozor ∗ Royal North Shore Hospital, Australia Background: STEMI and other unstable ACS are associated with widespread adrenergic activation which may increase radial artery (RA) spasm, requiring cross-over to the femoral artery (FA). We assessed if the incidence of failed trans-radial PCI was higher during emergency cases compared with non-emergency cases. Methods: PCI procedures attempted via the RA were assessed over a 25 month period. Those who had both RA and FA access were identified to assess if the double punctures were elective or necessitated due to failure of the RA approach. Cross-over rates were compared between emergency and non-emergency cases. Results: 680 cases of PCI were performed, 153 in an emergency setting. In non-emergency cases 403/527 (76.5%) were performed via the RA. In the emergency setting 139/153 (90.8%) were completed by the RA. Previous CABG with multiple arterial conduits was the most common reason for elective FA PCI in both groups. The RA to FA cross-over rate was low with no significant difference between the emergency and non-emergency groups (emergency 1.4%, non-emergency 1.2%, p = 1.0). In both groups there were no significant difference between RA and FA procedures in terms of fluoroscopy times (emergency – mean 13.1 ± 7.9 min vs 16.1 ± 16.1 min, p = 0.25, non-emergency 16.6 ± 10.3 min vs 18.7 ± 13.6 min, p = 0.07) or contrast volumes (emergency – mean 231 ± 126 ml vs 229 ± 102 ml, p = 0.77, non-emergency 223 ± 85 ml vs 237 ± 91 ml, p = 0.15). Conclusions: The vast majority of PCI can be successfully performed via the RA. Cross-over rates to the FA are low and are not more common in emergency patients. http://dx.doi.org/10.1016/j.hlc.2012.05.426 416 Reduced Times to Transfer Using a Novel Web-based Triage and Transfer System for Acute Coronary Syndrome: A Five Year Experience A. Incani 1,∗ , K. Poon 1 , M. Savage 1 , M. Dahl 1 , J. Fu 1 , H. Muller 2 , D. Colburn 2 , K. Renkin 2 , D. Callow 1 , C. Hammett 2 , D. Walters 1 1 The 2 The
Prince Charles Hospital, Australia Royal Brisbane and Women’s Hospital, Australia
Background: An Acute Coronary Syndrome (ACS) network linking two tertiary and ten non-metropolitan centres in Queensland via a web based referral system was implemented to improve time to triage and treatment, clinical decision making and improve access to invasive services. The aim of this study was to evaluate the change
ABSTRACTS
Heart, Lung and Circulation 2012;21:S143–S316
S171
414
415
Radiation Exposure During Percutaneous Treatment of Structural Heart Disease
Rates of Procedural Success in Percutaneous Coronary Intervention via the Radial Artery is Similar During Emergency Cases When Compared with Non-emergency Cases
J. Boland 1,∗ , B. Love 2 , D. Muller 3 1 St.
Vincent’s Hospital, Sydney, Australia 2 St. Vincent’s Private Hospital, Sydney, Australia 3 St. Vincent’s Hospital and St. Vincent’s Private Hospital, Sydney, Australia Background: Interventional cardiology has progressed from treating coronary arteries to correcting structural heart disease. There is concern over increased radiation exposure during prolonged percutaneous structural heart interventions. Aim: To compare differences in outcome, procedure time and radiation exposure between percutaneous coronary (PCI) and structural heart interventions (SHI). Methods: Data from 407 consecutive coronary interventions performed in 2011 were compared with 45 mitral valvuloplasties, 51 aortic valvuloplasties, 51 aortic valve replacements, 55 patent foramen ovale closures, 26 septal defect closures, 12 left atrial appendage closures and 3 Mitraclip procedures performed between July 2008 and Jan 2012. For all procedures, mean age was 68.1 ± 15.9 (range18–96 y); mean weight was 78.4 ± 17.1 (range 36–161 kg); 62% were male. Results: Analysis of procedure time (mean = 80.1 ± 24.3 min, range 35-185 min PCI vs 80.3 ± 50.1 min, range 11.9-454.0 min SHI, P = NS), fluoroscopy time (mean = 13.0 ± 9.9 min, range 1.3–113.3 min PCI vs 15.8 ± 11.9 min, range 0–63.2 min SHI, P < 0.01), and total radiation exposure (mean = 117.4 ± 92.5 Gy/cm2 , range 6.9–606.5 PCI vs 52.9 ± 60.2 Gy/cm2 , range 0–373.0 SHI, P < 0.0001) indicates that, although case times can be higher for SHI, radiation exposure is lower than for PCI. There were 29/407 failed PCI; there were 7/243 failed SHI with one death. Conclusion: Despite potentially longer case times, percutaneous structural heart interventions result in lower radiation exposure than coronary interventions. This is due primarily to increased use of transoesophageal echocardiography over fluoroscopy or cineangiography for structural heart interventions. The overall success rate for structural interventions is encouraging and justifies continued application of new techniques, particularly for inoperable patients, the aged and the infirm. http://dx.doi.org/10.1016/j.hlc.2012.05.425
J. Murphy, G. Figtree, M. Ward, R. Bhindi, R. Kozor ∗ Royal North Shore Hospital, Australia Background: STEMI and other unstable ACS are associated with widespread adrenergic activation which may increase radial artery (RA) spasm, requiring cross-over to the femoral artery (FA). We assessed if the incidence of failed trans-radial PCI was higher during emergency cases compared with non-emergency cases. Methods: PCI procedures attempted via the RA were assessed over a 25 month period. Those who had both RA and FA access were identified to assess if the double punctures were elective or necessitated due to failure of the RA approach. Cross-over rates were compared between emergency and non-emergency cases. Results: 680 cases of PCI were performed, 153 in an emergency setting. In non-emergency cases 403/527 (76.5%) were performed via the RA. In the emergency setting 139/153 (90.8%) were completed by the RA. Previous CABG with multiple arterial conduits was the most common reason for elective FA PCI in both groups. The RA to FA cross-over rate was low with no significant difference between the emergency and non-emergency groups (emergency 1.4%, non-emergency 1.2%, p = 1.0). In both groups there were no significant difference between RA and FA procedures in terms of fluoroscopy times (emergency – mean 13.1 ± 7.9 min vs 16.1 ± 16.1 min, p = 0.25, non-emergency 16.6 ± 10.3 min vs 18.7 ± 13.6 min, p = 0.07) or contrast volumes (emergency – mean 231 ± 126 ml vs 229 ± 102 ml, p = 0.77, non-emergency 223 ± 85 ml vs 237 ± 91 ml, p = 0.15). Conclusions: The vast majority of PCI can be successfully performed via the RA. Cross-over rates to the FA are low and are not more common in emergency patients. http://dx.doi.org/10.1016/j.hlc.2012.05.426 416 Reduced Times to Transfer Using a Novel Web-based Triage and Transfer System for Acute Coronary Syndrome: A Five Year Experience A. Incani 1,∗ , K. Poon 1 , M. Savage 1 , M. Dahl 1 , J. Fu 1 , H. Muller 2 , D. Colburn 2 , K. Renkin 2 , D. Callow 1 , C. Hammett 2 , D. Walters 1 1 The 2 The
Prince Charles Hospital, Australia Royal Brisbane and Women’s Hospital, Australia
Background: An Acute Coronary Syndrome (ACS) network linking two tertiary and ten non-metropolitan centres in Queensland via a web based referral system was implemented to improve time to triage and treatment, clinical decision making and improve access to invasive services. The aim of this study was to evaluate the change
ABSTRACTS
Heart, Lung and Circulation 2012;21:S143–S316