- Email: [email protected]
Recombinant Activated Factor VII and ECMO Following Paediatric Cardiac Surgery
Abstracts
mural viability cutoffs of <25% and <75% were less useful predictors of global LV recovery. Conclusions: Based on a 50% transmural viability cutoff, patients with ≥10 viable segments improve global LV function post revascularization, while patients with fewer viable segments do not. LGE-CMR is a simple and powerful tool for identifying which coronary artery disease patients with impaired LV function will benefit from CABG. doi:10.1016/j.hlc.2009.05.156 155 PRE-SURGICAL CARDIOPULMONARY EXERCISE (CPEX) TESTING PREDICTS OUTCOMES IN COMPLEX HEART VALVE DISEASE Naylin Bissessor 1 , R. Howes 2 , Zeng 3 ,
Stewart 3 ,
R. H. White 3
Jayasinghe 2 , Y. A.
Kerr 3 ,
J.
Shen-Wee 2 , L.
Kolbe 3 ,
K. Ellyett 3 , I.
1 Prince
Charles Hospital, Australia Coast Hospital, Australia 3 Greenlane Research Centre, New Zealand 2 Gold
Introduction: Complex heart valve disease constitutes chronic mixed and multiple valve pathologies coexisting in a single heart. Chronicity of the disease results in a slow decline in functional capacity toward a sedentary state. The assessment of dyspnoea (NYHA class) and overall functional capacity is central to the decision to operate and prognosis. Dyspnoea may be difficult to detect in some patients. Objectives: In complex valve disease: 1. To objectively assess functional aerobic capacity (peakVO2 ) using CPEX. 2. To assess predictors of outcomes. 3. To compare differences between NYHA class I with class II in relation to body composition, echocardiographic severity and functional capacity. Method: The study evaluated a cohort of 45 patients with complex valve disease referred for the timing of surgery and 15 healthy controls. All patients underwent a clinical assessment, NtproBNP, echocardiography and CPEX. Results: Patients with valve disease achieved significantly lower peak VO2 values than controls (16 ± 5.9 vs. 31.4 ± 5.9 ml/kg/min; p = 0.0001). PeakVO2 (% predicted) was significantly different between the class I (70.9 ± 20%) and the symptomatic class II (55.1 ± 21%; p = 0.003) with overlap. Ejection fraction correlated poorly with peakVO2 (r = 0.26). In a multivariable regression analysis the peak VO2 and VE/VCO2 slope were powerful predictors of poor outcomes (HR 2.15, 5.62; p < 0.05). Conclusion: Patients with complex valve disease may have a significant asymptomatic functional capacity impairment, which impacts on outcomes. When symptoms are in doubt a CPEX test is highly recommended to improve the timing of surgery and overall prognosis. doi:10.1016/j.hlc.2009.05.157
S71
156 RECOMBINANT ACTIVATED FACTOR VII AND ECMO FOLLOWING PAEDIATRIC CARDIAC SURGERY J.R. Egan 1,2,3 , A.D. Cole 3 , D.S. Winlaw 2,3 1 Paediatric Intensive Care Unit, The Children’s Hospital at Westmead, Sydney, Australia 2 Discipline of Paediatrics and Child Health, Faculty of Medicine, University of Sydney, Australia 3 Kids Heart Research, The Children’s Hospital at Westmead, Sydney, Australia
Background: Recombinant activated factor VII has been used for bleeding following paediatric cardiac surgery. We examined its use in children on ECMO with significant bleeding following cardiac surgery. Methods: Patients who required ECMO following cardiac surgery were retrospectively reviewed. Blood loss, blood product administration, haematological parameters, evidence of thrombosis and outcome were examined. Results: In the period from 2003 to 2009, 30 patients were supported postoperatively, with an overall survival to 28 days post-hospital discharge of 67%. Bleeding was a major issue in all patients, but in seven (23%) warranted recombinant activated factor VII, after conventional therapy failed. Eight of the 23 patients that did not receive recombinant activated factor died and there was no thrombosis or circuit occlusion noted in these 23 patients. Of the seven patients that did receive recombinant activated factor VII, two died of causes unrelated to bleeding, two patients had circuits requiring change within 2 h because of thrombus formation and another two had venous thrombosis detected two weeks post-ECMO. Recombinant activated factor VII did not significantly alter the volume of blood loss or blood administered. Recombinant activated factor VII did not significantly alter coagulation parameters. Conclusions: Recombinant activated factor VII administration to bleeding paediatric patients on ECMO following cardiac surgery was not associated with reduced blood loss, blood product administration or improved coagulation parameters. Its use was associated with circuit thrombosis and late venous thrombosis. Its use should be reserved for the most dire of circumstances only, in this setting. doi:10.1016/j.hlc.2009.05.158 157 SIX YEARS OF INFECTIONS SURVEILLANCE FOLLOWING CORONARY ARTERY BYPASS GRAFT SURGERY (CABGS) IN VICTORIA—AN OVERVIEW J. Brett, A. Bull, C. Boardman, C. Dunkley, L. Worth, M. Richards VICNISS Coordinating Centre, Melbourne, Australia The VICNISS Coordinating Centre (VCC), established in 2002, coordinates a state-wide standardised surveillance system for hospital acquired infections in Victorian
ABSTRACTS
Heart, Lung and Circulation 2009;18S:S1–S286
mural viability cutoffs of <25% and <75% were less useful predictors of global LV recovery. Conclusions: Based on a 50% transmural viability cutoff, patients with ≥10 viable segments improve global LV function post revascularization, while patients with fewer viable segments do not. LGE-CMR is a simple and powerful tool for identifying which coronary artery disease patients with impaired LV function will benefit from CABG. doi:10.1016/j.hlc.2009.05.156 155 PRE-SURGICAL CARDIOPULMONARY EXERCISE (CPEX) TESTING PREDICTS OUTCOMES IN COMPLEX HEART VALVE DISEASE Naylin Bissessor 1 , R. Howes 2 , Zeng 3 ,
Stewart 3 ,
R. H. White 3
Jayasinghe 2 , Y. A.
Kerr 3 ,
J.
Shen-Wee 2 , L.
Kolbe 3 ,
K. Ellyett 3 , I.
1 Prince
Charles Hospital, Australia Coast Hospital, Australia 3 Greenlane Research Centre, New Zealand 2 Gold
Introduction: Complex heart valve disease constitutes chronic mixed and multiple valve pathologies coexisting in a single heart. Chronicity of the disease results in a slow decline in functional capacity toward a sedentary state. The assessment of dyspnoea (NYHA class) and overall functional capacity is central to the decision to operate and prognosis. Dyspnoea may be difficult to detect in some patients. Objectives: In complex valve disease: 1. To objectively assess functional aerobic capacity (peakVO2 ) using CPEX. 2. To assess predictors of outcomes. 3. To compare differences between NYHA class I with class II in relation to body composition, echocardiographic severity and functional capacity. Method: The study evaluated a cohort of 45 patients with complex valve disease referred for the timing of surgery and 15 healthy controls. All patients underwent a clinical assessment, NtproBNP, echocardiography and CPEX. Results: Patients with valve disease achieved significantly lower peak VO2 values than controls (16 ± 5.9 vs. 31.4 ± 5.9 ml/kg/min; p = 0.0001). PeakVO2 (% predicted) was significantly different between the class I (70.9 ± 20%) and the symptomatic class II (55.1 ± 21%; p = 0.003) with overlap. Ejection fraction correlated poorly with peakVO2 (r = 0.26). In a multivariable regression analysis the peak VO2 and VE/VCO2 slope were powerful predictors of poor outcomes (HR 2.15, 5.62; p < 0.05). Conclusion: Patients with complex valve disease may have a significant asymptomatic functional capacity impairment, which impacts on outcomes. When symptoms are in doubt a CPEX test is highly recommended to improve the timing of surgery and overall prognosis. doi:10.1016/j.hlc.2009.05.157
S71
156 RECOMBINANT ACTIVATED FACTOR VII AND ECMO FOLLOWING PAEDIATRIC CARDIAC SURGERY J.R. Egan 1,2,3 , A.D. Cole 3 , D.S. Winlaw 2,3 1 Paediatric Intensive Care Unit, The Children’s Hospital at Westmead, Sydney, Australia 2 Discipline of Paediatrics and Child Health, Faculty of Medicine, University of Sydney, Australia 3 Kids Heart Research, The Children’s Hospital at Westmead, Sydney, Australia
Background: Recombinant activated factor VII has been used for bleeding following paediatric cardiac surgery. We examined its use in children on ECMO with significant bleeding following cardiac surgery. Methods: Patients who required ECMO following cardiac surgery were retrospectively reviewed. Blood loss, blood product administration, haematological parameters, evidence of thrombosis and outcome were examined. Results: In the period from 2003 to 2009, 30 patients were supported postoperatively, with an overall survival to 28 days post-hospital discharge of 67%. Bleeding was a major issue in all patients, but in seven (23%) warranted recombinant activated factor VII, after conventional therapy failed. Eight of the 23 patients that did not receive recombinant activated factor died and there was no thrombosis or circuit occlusion noted in these 23 patients. Of the seven patients that did receive recombinant activated factor VII, two died of causes unrelated to bleeding, two patients had circuits requiring change within 2 h because of thrombus formation and another two had venous thrombosis detected two weeks post-ECMO. Recombinant activated factor VII did not significantly alter the volume of blood loss or blood administered. Recombinant activated factor VII did not significantly alter coagulation parameters. Conclusions: Recombinant activated factor VII administration to bleeding paediatric patients on ECMO following cardiac surgery was not associated with reduced blood loss, blood product administration or improved coagulation parameters. Its use was associated with circuit thrombosis and late venous thrombosis. Its use should be reserved for the most dire of circumstances only, in this setting. doi:10.1016/j.hlc.2009.05.158 157 SIX YEARS OF INFECTIONS SURVEILLANCE FOLLOWING CORONARY ARTERY BYPASS GRAFT SURGERY (CABGS) IN VICTORIA—AN OVERVIEW J. Brett, A. Bull, C. Boardman, C. Dunkley, L. Worth, M. Richards VICNISS Coordinating Centre, Melbourne, Australia The VICNISS Coordinating Centre (VCC), established in 2002, coordinates a state-wide standardised surveillance system for hospital acquired infections in Victorian
ABSTRACTS
Heart, Lung and Circulation 2009;18S:S1–S286