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Single centre results of first 100 patients treated with the absorb bioresorbable vascular scaffold
S88
Abstracts
Methods: 10 healthy adult volunteers underwent blood flow measurement in the main (MPA), right (RPA) and left (LPA) pulmonary arteries on a 1.5T Siemens Avanto MR scanner, using both the standard and the interleaved sequences, in a varying order. Internal consistency of the measurements was checked by the sum MPA flow - (RPA + LPA flows). Flow measurements were analysed using Argus software (Siemens), statistical analysis with SPSS Statistics. Results: The mean MPA flow was 5.90 l/min using the standard sequence vs 5.47 l/min with the interleaved sequence (p=0.484). Mean RPA flow was 3.07 l/min vs. 2.75 l/min (p=0.249), and the mean LPA flow was 2.89 l/ min vs. 2.59 l/min (p=0.310). Internal consistency was comparable at 0.29 l/min standard vs. 0.28 l/min interleaved (p=0.959). Conclusion: The interleaved flow sequence produces similar results to the standard sequential method. No advantage for the interleaved sequence was demonstrated, but use thereof has no disadvantage either. In clinical situations where flow should be measured at multiple sites, eg shunt calculation, the interleaved sequence is preferable, with one source of potential error eliminated.
with 7.23.3 (SAVR) (p=0.0158). Mean cost of TAVI was $48,536$14,173 vs. $68,970$37,902 for SAVR (p<0.0001). The main cost-driver for TAVI is the valve (58% cost). Average LOS for TAVI was half that of SAVR patients. Mean ICU cost was $4,7624,724 (TAVI) compared to $15,471$19,516 (SAVR) (p<0.0001). TAVI cost varies between centres ($53,332-Auckland, $46,985-Waikato, $48,688-Christchurch) despite similar pre-procedural clinical risk (p=0.0005). Between centres the mean SAVR cost (Auckland=$69,560 vs Waikato=$67,394) is similar (p=0.2562) with comparable clinical risk (Auckland EuroSCORE-II=7.33.4 vs Waikato EuroSCORE-II=6.83.0). Conclusion: TAVI appears cost-saving using index-admission cost in intermediate-high risk patients requiring aortic valve replacement in NZ, due to reduced use of hospital resource and LOS. These data have implications for future fund allocations for severe AS in NZ.
http://dx.doi.org/10.1016/j.hlc.2015.04.094
Single centre results of first 100 patients treated with the absorb bioresorbable vascular scaffold
Free Communications (Interventional)
W. Jaffe *, A. Ko, D. Scott, M. Lindesay
O29 National multi-centre cost-comparison of trans-catheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR) in moderate to high-risk patients with severe symptomatic aortic stenosis in New Zealand (NZ) S. Bhattacharyya 1*, M. Roskruge 2, K. Sidhu 3, R. Nair 4, D. Smyth 5, M. Webster 3, P. Ruygrok 3, J. Ormiston 3, S. Pasupati 4 1
Waitemata District Health Board, Auckland, NZ University of Waikato, Hamilton, NZ 3 Auckland District Health Board, Auckland, NZ 4 Waikato District Health Board, Waikato, NZ 5 Canterbury District Health Board, Canterbury, NZ * Corresponding author. 2
Background: Many patients with severe aortic stenosis (AS) are high-risk for SAVR due to comorbidity, frailty and anatomical limitations. TAVI is an attractive alternative solution; however, there are perceptions that it is high-cost. Policy-makers fear that expansion of TAVI will impact detrimentally upon the public healthcare budget, but savings from reduced resource utilisation may offset the high transcatheter valve cost. Methods: We compare index-admission cost and clinical data for 201 patients who received TAVI across NZ in the public system with 99 intermediate-high risk SAVR patients (using EuroSCORE-II>4) from Auckland and Waikato, from August 2008 to March 2014. Variables include age, gender, weight, EuroSCORE-II, renal function, left-ventricular function, previous sternotomy, total cost, cost-breakdown and length of stay (LOS). Results: EuroSCORE-II independently correlates with cost. Mean EuroSCORE-II was 10.27.7 (TAVI) compared
http://dx.doi.org/10.1016/j.hlc.2015.04.095
O30
Ascot Cardiology, Auckland, NZ Corresponding author.
*
Background: The Absorb Bioresorbable Vascular Scaffold (BVS) was released for clinical use in New Zealand in September 2012. We report our experience in the first 100 patients treated with this new technology. Methods: We prospectively collected clinical data on all patients in our lab who had BVS implantation. Angiographic measurements were done using a semi-quantitative technique. Results: 123 lesions were treated in 100 patients, all with stable symptoms. Mean age was 55 (90% males, 12% diabetics). Lesion location was LAD (55%), RCA (24%), Cx (21%). Lesion complexity – 35% B2/C. Calcification was none or mild in 97%. OCT was used in 15% of cases. Post dilatation was performed in 65% of cases. Procedural success was 100%. Device success was 99% - the BVS could not be advanced in one patient. Three patients with edge-dissection required “Bailout” DES. At a median follow-up of 8 months (range 1 - 29 months) 98% of patients were free of BVS-related events. There was 1 non-fatal acute stent thrombosis 6 weeks post BVS implantation. OCT following thrombus aspiration showed no obvious problem with the BVS. One patient with recurrent angina at 19 months was treated with a DES for in-stent restenosis. There was no significant in-stent restenosis (>50% diameter loss) in 19 patients who have had clinically-driven repeat angiography (at a median time of 14 months). 11 of the patients restudied had nontarget lesion revascularisation. Conclusions: At a median follow-up of 8 months excellent outcomes were achieved with this new technology, with a low rate of OCT usage. http://dx.doi.org/10.1016/j.hlc.2015.04.096
Abstracts
Methods: 10 healthy adult volunteers underwent blood flow measurement in the main (MPA), right (RPA) and left (LPA) pulmonary arteries on a 1.5T Siemens Avanto MR scanner, using both the standard and the interleaved sequences, in a varying order. Internal consistency of the measurements was checked by the sum MPA flow - (RPA + LPA flows). Flow measurements were analysed using Argus software (Siemens), statistical analysis with SPSS Statistics. Results: The mean MPA flow was 5.90 l/min using the standard sequence vs 5.47 l/min with the interleaved sequence (p=0.484). Mean RPA flow was 3.07 l/min vs. 2.75 l/min (p=0.249), and the mean LPA flow was 2.89 l/ min vs. 2.59 l/min (p=0.310). Internal consistency was comparable at 0.29 l/min standard vs. 0.28 l/min interleaved (p=0.959). Conclusion: The interleaved flow sequence produces similar results to the standard sequential method. No advantage for the interleaved sequence was demonstrated, but use thereof has no disadvantage either. In clinical situations where flow should be measured at multiple sites, eg shunt calculation, the interleaved sequence is preferable, with one source of potential error eliminated.
with 7.23.3 (SAVR) (p=0.0158). Mean cost of TAVI was $48,536$14,173 vs. $68,970$37,902 for SAVR (p<0.0001). The main cost-driver for TAVI is the valve (58% cost). Average LOS for TAVI was half that of SAVR patients. Mean ICU cost was $4,7624,724 (TAVI) compared to $15,471$19,516 (SAVR) (p<0.0001). TAVI cost varies between centres ($53,332-Auckland, $46,985-Waikato, $48,688-Christchurch) despite similar pre-procedural clinical risk (p=0.0005). Between centres the mean SAVR cost (Auckland=$69,560 vs Waikato=$67,394) is similar (p=0.2562) with comparable clinical risk (Auckland EuroSCORE-II=7.33.4 vs Waikato EuroSCORE-II=6.83.0). Conclusion: TAVI appears cost-saving using index-admission cost in intermediate-high risk patients requiring aortic valve replacement in NZ, due to reduced use of hospital resource and LOS. These data have implications for future fund allocations for severe AS in NZ.
http://dx.doi.org/10.1016/j.hlc.2015.04.094
Single centre results of first 100 patients treated with the absorb bioresorbable vascular scaffold
Free Communications (Interventional)
W. Jaffe *, A. Ko, D. Scott, M. Lindesay
O29 National multi-centre cost-comparison of trans-catheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR) in moderate to high-risk patients with severe symptomatic aortic stenosis in New Zealand (NZ) S. Bhattacharyya 1*, M. Roskruge 2, K. Sidhu 3, R. Nair 4, D. Smyth 5, M. Webster 3, P. Ruygrok 3, J. Ormiston 3, S. Pasupati 4 1
Waitemata District Health Board, Auckland, NZ University of Waikato, Hamilton, NZ 3 Auckland District Health Board, Auckland, NZ 4 Waikato District Health Board, Waikato, NZ 5 Canterbury District Health Board, Canterbury, NZ * Corresponding author. 2
Background: Many patients with severe aortic stenosis (AS) are high-risk for SAVR due to comorbidity, frailty and anatomical limitations. TAVI is an attractive alternative solution; however, there are perceptions that it is high-cost. Policy-makers fear that expansion of TAVI will impact detrimentally upon the public healthcare budget, but savings from reduced resource utilisation may offset the high transcatheter valve cost. Methods: We compare index-admission cost and clinical data for 201 patients who received TAVI across NZ in the public system with 99 intermediate-high risk SAVR patients (using EuroSCORE-II>4) from Auckland and Waikato, from August 2008 to March 2014. Variables include age, gender, weight, EuroSCORE-II, renal function, left-ventricular function, previous sternotomy, total cost, cost-breakdown and length of stay (LOS). Results: EuroSCORE-II independently correlates with cost. Mean EuroSCORE-II was 10.27.7 (TAVI) compared
http://dx.doi.org/10.1016/j.hlc.2015.04.095
O30
Ascot Cardiology, Auckland, NZ Corresponding author.
*
Background: The Absorb Bioresorbable Vascular Scaffold (BVS) was released for clinical use in New Zealand in September 2012. We report our experience in the first 100 patients treated with this new technology. Methods: We prospectively collected clinical data on all patients in our lab who had BVS implantation. Angiographic measurements were done using a semi-quantitative technique. Results: 123 lesions were treated in 100 patients, all with stable symptoms. Mean age was 55 (90% males, 12% diabetics). Lesion location was LAD (55%), RCA (24%), Cx (21%). Lesion complexity – 35% B2/C. Calcification was none or mild in 97%. OCT was used in 15% of cases. Post dilatation was performed in 65% of cases. Procedural success was 100%. Device success was 99% - the BVS could not be advanced in one patient. Three patients with edge-dissection required “Bailout” DES. At a median follow-up of 8 months (range 1 - 29 months) 98% of patients were free of BVS-related events. There was 1 non-fatal acute stent thrombosis 6 weeks post BVS implantation. OCT following thrombus aspiration showed no obvious problem with the BVS. One patient with recurrent angina at 19 months was treated with a DES for in-stent restenosis. There was no significant in-stent restenosis (>50% diameter loss) in 19 patients who have had clinically-driven repeat angiography (at a median time of 14 months). 11 of the patients restudied had nontarget lesion revascularisation. Conclusions: At a median follow-up of 8 months excellent outcomes were achieved with this new technology, with a low rate of OCT usage. http://dx.doi.org/10.1016/j.hlc.2015.04.096