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The First New Zealand Experience of Percutaneous Coronary Intervention Without Onsite Cardiac Surgery
S2
Abstracts
Heart, Lung and Circulation 2009;18S:S1–S31
ABSTRACTS
1 THE FIRST NEW ZEALAND EXPERIENCE OF PERCUTANEOUS CORONARY INTERVENTION WITHOUT ONSITE CARDIAC SURGERY
Results: 17 patients have undergone PFO closure since 17 June 2008.
P Adamson ∗ , J Ayling, J Gillespie, J Walker, A Hamer, N Fisher
Baseline characteristics Male (%) Age, median (range)
Nelson Hospital, Nelson, New Zealand Background: Percutaneous Coronary Intervention (PCI) is a well recognised treatment for stable angina and in the setting of an acute coronary syndrome (ACS) has morbidity and mortality benefit if performed within 72 h. Time delays often mean that these benefits are not afforded to patients in provincial hospitals who are transferred at considerable expense. The increased safety of PCI has allowed these issues to be addressed internationally by providing local PCI in non-surgical centres. Nelson Hospital recently became the first non-surgical centre to offer PCI in New Zealand. We report on our first year of operation. Methods: Tertiary centre operator supervision was provided locally for the first 2 months following which all cases were performed by a single resident operator. Results: 180 patients were treated (77% male; average age 60). The average wait time for acute PCI fell from 96 to 57 h. In total 212 stents were deployed (31% drug-eluting). There were no major procedure-related complications. No patients required transfer for emergency cardiac surgery. The majority of cases (64%) were in the setting of an ACS including primary PCI which by necessity required high risk patients to be included in this cohort. Initial indications suggest savings in excess of $300,000. Conclusion: Our early results suggest comparable outcomes with other international peripheral PCI centres. We have safely achieved our objective of significantly reducing waiting times for acute revascularisation while achieving significant cost reductions for the district health board. These outcomes support consideration of expanding this service to other NZ provincial hospitals. doi:10.1016/j.hlc.2009.04.004 2 CHRISTCHURCH HOSPITAL EXPERIENCE IN PFO CLOSURE S Aldous ∗ , R Troughton, J Blake Christchurch Hospital, New Zealand Background: There is some evidence that a patent foramen ovale (PFO) is the culprit in otherwise unexplained paradoxical embolic events. Percutaneous closure of PFO to prevent recurrent events is an emerging therapeutic option in selected patients. Methods: An audit was undertaken of all patients undergoing closure of PFO at Christchurch Hospital. All PFOs were closed using an Amplatzer PFO occluder under fluoroscopic and intra-cardiac echo guidance.
N
Vascular risk factors (%) Hypertension Dyslipidaemia
10 (59) 45 (28–68) 3 (18) 6 (35)
Smoking history Current Ex
4 (24) 2 (12) 2 (12)
Diabetes Ischaemic heart disease PVD
0 0 0
Presentation (%) Cerebrovascular accident Trans-ischaemic attack Peripheral embolism
12 (70) 3 (18) 2 (12)
Referral source (%) Neurology Surgery Ophthalmology General medicine
14 (82) 1 (6) 1 (6) 1 (6)
Echo characteristics (%) PFO on colour Doppler alone PFO on colour Doppler + contrast (bubble study) Mobile atrial septum Atrial septal aneurysm Procedural characteristics (%) Device Amplatzer 25mm PFO occluder Amplatzer 35mm PFO occluder Procedural success Complications Follow-up data* (%) Embolic events (17 patients reviewed clinically) Residual shunt (14 patients reviewed by echo)
13 (76) 17 (100) 17 (100) 11 (65)
16 (94) 1 (6) 17 (100) 0
0 2 (14)
* Clinical review at 6 weeks, transthoracic echo with bubble study at 6 months.
Conclusion: Percutaneous closure of PFOs in our institution is a safe procedure with no recurrent events at short term follow-up. doi:10.1016/j.hlc.2009.04.005
Abstracts
Heart, Lung and Circulation 2009;18S:S1–S31
ABSTRACTS
1 THE FIRST NEW ZEALAND EXPERIENCE OF PERCUTANEOUS CORONARY INTERVENTION WITHOUT ONSITE CARDIAC SURGERY
Results: 17 patients have undergone PFO closure since 17 June 2008.
P Adamson ∗ , J Ayling, J Gillespie, J Walker, A Hamer, N Fisher
Baseline characteristics Male (%) Age, median (range)
Nelson Hospital, Nelson, New Zealand Background: Percutaneous Coronary Intervention (PCI) is a well recognised treatment for stable angina and in the setting of an acute coronary syndrome (ACS) has morbidity and mortality benefit if performed within 72 h. Time delays often mean that these benefits are not afforded to patients in provincial hospitals who are transferred at considerable expense. The increased safety of PCI has allowed these issues to be addressed internationally by providing local PCI in non-surgical centres. Nelson Hospital recently became the first non-surgical centre to offer PCI in New Zealand. We report on our first year of operation. Methods: Tertiary centre operator supervision was provided locally for the first 2 months following which all cases were performed by a single resident operator. Results: 180 patients were treated (77% male; average age 60). The average wait time for acute PCI fell from 96 to 57 h. In total 212 stents were deployed (31% drug-eluting). There were no major procedure-related complications. No patients required transfer for emergency cardiac surgery. The majority of cases (64%) were in the setting of an ACS including primary PCI which by necessity required high risk patients to be included in this cohort. Initial indications suggest savings in excess of $300,000. Conclusion: Our early results suggest comparable outcomes with other international peripheral PCI centres. We have safely achieved our objective of significantly reducing waiting times for acute revascularisation while achieving significant cost reductions for the district health board. These outcomes support consideration of expanding this service to other NZ provincial hospitals. doi:10.1016/j.hlc.2009.04.004 2 CHRISTCHURCH HOSPITAL EXPERIENCE IN PFO CLOSURE S Aldous ∗ , R Troughton, J Blake Christchurch Hospital, New Zealand Background: There is some evidence that a patent foramen ovale (PFO) is the culprit in otherwise unexplained paradoxical embolic events. Percutaneous closure of PFO to prevent recurrent events is an emerging therapeutic option in selected patients. Methods: An audit was undertaken of all patients undergoing closure of PFO at Christchurch Hospital. All PFOs were closed using an Amplatzer PFO occluder under fluoroscopic and intra-cardiac echo guidance.
N
Vascular risk factors (%) Hypertension Dyslipidaemia
10 (59) 45 (28–68) 3 (18) 6 (35)
Smoking history Current Ex
4 (24) 2 (12) 2 (12)
Diabetes Ischaemic heart disease PVD
0 0 0
Presentation (%) Cerebrovascular accident Trans-ischaemic attack Peripheral embolism
12 (70) 3 (18) 2 (12)
Referral source (%) Neurology Surgery Ophthalmology General medicine
14 (82) 1 (6) 1 (6) 1 (6)
Echo characteristics (%) PFO on colour Doppler alone PFO on colour Doppler + contrast (bubble study) Mobile atrial septum Atrial septal aneurysm Procedural characteristics (%) Device Amplatzer 25mm PFO occluder Amplatzer 35mm PFO occluder Procedural success Complications Follow-up data* (%) Embolic events (17 patients reviewed clinically) Residual shunt (14 patients reviewed by echo)
13 (76) 17 (100) 17 (100) 11 (65)
16 (94) 1 (6) 17 (100) 0
0 2 (14)
* Clinical review at 6 weeks, transthoracic echo with bubble study at 6 months.
Conclusion: Percutaneous closure of PFOs in our institution is a safe procedure with no recurrent events at short term follow-up. doi:10.1016/j.hlc.2009.04.005