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Thrombocytopenia Post Transcatheter Aortic Valve Insertion: A Single Centre Experience
Abstracts
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There were no significant differences in key performance measures among the participating hospitals. Conclusion: VCOR has identified high-quality PCI outcomes in Victoria across a 2-year period, with notable trends towards increased use of radial access and drug-eluting stents, and no performance outliers among participating hospitals. http://dx.doi.org/10.1016/j.hlc.2016.06.478 477 Three-Year Follow-up of Transcatheter Aortic Valve Intervention Cases From a Single Private Hospital M. Silagy 1,∗ , J. Warren 2 , J. Doyle 3 , R. Dick 3 , A. Walton 3 1 Monash
Health, Dandenong Hospital, Dandenong, Australia 2 Alfred Health, Alfred Hospital, Prahran, Australia 3 Victorian Cardiovascular Services Epworth Hospital, Richmond, Australia Background: Aortic stenosis confers a poor prognosis following the onset of symptoms. Transcatheter aortic valve intervention (TAVI) has become the optimal treatment in high risk patients. Success rates have improved with new technologies and operator experience. We present the 3-year data of the single-centre private hospital experience in Melbourne. Method: We evaluated 194 consecutive patients who underwent TAVI at the Epworth Hospital between March 2010 and December 2015. Patients were followed up to three years, with transthoracic echocardiography performed at 1 month, 6 months and 1-, 2- and 3-years. Results: 196 TAVI procedures were performed on 194 patients (104 females, mean age 84.7 years). The mean STS score was 5.22, with 26 high risk patients (STS >8%). Most patients (n. 143) were classified NYHA III/IV. Of the valves implanted, 166 were Corevalve, 26 Evolut R and 2 Centera. 55 patients required pacemaker insertion in the month following their procedure. Mean length of stay was 6.5 days ± 4.37. At one month, the all-cause mortality rate was 2.7% (n = 5) with a mean STS score of 6.6 in these patients (1 high risk, 3 intermediate-risk), 8.1% at 6-months (n=14, mean STS 6.8, 3 high risk, 9 intermediate-risk) and 9.3% at one year. At two years, mortality was 16.7% and 20% at three years. There was a reduction in MPG from baseline (50.9 ± 15.53) to one-year (9.89 ± 3.27). Conclusion: We describe the outcomes of 194 patients undergoing TAVI at the Epworth Hospital. TAVI offers an alternative to patients who are high risk for aortic valve replacement surgery. http://dx.doi.org/10.1016/j.hlc.2016.06.479
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478 Thrombocytopenia Post Transcatheter Aortic Valve Insertion: A Single Centre Experience S. Kyranis 1,2,∗ , R. Markham 1,2 , E. Shaw 1,2 , M. Savage 1,2 , J. Crowhurst 1,2 , D. Murdoch 1,2 , K. Poon 1,2 , O. Raffel 1,2 , D. Walters 1,2 1 The
Prince Charles Hospital, Brisbane, Australia 2 University of Queensland, Brisbane, Australia Introduction: Thromboctyopenia post transcatheter aortic valve insertion (TAVI) is reported in the literature with a suggested association with mortality. Hypothesis: Early major thrombocytopenia post Transcatheter Aortic Valve Insertion is predictive of survival at 30 days. Methods: All patients that underwent TAVI (surgical or via the femoral approach) at The Prince Charles Hospital between August 2008 and December 2014 were included in this study. Platelet counts were routinely measured the day prior to procedure and daily for the first five days post procedure. Thrombocytopenia was defined as a platelet count of less than 100x109 /L. Platelet counts were entered retrospectively into a standardised registry which was then analysed. Platelet count nadir was assessed as a predictor of 30-day mortality. Results: 329 patients underwent TAVI with 222 transfemoral and 107 surgical TAVI (60 transaortic, 42 transapical and 5 subclavian). 85 (25.8%) patients had a nadir platelet count of less than 100x109 /L. Mortality was significantly higher in patients with a nadir platelet count of less than 100x109 /L (8.2% vs 2.0%, LR 5.9, p-value = 0.015) Conclusion: Early thrombocytopenia post TAVI is associated with higher 30-day mortality. http://dx.doi.org/10.1016/j.hlc.2016.06.480 479 TOE Guidance May Not be Required for TAVR With the Repositionable Lotus Valve D. Jackson 1,∗ , R. Gooley 1,2 , R. Muthalaly 1 , I. Meredith 1,2 , S. Zaman 1,2 , L. McCormick 1 , S. Ramkumar 1 , H. Rashid 1 , S. Lockwood 1 , Y. Koh 1 , N. Nerleker 1 , P. Mottram 1 1 MonashHEART,
Monash Health, Melbourne, Australia 2 Monash University, Melbourne, Australia Objective: Determine the impact of transoesophageal echocardiography (TOE) guidance on outcomes in patients undergoing TAVR with the repositionable Lotus valve. Introduction: Early in the TAVR experience, the procedure was largely performed with TOE guidance. Given the repositionability of the Lotus valve, TOE guidance and therefore general anaesthesia may be avoided.
S204
There were no significant differences in key performance measures among the participating hospitals. Conclusion: VCOR has identified high-quality PCI outcomes in Victoria across a 2-year period, with notable trends towards increased use of radial access and drug-eluting stents, and no performance outliers among participating hospitals. http://dx.doi.org/10.1016/j.hlc.2016.06.478 477 Three-Year Follow-up of Transcatheter Aortic Valve Intervention Cases From a Single Private Hospital M. Silagy 1,∗ , J. Warren 2 , J. Doyle 3 , R. Dick 3 , A. Walton 3 1 Monash
Health, Dandenong Hospital, Dandenong, Australia 2 Alfred Health, Alfred Hospital, Prahran, Australia 3 Victorian Cardiovascular Services Epworth Hospital, Richmond, Australia Background: Aortic stenosis confers a poor prognosis following the onset of symptoms. Transcatheter aortic valve intervention (TAVI) has become the optimal treatment in high risk patients. Success rates have improved with new technologies and operator experience. We present the 3-year data of the single-centre private hospital experience in Melbourne. Method: We evaluated 194 consecutive patients who underwent TAVI at the Epworth Hospital between March 2010 and December 2015. Patients were followed up to three years, with transthoracic echocardiography performed at 1 month, 6 months and 1-, 2- and 3-years. Results: 196 TAVI procedures were performed on 194 patients (104 females, mean age 84.7 years). The mean STS score was 5.22, with 26 high risk patients (STS >8%). Most patients (n. 143) were classified NYHA III/IV. Of the valves implanted, 166 were Corevalve, 26 Evolut R and 2 Centera. 55 patients required pacemaker insertion in the month following their procedure. Mean length of stay was 6.5 days ± 4.37. At one month, the all-cause mortality rate was 2.7% (n = 5) with a mean STS score of 6.6 in these patients (1 high risk, 3 intermediate-risk), 8.1% at 6-months (n=14, mean STS 6.8, 3 high risk, 9 intermediate-risk) and 9.3% at one year. At two years, mortality was 16.7% and 20% at three years. There was a reduction in MPG from baseline (50.9 ± 15.53) to one-year (9.89 ± 3.27). Conclusion: We describe the outcomes of 194 patients undergoing TAVI at the Epworth Hospital. TAVI offers an alternative to patients who are high risk for aortic valve replacement surgery. http://dx.doi.org/10.1016/j.hlc.2016.06.479
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478 Thrombocytopenia Post Transcatheter Aortic Valve Insertion: A Single Centre Experience S. Kyranis 1,2,∗ , R. Markham 1,2 , E. Shaw 1,2 , M. Savage 1,2 , J. Crowhurst 1,2 , D. Murdoch 1,2 , K. Poon 1,2 , O. Raffel 1,2 , D. Walters 1,2 1 The
Prince Charles Hospital, Brisbane, Australia 2 University of Queensland, Brisbane, Australia Introduction: Thromboctyopenia post transcatheter aortic valve insertion (TAVI) is reported in the literature with a suggested association with mortality. Hypothesis: Early major thrombocytopenia post Transcatheter Aortic Valve Insertion is predictive of survival at 30 days. Methods: All patients that underwent TAVI (surgical or via the femoral approach) at The Prince Charles Hospital between August 2008 and December 2014 were included in this study. Platelet counts were routinely measured the day prior to procedure and daily for the first five days post procedure. Thrombocytopenia was defined as a platelet count of less than 100x109 /L. Platelet counts were entered retrospectively into a standardised registry which was then analysed. Platelet count nadir was assessed as a predictor of 30-day mortality. Results: 329 patients underwent TAVI with 222 transfemoral and 107 surgical TAVI (60 transaortic, 42 transapical and 5 subclavian). 85 (25.8%) patients had a nadir platelet count of less than 100x109 /L. Mortality was significantly higher in patients with a nadir platelet count of less than 100x109 /L (8.2% vs 2.0%, LR 5.9, p-value = 0.015) Conclusion: Early thrombocytopenia post TAVI is associated with higher 30-day mortality. http://dx.doi.org/10.1016/j.hlc.2016.06.480 479 TOE Guidance May Not be Required for TAVR With the Repositionable Lotus Valve D. Jackson 1,∗ , R. Gooley 1,2 , R. Muthalaly 1 , I. Meredith 1,2 , S. Zaman 1,2 , L. McCormick 1 , S. Ramkumar 1 , H. Rashid 1 , S. Lockwood 1 , Y. Koh 1 , N. Nerleker 1 , P. Mottram 1 1 MonashHEART,
Monash Health, Melbourne, Australia 2 Monash University, Melbourne, Australia Objective: Determine the impact of transoesophageal echocardiography (TOE) guidance on outcomes in patients undergoing TAVR with the repositionable Lotus valve. Introduction: Early in the TAVR experience, the procedure was largely performed with TOE guidance. Given the repositionability of the Lotus valve, TOE guidance and therefore general anaesthesia may be avoided.