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TAVI Conduction Problems: Is it all About the Valve?
Abstracts
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revealed evidence of a coronary perforation within the distal circumflex, presumably related to snaring. The patient subsequently recovered well and was discharged on day seventeen. Rotational atherectomy within heavily calcified, angulated lesions may be extremely challenging. Snare retrieval of a free rota wire may be possible in the unlikely event of wire shear, however this is not without significant risk of further complications. http://dx.doi.org/10.1016/j.hlc.2016.06.468 467 TAVI Conduction Problems: Is it all About the Valve? J. Nathan ∗ , A. Walton, D. Stub, S. Duffy The Alfred Hospital, Melbourne, Australia Background: Left bundle branch block (LBBB) and complete heart block (CHB) are frequent complications of transcatheter aortic valve implantation (TAVI). This study addresses at what time during the procedure these conduction problems occur. Methods: A prospective analysis was performed on 86 consecutive TAVI procedures (mean age 82±6 years; female 49%). Implanted valves included self-expanding valves (Medtronic CoreValve and Evolut R: 55%, and St. Jude Portico: 8%) and balloon-expandable valves (Edwards Sapien XT and S3: 37%). The electrocardiogram characteristics of LBBB and CHB were recorded at baseline, initial valve crossing with an extra- or super-stiff wire, aortic valvuloplasty and valve deployment. Results: Nine patients were excluded from the analysis due to baseline conduction anomalies (7 LBBB; 2 ventricular pacing). Of the remaining 77 patients (46 [60%] self-expanding and 31 [40%] balloon-expanding valves), 3 (4%) acquired a LBBB with valve crossing with the wire, 16 (21%) with valvuloplasty and 23 (30%) with valve deployment. Of the LBBB occurring with valve deployment 18 (78%) occurred with selfexpanding compared to 5 (22%) balloon expandable valves (p=0.03). No new CHB were seen with valve crossing with the wire or valvuloplasty. Eleven (13%) patients acquired CHB with valve deployment (9 [73%] self–expanding, 2 [27%] balloon-expanding; p=0.07). Of these patients, four (36%) acquired CHB after sustaining a LBBB with valvuloplasty. Conclusion: This study shows a high incidence of LBBB with valvuloplasty as well as with valve deployment, as opposed to CHB, which most frequently occurs with deployment of self-expanding valves. http://dx.doi.org/10.1016/j.hlc.2016.06.469
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468 TAVI in the Younger Population: A Comparison Between <75 Year and >75 Year Cohorts N. Gaikwad ∗ , B. Khaled, S. Kyranis, M. Savage, E. Shaw, B. Robinson, J. Crowhurst, D. Murdoch, C. Raffel, K. Poon, A. Clarke, P. Tessar, D. Walters The Prince Charles Hospital, Brisbane, Australia Background: Transcatheter aortic valve replacement (TAVI) is now accepted treatment in the high surgical risk population with severe symptomatic aortic stenosis. We aimed to compare outcomes of a relatively young cohort of patients less than ≤75 years old, to the cohort of patients >75 years old. Methods: Between August 2008 and June 2015, 52 patients ≤75 years and 322 patients >75 years had TAVI at a The Prince Charles Hospital. Categorical variables were analysed with the Chi squared test and continuous variables were analysed using T test. Results: Mean age was 69.3 (+/- 5.3) in the ≤75 years group, and 84.9 (+/- 4.45) in the >75 year group. The ≤75 years group had higher incidence of prior coronary bypass surgery (p<0.05), left ventricular dysfunction (p< 0.01), higher baseline creatinine (p<0.001) and COPD (p <0.001). The ≤75 year’s group had a lower STS score (4.75 +/- 3.2 vs. 5.99 +/- 3.32, p= 0.02). There was no significant difference in procedural complication rate of MI (p= 0.47), CVA (p =0.57), vascular complications (p= 0.06) and bleeding (p = 0.71), and 30-day mortality (p = 0.85), and I year mortality (p = 0.52). Conclusion: In selected patients ≤75 years with intermediate to high surgical risk, TAVI is a safe and effective treatment with outcomes comparable to the older age population. http://dx.doi.org/10.1016/j.hlc.2016.06.470 469 Techniques for the Percutaneous Retrieval of Embolised Vascular Devices C. Mengel ∗ , S. Adusumalli, K. Bhuiyan, M. Habibian, D. Walters, K. Poon The Prince Charles Hospital, Brisbane, Australia Intravascular devices are frequently employed to allow repeated central venous access. One rare complication is embolisation. We describe three unique cases which required advanced strategies to percutaneously retrieve the foreign body.
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revealed evidence of a coronary perforation within the distal circumflex, presumably related to snaring. The patient subsequently recovered well and was discharged on day seventeen. Rotational atherectomy within heavily calcified, angulated lesions may be extremely challenging. Snare retrieval of a free rota wire may be possible in the unlikely event of wire shear, however this is not without significant risk of further complications. http://dx.doi.org/10.1016/j.hlc.2016.06.468 467 TAVI Conduction Problems: Is it all About the Valve? J. Nathan ∗ , A. Walton, D. Stub, S. Duffy The Alfred Hospital, Melbourne, Australia Background: Left bundle branch block (LBBB) and complete heart block (CHB) are frequent complications of transcatheter aortic valve implantation (TAVI). This study addresses at what time during the procedure these conduction problems occur. Methods: A prospective analysis was performed on 86 consecutive TAVI procedures (mean age 82±6 years; female 49%). Implanted valves included self-expanding valves (Medtronic CoreValve and Evolut R: 55%, and St. Jude Portico: 8%) and balloon-expandable valves (Edwards Sapien XT and S3: 37%). The electrocardiogram characteristics of LBBB and CHB were recorded at baseline, initial valve crossing with an extra- or super-stiff wire, aortic valvuloplasty and valve deployment. Results: Nine patients were excluded from the analysis due to baseline conduction anomalies (7 LBBB; 2 ventricular pacing). Of the remaining 77 patients (46 [60%] self-expanding and 31 [40%] balloon-expanding valves), 3 (4%) acquired a LBBB with valve crossing with the wire, 16 (21%) with valvuloplasty and 23 (30%) with valve deployment. Of the LBBB occurring with valve deployment 18 (78%) occurred with selfexpanding compared to 5 (22%) balloon expandable valves (p=0.03). No new CHB were seen with valve crossing with the wire or valvuloplasty. Eleven (13%) patients acquired CHB with valve deployment (9 [73%] self–expanding, 2 [27%] balloon-expanding; p=0.07). Of these patients, four (36%) acquired CHB after sustaining a LBBB with valvuloplasty. Conclusion: This study shows a high incidence of LBBB with valvuloplasty as well as with valve deployment, as opposed to CHB, which most frequently occurs with deployment of self-expanding valves. http://dx.doi.org/10.1016/j.hlc.2016.06.469
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468 TAVI in the Younger Population: A Comparison Between <75 Year and >75 Year Cohorts N. Gaikwad ∗ , B. Khaled, S. Kyranis, M. Savage, E. Shaw, B. Robinson, J. Crowhurst, D. Murdoch, C. Raffel, K. Poon, A. Clarke, P. Tessar, D. Walters The Prince Charles Hospital, Brisbane, Australia Background: Transcatheter aortic valve replacement (TAVI) is now accepted treatment in the high surgical risk population with severe symptomatic aortic stenosis. We aimed to compare outcomes of a relatively young cohort of patients less than ≤75 years old, to the cohort of patients >75 years old. Methods: Between August 2008 and June 2015, 52 patients ≤75 years and 322 patients >75 years had TAVI at a The Prince Charles Hospital. Categorical variables were analysed with the Chi squared test and continuous variables were analysed using T test. Results: Mean age was 69.3 (+/- 5.3) in the ≤75 years group, and 84.9 (+/- 4.45) in the >75 year group. The ≤75 years group had higher incidence of prior coronary bypass surgery (p<0.05), left ventricular dysfunction (p< 0.01), higher baseline creatinine (p<0.001) and COPD (p <0.001). The ≤75 year’s group had a lower STS score (4.75 +/- 3.2 vs. 5.99 +/- 3.32, p= 0.02). There was no significant difference in procedural complication rate of MI (p= 0.47), CVA (p =0.57), vascular complications (p= 0.06) and bleeding (p = 0.71), and 30-day mortality (p = 0.85), and I year mortality (p = 0.52). Conclusion: In selected patients ≤75 years with intermediate to high surgical risk, TAVI is a safe and effective treatment with outcomes comparable to the older age population. http://dx.doi.org/10.1016/j.hlc.2016.06.470 469 Techniques for the Percutaneous Retrieval of Embolised Vascular Devices C. Mengel ∗ , S. Adusumalli, K. Bhuiyan, M. Habibian, D. Walters, K. Poon The Prince Charles Hospital, Brisbane, Australia Intravascular devices are frequently employed to allow repeated central venous access. One rare complication is embolisation. We describe three unique cases which required advanced strategies to percutaneously retrieve the foreign body.