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Scoring System Validity for Short-term Outcomes of Coronary Artery Bypass Surgery in Indigenous Australians
e90
transplantation utilising ex-vivo perfusion (EVP) preservation. A better understanding of the withdrawal period, DCD heart physiology and EVP science is required to improve outcomes. We aimed to define the derangements following withdrawal, noting their impact on donor blood use in EVP. Methodology: In a clinically relevant porcine asphyxia model (n=24) and initial human trials, haemodynamic (MAP, CVP, intra-ventricular pressures(IVP)), electrical/circulatory arrest times, metabolic (pH, O2, lactate, trop-T), biochemical (K+) and endocrine changes (noradrenaline & adrenaline measured in coronary sinus and systemic sites) during withdrawal periods (20-40 min) were analysed. Blood collection methods for EVP, and perfusion strategies (pressure vs. flow) were tested. Results: From pre-withdrawal to post-arrest, IVP increased in the RV, while LV IVP fell (PV loop studies). Early rapid O2 desaturations were noted (14 mmHg +/-1 at 5 min post withdrawal). By 30 min post-withdrawal, pH was < 7.2, lactates >10mmol/L, troponin-T >200 mg/L and K+ >10mmol/L. Adrenaline and noradrenaline (NA) surges were noted at 4 min post withdrawal (assoc. HR increase) with ongoing amine release (NA) in the coronary sinus, but no further increase systemically (p<0.05). Conclusion: Dramatic changes occurred during the withdrawal period, notably RV distension, profound acidosis, myocardial ischaemia & hyperkalaemia - all of which have important implications for clinical cardiac transplantation/ EVP. A greater understanding of these processes provides insight for post-mortem interventions to limit impact and optimise EVP perfusate. http://dx.doi.org/10.1016/j.hlc.2015.12.012 SCIENTIFIC SESSION 5: YOUNG ACHIEVER’S AWARD 17th Nov (TUE) 14:29 - 14:41 Scoring System Validity for Short-term Outcomes of Coronary Artery Bypass Surgery in Indigenous Australians Scott Jennings *, Adam Cristaudo, Greg Rice, David Lance, Hugh Cullen, Rob Baker, Jayme Bennetts Flinders Medical Centre, Adelaide, SA, Australia Purpose: Australia and Torres Strait Island (ATSI) Australians are over-represented with regards to cardiovascular disease. Despite social awareness and health policy advancements, ATSI patients present significantly earlier for CABG with a heavier burden of co-morbidities. ATSI patients face obstacles in accessing healthcare and available risk stratification models may under-estimate risk due to younger age and greater co-morbitidies. This study reviewed isolated CABG short-term outcomes in ATSI patients and the value of predicted mortality using the euroSCORE. Methods: A retrospective case audit was performed identifying 1918 cases from 2006 to 2015. Major outcome
Abstracts
measures were mortality, 30-day readmission and DSWI. Mortality risk was predicted by euroSCORE. A multivariate model using linear regression was constructed to assess the influence of ATSI status on outcomes. Results: 17% of patients were ATSI. ATSI patients were younger and had more renal disease, dialysis, diabetes, smoking, myocardial infarction and poor LVEF whilst non-ATSI had higher BMI and euroSCORE (p<0.001). Major post-operative outcomes were not significantly different, EuroSCORE over-predicted non-ATSI mortality 4.8% vs. 1.9%, but the ATSI rate was similar 2.7% vs. 2.4%. On multivariate analysis, ATSI status conferred a statistically significant increased risk of early mortality (p=0.015). The Odds Ratio for ATSI mortality was 1.3 (0.6 to 2.9, 95% CI). Conclusion: ATSI patients traditionally have poorer outcomes and greater morbidity than non-ATSI cohorts; however we have shown similar morbidity for this group of patients, albeit in a younger cohort. ATSI status is an independent predictor of mortality and current risk models under predict mortality. ATSI patients also showed lower rates of DSWI. http://dx.doi.org/10.1016/j.hlc.2015.12.013 SCIENTIFIC SESSION 5: YOUNG ACHIEVER’S AWARD 17th Nov (TUE) 14:05 - 14:17 Sternal Cables are not Superior to Traditional Sternal Wiring. A Randomised Controlled Trial of Sternal Closure with Sternal Wires or Sternal Cables Ben Dunne *, Mark Murphy, Rohen Skiba, Dora Wang, Kwok Ho, Chris Merry Fiona Stanley Hospital, Perth, WA, Australia Purpose: Deep sternal wound infection is a devastating complication of cardiac surgery. In the current era of increasing patient co-morbidity, newer techniques must be evaluated in attempts to reduce the rates of deep sternal wound infection. Methodology: A randomised controlled trial comparing sternal closure with traditional sternal wires in figure-8 formation with the Pioneer cabling system from Medigroup after adult cardiac surgery was performed. Results: 273 patients were enrolled with 137 and 135 patients randomised to sternal wires and cables group, respectively. Baseline characteristics between the two groups were well balanced. Deep sternal wound infection occurred in 0.7% of patients in the wires group and 3.7% of patients in the cables group (absolute risk difference = -3.0%, 95% confidence interval: -7.7% to 0.9%; p=0.12). Patients in the cables group were extubated slightly earlier than the patients in the sternal wires group postoperatively (9.7 vs. 12.8 hours; p=0.03). There was, however, no significant difference in hospital and follow-up pain scores or analgaesia requirements.
transplantation utilising ex-vivo perfusion (EVP) preservation. A better understanding of the withdrawal period, DCD heart physiology and EVP science is required to improve outcomes. We aimed to define the derangements following withdrawal, noting their impact on donor blood use in EVP. Methodology: In a clinically relevant porcine asphyxia model (n=24) and initial human trials, haemodynamic (MAP, CVP, intra-ventricular pressures(IVP)), electrical/circulatory arrest times, metabolic (pH, O2, lactate, trop-T), biochemical (K+) and endocrine changes (noradrenaline & adrenaline measured in coronary sinus and systemic sites) during withdrawal periods (20-40 min) were analysed. Blood collection methods for EVP, and perfusion strategies (pressure vs. flow) were tested. Results: From pre-withdrawal to post-arrest, IVP increased in the RV, while LV IVP fell (PV loop studies). Early rapid O2 desaturations were noted (14 mmHg +/-1 at 5 min post withdrawal). By 30 min post-withdrawal, pH was < 7.2, lactates >10mmol/L, troponin-T >200 mg/L and K+ >10mmol/L. Adrenaline and noradrenaline (NA) surges were noted at 4 min post withdrawal (assoc. HR increase) with ongoing amine release (NA) in the coronary sinus, but no further increase systemically (p<0.05). Conclusion: Dramatic changes occurred during the withdrawal period, notably RV distension, profound acidosis, myocardial ischaemia & hyperkalaemia - all of which have important implications for clinical cardiac transplantation/ EVP. A greater understanding of these processes provides insight for post-mortem interventions to limit impact and optimise EVP perfusate. http://dx.doi.org/10.1016/j.hlc.2015.12.012 SCIENTIFIC SESSION 5: YOUNG ACHIEVER’S AWARD 17th Nov (TUE) 14:29 - 14:41 Scoring System Validity for Short-term Outcomes of Coronary Artery Bypass Surgery in Indigenous Australians Scott Jennings *, Adam Cristaudo, Greg Rice, David Lance, Hugh Cullen, Rob Baker, Jayme Bennetts Flinders Medical Centre, Adelaide, SA, Australia Purpose: Australia and Torres Strait Island (ATSI) Australians are over-represented with regards to cardiovascular disease. Despite social awareness and health policy advancements, ATSI patients present significantly earlier for CABG with a heavier burden of co-morbidities. ATSI patients face obstacles in accessing healthcare and available risk stratification models may under-estimate risk due to younger age and greater co-morbitidies. This study reviewed isolated CABG short-term outcomes in ATSI patients and the value of predicted mortality using the euroSCORE. Methods: A retrospective case audit was performed identifying 1918 cases from 2006 to 2015. Major outcome
Abstracts
measures were mortality, 30-day readmission and DSWI. Mortality risk was predicted by euroSCORE. A multivariate model using linear regression was constructed to assess the influence of ATSI status on outcomes. Results: 17% of patients were ATSI. ATSI patients were younger and had more renal disease, dialysis, diabetes, smoking, myocardial infarction and poor LVEF whilst non-ATSI had higher BMI and euroSCORE (p<0.001). Major post-operative outcomes were not significantly different, EuroSCORE over-predicted non-ATSI mortality 4.8% vs. 1.9%, but the ATSI rate was similar 2.7% vs. 2.4%. On multivariate analysis, ATSI status conferred a statistically significant increased risk of early mortality (p=0.015). The Odds Ratio for ATSI mortality was 1.3 (0.6 to 2.9, 95% CI). Conclusion: ATSI patients traditionally have poorer outcomes and greater morbidity than non-ATSI cohorts; however we have shown similar morbidity for this group of patients, albeit in a younger cohort. ATSI status is an independent predictor of mortality and current risk models under predict mortality. ATSI patients also showed lower rates of DSWI. http://dx.doi.org/10.1016/j.hlc.2015.12.013 SCIENTIFIC SESSION 5: YOUNG ACHIEVER’S AWARD 17th Nov (TUE) 14:05 - 14:17 Sternal Cables are not Superior to Traditional Sternal Wiring. A Randomised Controlled Trial of Sternal Closure with Sternal Wires or Sternal Cables Ben Dunne *, Mark Murphy, Rohen Skiba, Dora Wang, Kwok Ho, Chris Merry Fiona Stanley Hospital, Perth, WA, Australia Purpose: Deep sternal wound infection is a devastating complication of cardiac surgery. In the current era of increasing patient co-morbidity, newer techniques must be evaluated in attempts to reduce the rates of deep sternal wound infection. Methodology: A randomised controlled trial comparing sternal closure with traditional sternal wires in figure-8 formation with the Pioneer cabling system from Medigroup after adult cardiac surgery was performed. Results: 273 patients were enrolled with 137 and 135 patients randomised to sternal wires and cables group, respectively. Baseline characteristics between the two groups were well balanced. Deep sternal wound infection occurred in 0.7% of patients in the wires group and 3.7% of patients in the cables group (absolute risk difference = -3.0%, 95% confidence interval: -7.7% to 0.9%; p=0.12). Patients in the cables group were extubated slightly earlier than the patients in the sternal wires group postoperatively (9.7 vs. 12.8 hours; p=0.03). There was, however, no significant difference in hospital and follow-up pain scores or analgaesia requirements.