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RISK FACTORS OF MORTALITY AFTER SURGICAL CORRECTION OF VENTRICULAR SEPTAL DEFECT FOLLOWING MYOCARDIAL INFARCTION
S42
Canadian Cardiovascular Society (CCS) Poster A CARDIAC POTPOURRI: INTERESTING CONGENITAL CASES, HYPERTENSION, AND ISCHEMIC HEART DISEASE Saturday, October 24, 2015
Canadian Journal of Cardiology Volume 31 2015
endovascular grafting of the descending aorta. The maximum diameter growth was about 0.36 mm/months in our cohort. As an immediate consequence of diameter increase and geometrical changes of the ascending aorta, the stress distribution changes and the maximum stress rise post stent-graft in the descending aorta.
084 POST ENDOVASCULAR STENT REPAIR OF DESCENDING AORTA: SIDE EFFECTS AND DEVELOPMENT OF ANEURYSM IN THE ASCENDING AORTA M Altamimi Calgary, Alberta INTRODUCTION:
Thoracic aortic aneurysms are an indolent but catastrophic process. The purpose of this study was to evaluate changes in the wall mechanics in the ascending aorta proximal to where the endovascular stent graft is placed. Secondary purpose was to investigate the growth of the ascending segment after endovascular placement of a stent in the descending aorta. METHODS: Patient’s population: From December 2005 to December 2013, 16 patients (14 males and 3 females, aged of 60 10 years) with descending thoracic aortic lesions subjects. Patients were monitored prior to surgery and between 2 to 24 months after the surgery with repeated contrastenhanced multislice Computed Tomography (CT). Geometry Reconstruction: A 3D model of the thoracic aorta was obtained from CT images using the segmentation features of the image processing software ScanIP (Simpleware Ltd., Exeter, UK). The maximum diameter was manually evaluated directly from CT images by using the existing measuring tool in Scan IP. FINITE ELEMENT ANALYSIS: Non-linear isotropic constitutive descriptions of the wall as proposed previously were used for the FE analysis. The mean arterial blood pressure of 100 mmHg (13.33 kPa) was prescribed, and the nodal degrees of freedom of the distal ends of supra-aortic vessels, the descending aorta and the proximal aortic sinus were fixed in all directions. No contact with the surrounding organs was considered. The stress field was evaluated and the Maximum Wall Stress of the Ascending aorta (MWSA) was computed. RESULTS: The maximum principal Cauchy stress distribution obtained for one representative preoperative model is plotted in Figure 1. Stress and a diameter increase was observed in the postoperative analysis. In details, for the postoperative representative model the MWSA increased from 200 kPa to 212 kPa, while the ascending aorta diameter increased from 32 mm to 33.2 mm with an average growth rate of 0.2 mm/ months. Additionally, not only the magnitude of MWSA was increased in the postoperative model but also the location changed over time. DISCUSSION: The tissue response to implantation of an endovascular device involves a complex interplay among device design, materials, and deployment technique. Our data underlines the sensitivity of the ascending aorta to
085 RISK FACTORS OF MORTALITY AFTER SURGICAL CORRECTION OF VENTRICULAR SEPTAL DEFECT FOLLOWING MYOCARDIAL INFARCTION A Cinq-Mars, S Veilleux, P Voisine, F Dagenais, F Le Ven, P Poirier, K O’Connor, M Bernier, S Bergeron, M Sénéchal Québec, Québec BACKGROUND:
Rupture of the ventricular septum following myocardial infarction (MI) is an uncommon but serious complication, usually leading to congestive heart failure and cardiogenic shock. Surgical repair is the only definitive treatment for this condition but is associated with a high operative mortality. This study sought to analyze the associated risk factors and outcomes in this population. METHOD/RESULTS: A retrospective review was performed on 34 consecutive patients who had undergone surgical repair of ventricular septal defect (VSD) following MI from December 1991 to June 2013. Preoperative, clinical and echocardiographic variables were analysis. Mean age was 695 years and 44% were females. The VSD was anterior in 11 (32%) and posterior in 23 (68%) patients. Twenty-four (71%) patients were in cardiogenic shock. Mean aortic cross clamp time was 94 minutes and mean cardiopulmonary bypass time was 141 minutes. Median interval from MI to VSD repair was 7 days. Overall operative mortality within 30 days was 65%. Mortality within the posterior VSD group was 74% and the anterior VSD group was 46% (p¼0.1) Concomitant CABG did not influence early or late survival. Multivariate analysis identified age and time between MI and operation as independent predictors of 30-day and long-term mortality. CONCLUSION: Surgical repair of post-infarction VSD carries a high operative mortality. Age and time between MI and operation are independent predictors of 30-days and longterm mortality. In presence of such high-expected postoperative mortality with conventional surgery, alternative
Abstracts
therapy may need to be considered (percutaneous VSD closure and heart transplant) especially in patients with posterior VSD.
086 THE EFFECT OF SHORT- VERSUS LONG-ACTING ANTIHYPERTENSIVES ON BLOOD PRESSURE, NIGHT-DAY RATIO AND OTHER PARAMETERS OF BLOOD PRESSURE VARIABILITY J Gorgui, SS Daskalopoulou Montréal, Québec INTRODUCTION:
Hypertension (HTN) affects 19.7% of Canadian adults. HTN is a common modifiable risk factor for cardiovascular and cerebrovascular disease (CVD). Intraindividual BP variability is increasingly viewed as a better predictor for cardiovascular and cerebrovascular disease than average BP. Despite the numerous and effective treatment options available, HTN remains a public health concern worldwide because of inadequate BP control rates. METHODS: Data from medical charts of patients from clinics of a tertiary health care centre were collected. Using 24h ambulatory BP measurements, parameters of diurnal and nocturnal BP as well as BP variability (BPV) were calculated and analysed in terms of the duration of action (determined by the half-life and trought-to-peak ratio) of used antihypertensives (antiHTN), as well as their relative dosage. RESULTS: 321 patients were identified. The cohort was mainly male (53%) and had a mean age of 61,47 15,32 years. Despite a high treatment rate (60% using 1-3 antiHTN), day, night, and 24-hour systolic BP (SBP) was controlled in only 40% of the cohort. The variability of the observed effects across primary antiHTN classes do not show a better BP or BPV control with longer acting drugs (p>0.05). Nocturnal SBP dipping was 70% uncontrolled although other parameters of BP were controlled, and a combination of antiHTN was given. CONCLUSION: Certain long-acting or high dose antiHTN may improve control of ambulatory BP parameters, but not nocturnal BP or BPV.
087 SAFETY OF RENAL SYMPATHETIC DENERVATION FOLLOWING RECENT MYOCARDIAL INFARCTION S Gizurarson, N Jackson, B King, A Ramadeen, N Zamiri, A Porta-Sanchez, A Al-Hesayen, J Graham, M Kusha, S Masse, P Lai, P Dorian, K Nanthakumar Toronto, Ontario BACKGROUND:
The post myocardial infarction (AMI) state is associated with increase in sympathetic activity. Renal sympathetic denervation (RDN) has been shown to reduce central sympathetic outflow. Studies are ongoing in patients with stable heart failure, but no study has demonstrated safety of RDN following a recent myocardial infarction.
S43 METHODS:
Fifteen pigs were randomised to real AMI&real RDN (6 pigs), real AMI&sham RDN (6 pigs) and to sham AMI&sham RDN (3 pigs). Infarcts were created by percutaneous occlusion of the mid to distal LAD and 2 weeks later RDN was performed bilaterally with the St Jude EnligHTNÒ basket catheter. Amubulatory sinus rates, ventricular remodelling parameters and urinary sodium were measured throughout the 3-week duration of the study. RESULTS: The mean sinus heart rates in the real AMI&sham RDN group went from 224+/-4 bpm to 234+/-9bpm and in the real AMI&real RDN group they went from 225+/-15bpm to 219+/-11bpm following RDN (p¼0.04). The peak sinus rhythm rate for each pig was also significantly less in the real AMI&real RDN group (261+/-15bpm to 276+/-28bpm in the sham RDN group compared with 271+/-22bpm to 254+/-30bpm in the real RDN group, p¼0.03). The mean LVEF went from 58+/-4% pre infarct to 54+/-4% (p¼0.28) post infarct and the mean LVEDV increased from 42+/-7mls3 to 49+/-8mls3 (p¼0.02) in the groups where a real AMI was performed. Pairwise comparison showed no significant difference between the real AMI&sham RDN group and the real AMI&real RDN group for LVEF (p¼0.28) or LVEDV (p¼0.44). Mean urinary sodium levels were 55+/-14mmol/L in the real AMI&sham RDN group and were 62+/-14mmol/ L in the real AMI&real RDN group (p¼0.45). CONCLUSION: RDN seems to be safe following a recent myocardial infarction in an ambulatory porcine model of AMI. RDN attenuates peak and mean sinus tachycardia rates, but does not cause worsening of heart function.
St. Jude Medical
088 AGGRESSIVE INCREASE IN DIETARY POTASSIUM DOES NOT CAUSE HYPERKALEMIA IN MEDICATED HYPERTENSIVE INDIVIDUALS D Malta, J Arcand, J Allard, G Newton Toronto, Ontario BACKGROUND:
A high potassium diet decreases blood pressure. As such, the Canadian Hypertension Education
Canadian Cardiovascular Society (CCS) Poster A CARDIAC POTPOURRI: INTERESTING CONGENITAL CASES, HYPERTENSION, AND ISCHEMIC HEART DISEASE Saturday, October 24, 2015
Canadian Journal of Cardiology Volume 31 2015
endovascular grafting of the descending aorta. The maximum diameter growth was about 0.36 mm/months in our cohort. As an immediate consequence of diameter increase and geometrical changes of the ascending aorta, the stress distribution changes and the maximum stress rise post stent-graft in the descending aorta.
084 POST ENDOVASCULAR STENT REPAIR OF DESCENDING AORTA: SIDE EFFECTS AND DEVELOPMENT OF ANEURYSM IN THE ASCENDING AORTA M Altamimi Calgary, Alberta INTRODUCTION:
Thoracic aortic aneurysms are an indolent but catastrophic process. The purpose of this study was to evaluate changes in the wall mechanics in the ascending aorta proximal to where the endovascular stent graft is placed. Secondary purpose was to investigate the growth of the ascending segment after endovascular placement of a stent in the descending aorta. METHODS: Patient’s population: From December 2005 to December 2013, 16 patients (14 males and 3 females, aged of 60 10 years) with descending thoracic aortic lesions subjects. Patients were monitored prior to surgery and between 2 to 24 months after the surgery with repeated contrastenhanced multislice Computed Tomography (CT). Geometry Reconstruction: A 3D model of the thoracic aorta was obtained from CT images using the segmentation features of the image processing software ScanIP (Simpleware Ltd., Exeter, UK). The maximum diameter was manually evaluated directly from CT images by using the existing measuring tool in Scan IP. FINITE ELEMENT ANALYSIS: Non-linear isotropic constitutive descriptions of the wall as proposed previously were used for the FE analysis. The mean arterial blood pressure of 100 mmHg (13.33 kPa) was prescribed, and the nodal degrees of freedom of the distal ends of supra-aortic vessels, the descending aorta and the proximal aortic sinus were fixed in all directions. No contact with the surrounding organs was considered. The stress field was evaluated and the Maximum Wall Stress of the Ascending aorta (MWSA) was computed. RESULTS: The maximum principal Cauchy stress distribution obtained for one representative preoperative model is plotted in Figure 1. Stress and a diameter increase was observed in the postoperative analysis. In details, for the postoperative representative model the MWSA increased from 200 kPa to 212 kPa, while the ascending aorta diameter increased from 32 mm to 33.2 mm with an average growth rate of 0.2 mm/ months. Additionally, not only the magnitude of MWSA was increased in the postoperative model but also the location changed over time. DISCUSSION: The tissue response to implantation of an endovascular device involves a complex interplay among device design, materials, and deployment technique. Our data underlines the sensitivity of the ascending aorta to
085 RISK FACTORS OF MORTALITY AFTER SURGICAL CORRECTION OF VENTRICULAR SEPTAL DEFECT FOLLOWING MYOCARDIAL INFARCTION A Cinq-Mars, S Veilleux, P Voisine, F Dagenais, F Le Ven, P Poirier, K O’Connor, M Bernier, S Bergeron, M Sénéchal Québec, Québec BACKGROUND:
Rupture of the ventricular septum following myocardial infarction (MI) is an uncommon but serious complication, usually leading to congestive heart failure and cardiogenic shock. Surgical repair is the only definitive treatment for this condition but is associated with a high operative mortality. This study sought to analyze the associated risk factors and outcomes in this population. METHOD/RESULTS: A retrospective review was performed on 34 consecutive patients who had undergone surgical repair of ventricular septal defect (VSD) following MI from December 1991 to June 2013. Preoperative, clinical and echocardiographic variables were analysis. Mean age was 695 years and 44% were females. The VSD was anterior in 11 (32%) and posterior in 23 (68%) patients. Twenty-four (71%) patients were in cardiogenic shock. Mean aortic cross clamp time was 94 minutes and mean cardiopulmonary bypass time was 141 minutes. Median interval from MI to VSD repair was 7 days. Overall operative mortality within 30 days was 65%. Mortality within the posterior VSD group was 74% and the anterior VSD group was 46% (p¼0.1) Concomitant CABG did not influence early or late survival. Multivariate analysis identified age and time between MI and operation as independent predictors of 30-day and long-term mortality. CONCLUSION: Surgical repair of post-infarction VSD carries a high operative mortality. Age and time between MI and operation are independent predictors of 30-days and longterm mortality. In presence of such high-expected postoperative mortality with conventional surgery, alternative
Abstracts
therapy may need to be considered (percutaneous VSD closure and heart transplant) especially in patients with posterior VSD.
086 THE EFFECT OF SHORT- VERSUS LONG-ACTING ANTIHYPERTENSIVES ON BLOOD PRESSURE, NIGHT-DAY RATIO AND OTHER PARAMETERS OF BLOOD PRESSURE VARIABILITY J Gorgui, SS Daskalopoulou Montréal, Québec INTRODUCTION:
Hypertension (HTN) affects 19.7% of Canadian adults. HTN is a common modifiable risk factor for cardiovascular and cerebrovascular disease (CVD). Intraindividual BP variability is increasingly viewed as a better predictor for cardiovascular and cerebrovascular disease than average BP. Despite the numerous and effective treatment options available, HTN remains a public health concern worldwide because of inadequate BP control rates. METHODS: Data from medical charts of patients from clinics of a tertiary health care centre were collected. Using 24h ambulatory BP measurements, parameters of diurnal and nocturnal BP as well as BP variability (BPV) were calculated and analysed in terms of the duration of action (determined by the half-life and trought-to-peak ratio) of used antihypertensives (antiHTN), as well as their relative dosage. RESULTS: 321 patients were identified. The cohort was mainly male (53%) and had a mean age of 61,47 15,32 years. Despite a high treatment rate (60% using 1-3 antiHTN), day, night, and 24-hour systolic BP (SBP) was controlled in only 40% of the cohort. The variability of the observed effects across primary antiHTN classes do not show a better BP or BPV control with longer acting drugs (p>0.05). Nocturnal SBP dipping was 70% uncontrolled although other parameters of BP were controlled, and a combination of antiHTN was given. CONCLUSION: Certain long-acting or high dose antiHTN may improve control of ambulatory BP parameters, but not nocturnal BP or BPV.
087 SAFETY OF RENAL SYMPATHETIC DENERVATION FOLLOWING RECENT MYOCARDIAL INFARCTION S Gizurarson, N Jackson, B King, A Ramadeen, N Zamiri, A Porta-Sanchez, A Al-Hesayen, J Graham, M Kusha, S Masse, P Lai, P Dorian, K Nanthakumar Toronto, Ontario BACKGROUND:
The post myocardial infarction (AMI) state is associated with increase in sympathetic activity. Renal sympathetic denervation (RDN) has been shown to reduce central sympathetic outflow. Studies are ongoing in patients with stable heart failure, but no study has demonstrated safety of RDN following a recent myocardial infarction.
S43 METHODS:
Fifteen pigs were randomised to real AMI&real RDN (6 pigs), real AMI&sham RDN (6 pigs) and to sham AMI&sham RDN (3 pigs). Infarcts were created by percutaneous occlusion of the mid to distal LAD and 2 weeks later RDN was performed bilaterally with the St Jude EnligHTNÒ basket catheter. Amubulatory sinus rates, ventricular remodelling parameters and urinary sodium were measured throughout the 3-week duration of the study. RESULTS: The mean sinus heart rates in the real AMI&sham RDN group went from 224+/-4 bpm to 234+/-9bpm and in the real AMI&real RDN group they went from 225+/-15bpm to 219+/-11bpm following RDN (p¼0.04). The peak sinus rhythm rate for each pig was also significantly less in the real AMI&real RDN group (261+/-15bpm to 276+/-28bpm in the sham RDN group compared with 271+/-22bpm to 254+/-30bpm in the real RDN group, p¼0.03). The mean LVEF went from 58+/-4% pre infarct to 54+/-4% (p¼0.28) post infarct and the mean LVEDV increased from 42+/-7mls3 to 49+/-8mls3 (p¼0.02) in the groups where a real AMI was performed. Pairwise comparison showed no significant difference between the real AMI&sham RDN group and the real AMI&real RDN group for LVEF (p¼0.28) or LVEDV (p¼0.44). Mean urinary sodium levels were 55+/-14mmol/L in the real AMI&sham RDN group and were 62+/-14mmol/ L in the real AMI&real RDN group (p¼0.45). CONCLUSION: RDN seems to be safe following a recent myocardial infarction in an ambulatory porcine model of AMI. RDN attenuates peak and mean sinus tachycardia rates, but does not cause worsening of heart function.
St. Jude Medical
088 AGGRESSIVE INCREASE IN DIETARY POTASSIUM DOES NOT CAUSE HYPERKALEMIA IN MEDICATED HYPERTENSIVE INDIVIDUALS D Malta, J Arcand, J Allard, G Newton Toronto, Ontario BACKGROUND:
A high potassium diet decreases blood pressure. As such, the Canadian Hypertension Education