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The Relationship Between Mortality, Restrictive Mitral Filling, Ejection Fraction and End-Systolic Volume Post-Acute Myocardial Infarction: Results From an Individual Patient Meta-Analysis (MeRGE)
tion in LVOT pressure gradient. Late complications are not evident; however, long-term follow-up is required.
Abstracts
S99
Imaging
248 Intermediate and Long-Term Outcomes Following Robotic Cardiac Surgery in an Australian Cohort
249 The Relationship Between Mortality, Restrictive Mitral Filling, Ejection Fraction and End-Systolic Volume PostAcute Myocardial Infarction: Results From an Individual Patient Meta-Analysis (MeRGE)
Melynda Turner 1,∗ , Mari Botti 1,2 , Rosemary Watts 1,2 , Robyn English 1 , Christine Balfour 1
G. Whalley ∗ , M. Quintana, J. Møller, G. Gamble, A. Klein, C.M. Yu, F. Dini, R. Doughty,
doi:10.1016/j.hlc.2007.06.252
Hospital, Richmond, Victoria, Australia; 2 Epworth Hospital, Deakin University, Centre for Clinical Nursing Research, Australia 1 Epworth
Background: Robotic cardiac surgery offers an alternative to conventional sternotomy surgery; recovery is expected to be quicker and length of stay shorter presenting new challenges in the postoperative period. This paper presents the outcomes from the first Australian centre to offer robotic surgery. Since 2004, at Epworth Hospital, Richmond, the majority of patients have undergone mitral valve repair via robot-assisted minimally invasive surgery performed via thoracotomy. Methods: Data were collected prospectively from 62 consecutive patients during 4 trajectories of recovery: preoperatively, hyperacute, acute, intermediate (4-weeks) and long term (3 months). This paper reports patient recovery during the intermediate and long-term phases. Age ranged from 20 to 82 (M = 59.2, S.D. = 13.9) years; 71% male. All were elective admissions for mitral valve repair; the majority (90%) severe mitral regurgitation. Mean length of stay was 6.3 (S.D. 1.9) days compared to 8 days for traditional surgery. Results: At 4 weeks, 44% of patients had resumed employment and 52% were driving. At 12 weeks, 78% were working. Important trends in the intermediate and long term included the prevalence of groin wound complications and prevalence of thoracic wound pain (60% at 4 weeks, 30% at 12 weeks). Higher levels of pain and interference with activities of daily living were reported at 4 weeks than during the acute period. Patients reported decline in psychosocial outcomes during the intermediate phase. Conclusion: These data represent beginning experience with robotic surgery. The findings have implications for postoperative preparation of patients and the need for comparative studies to investigate the trajectory of recovery for robotic and traditional surgery. doi:10.1016/j.hlc.2007.06.253
on behalf of the MeRGE AMI collaborators The University of Auckland, Auckland, New Zealand Background: The adverse remodelling that occurs postacute myocardial infarction (AMI), including increased LV end-systolic volume (ESV) and reduced ejection fraction (EF), are important determinants of survival. The restrictive filling pattern (RFP) is associated with high LV filling pressure and also predicts outcome post-AMI. However, the relative contribution of RFP, ESV index (ESVi) and EF in predicting survival remains uncertain. The aim of this analysis was to investigate this relationship. Methods: MeRGE is a global collaboration of 12 prospective outcome studies post-AMI. This sub-analysis includes 1482 patients with complete LV volumes and EF measurements (7 studies). Cox proportional hazards model (including EF, ESVi, age and RFP) was used to determine independent predictors of outcome. EF was used in the models in two ways: EF< or >35% and as a continuous variable. Results: One hundred and forty deaths occurred over a 4-year follow-up period. Deceleration time, RFP, EF and ESVi were independently associated with outcome (univariate). In multivariate analysis, only RFP: HR 1.84 (95% CI: 1.3, 2.6), EF: HR 0.96 (95% CI: 0.94, 0.98) and age: HR 1.07 (95% CI: 1.06, 1.09) were significant independent predictors. When EF < 35% was included in the model the results were similar, RFP: HR 2.05 (95% CI: 1.46, 2.9), EF < 35%: HR 2.05 (95% CI: 1.37, 3.07) and age: HR: 1.07 (95% CI: 1.06, 1.09) contributed significantly to the model. Conclusion: RFP remained a significant predictor of outcome in this post-AMI cohort alongside age and EF. ESVi did not contribute further to the model. Thus, the assessment of EF and the RFP should be an important goal of echocardiography post-AMI. doi:10.1016/j.hlc.2007.06.254 250 Changes with Normal Ageing on Left Atrial Volume and Phases of Atrial Filling L. Thomas ∗ , A.C. Boyd, T. Mckay, M. Mikhail, D.L. Ross Westmead Hospital, University of Sydney, Australia Background: Left atrial (LA) size is emerging as a biomarker of cardiovascular disease. There is conflicting data about an increase in LA size with normal ageing. Changes due to physiological ageing need to be
ABSTRACTS
Heart, Lung and Circulation 2007;16:S1–S201
Abstracts
S99
Imaging
248 Intermediate and Long-Term Outcomes Following Robotic Cardiac Surgery in an Australian Cohort
249 The Relationship Between Mortality, Restrictive Mitral Filling, Ejection Fraction and End-Systolic Volume PostAcute Myocardial Infarction: Results From an Individual Patient Meta-Analysis (MeRGE)
Melynda Turner 1,∗ , Mari Botti 1,2 , Rosemary Watts 1,2 , Robyn English 1 , Christine Balfour 1
G. Whalley ∗ , M. Quintana, J. Møller, G. Gamble, A. Klein, C.M. Yu, F. Dini, R. Doughty,
doi:10.1016/j.hlc.2007.06.252
Hospital, Richmond, Victoria, Australia; 2 Epworth Hospital, Deakin University, Centre for Clinical Nursing Research, Australia 1 Epworth
Background: Robotic cardiac surgery offers an alternative to conventional sternotomy surgery; recovery is expected to be quicker and length of stay shorter presenting new challenges in the postoperative period. This paper presents the outcomes from the first Australian centre to offer robotic surgery. Since 2004, at Epworth Hospital, Richmond, the majority of patients have undergone mitral valve repair via robot-assisted minimally invasive surgery performed via thoracotomy. Methods: Data were collected prospectively from 62 consecutive patients during 4 trajectories of recovery: preoperatively, hyperacute, acute, intermediate (4-weeks) and long term (3 months). This paper reports patient recovery during the intermediate and long-term phases. Age ranged from 20 to 82 (M = 59.2, S.D. = 13.9) years; 71% male. All were elective admissions for mitral valve repair; the majority (90%) severe mitral regurgitation. Mean length of stay was 6.3 (S.D. 1.9) days compared to 8 days for traditional surgery. Results: At 4 weeks, 44% of patients had resumed employment and 52% were driving. At 12 weeks, 78% were working. Important trends in the intermediate and long term included the prevalence of groin wound complications and prevalence of thoracic wound pain (60% at 4 weeks, 30% at 12 weeks). Higher levels of pain and interference with activities of daily living were reported at 4 weeks than during the acute period. Patients reported decline in psychosocial outcomes during the intermediate phase. Conclusion: These data represent beginning experience with robotic surgery. The findings have implications for postoperative preparation of patients and the need for comparative studies to investigate the trajectory of recovery for robotic and traditional surgery. doi:10.1016/j.hlc.2007.06.253
on behalf of the MeRGE AMI collaborators The University of Auckland, Auckland, New Zealand Background: The adverse remodelling that occurs postacute myocardial infarction (AMI), including increased LV end-systolic volume (ESV) and reduced ejection fraction (EF), are important determinants of survival. The restrictive filling pattern (RFP) is associated with high LV filling pressure and also predicts outcome post-AMI. However, the relative contribution of RFP, ESV index (ESVi) and EF in predicting survival remains uncertain. The aim of this analysis was to investigate this relationship. Methods: MeRGE is a global collaboration of 12 prospective outcome studies post-AMI. This sub-analysis includes 1482 patients with complete LV volumes and EF measurements (7 studies). Cox proportional hazards model (including EF, ESVi, age and RFP) was used to determine independent predictors of outcome. EF was used in the models in two ways: EF< or >35% and as a continuous variable. Results: One hundred and forty deaths occurred over a 4-year follow-up period. Deceleration time, RFP, EF and ESVi were independently associated with outcome (univariate). In multivariate analysis, only RFP: HR 1.84 (95% CI: 1.3, 2.6), EF: HR 0.96 (95% CI: 0.94, 0.98) and age: HR 1.07 (95% CI: 1.06, 1.09) were significant independent predictors. When EF < 35% was included in the model the results were similar, RFP: HR 2.05 (95% CI: 1.46, 2.9), EF < 35%: HR 2.05 (95% CI: 1.37, 3.07) and age: HR: 1.07 (95% CI: 1.06, 1.09) contributed significantly to the model. Conclusion: RFP remained a significant predictor of outcome in this post-AMI cohort alongside age and EF. ESVi did not contribute further to the model. Thus, the assessment of EF and the RFP should be an important goal of echocardiography post-AMI. doi:10.1016/j.hlc.2007.06.254 250 Changes with Normal Ageing on Left Atrial Volume and Phases of Atrial Filling L. Thomas ∗ , A.C. Boyd, T. Mckay, M. Mikhail, D.L. Ross Westmead Hospital, University of Sydney, Australia Background: Left atrial (LA) size is emerging as a biomarker of cardiovascular disease. There is conflicting data about an increase in LA size with normal ageing. Changes due to physiological ageing need to be
ABSTRACTS
Heart, Lung and Circulation 2007;16:S1–S201