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Non-Surgical Patients with Severe Aortic Stenosis – The Prince Charles Hospital Experience
8 Trans-Catheter Aortic Valve Replacement for High Surgical Risk/Non-Surgical Patients with Severe Aortic Stenosis – The Prince Charles Hospital Experience M. Savage 1,∗ , V. Subban 1 , A. Incani 1 , A. Clarke 1 , C. Raffel 1 , C. Aroney 2 , D. Walters 1 1 The
Prince Charles Hospital, Australia Spirit Northside Hospital, Australia
2 Holy
Background: Trans-catheter aortic valve replacement (TAVI) has been shown to improve outcomes in nonsurgical patients with severe aortic stenosis and be an alternative treatment option in patients with high surgical risk. Methods: We analysed demographics, procedural characteristics and outcomes of patients who underwent TAVI in our institute between January 2008 and January 2013. Results: A total of 204 patients underwent TAVI during this period: 197 patients for degenerated native aortic valve and seven for failed prosthetic valves. The mean age was 83.7 ± 6.5 years and 99 (49%) were males. The various valves implanted were: Medtronic-CoreValve (Medtronic, Minneapolis, Minnesota) in 84 (41.2%), Edwards-SAPIEN valve (Edwards Lifesciences, Irvine, California) in 101 (49.5%) and Sadra Lotus valve (Boston Scientific, USA) in 19 (9.3%) patients. The approach was trans-femoral in 138 (67.6%), trans-subclavian in 3 (1.5%), trans-aortic in 30 (14.7%), and trans-apical in 33 (16.2%) patients. The valve successfully implanted in 201 (98.5%) patients. The 30 day mortality was 10 (4.84%) and the one year mortality in those who had the valves done before February 2012 was 15 (7.53%). Conclusions: TAVI with various devices and through various approaches is feasible in high surgical risk/non surgical patients with severe aortic stenosis with acceptable outcomes at short and intermediate follow up. http://dx.doi.org/10.1016/j.hlc.2013.05.009 9 Family Screening for Hypertrophic Cardiomyopathy is Underperformed – A First Year Experience from the HCM Clinic @ The Alfred A. Olaussen 1,∗ , I. Macciocca 2,3 , A. Ellims 2,4 1 Monash
University, Melbourne, Australia Clinic @ The Alfred, Melbourne, Australia 3 Victorian Clinical Genetics Services, Murdoch Childrens Research Institute, Melbourne, Australia 4 Baker IDI Heart and Diabetes Institute, Melbourne, Australia 2 HCM
Background: Hypertrophic cardiomyopathy (HCM) is the most common genetically determined cardiac disease and can cause significant morbidity and sudden death. Relatives of affected patients are at risk of developing the disease due to its autosomal dominant inheritance. CSANZ guidelines strongly recommend clinical screening, including echocardiography, for all first-degree
CSANZ 2013 Abstracts
S5
relatives of HCM patients. We sought to determine the degree of adherence to these guidelines in patients referred to our newly established specialised HCM clinic. Methods: A detailed family pedigree was obtained from all patients referred to the HCM Clinic @ The Alfred during its first year of operation. For each patient with clinically diagnosed HCM, the number of living first-degree relatives was determined, as was whether they had previously been screened with echocardiography. Results: Sixty-one of 66 patients evaluated in our HCM clinic had a clinical diagnosis of HCM. These patients had a total of 302 living first-degree relatives, of whom only 80 (26%) had previously had a screening echocardiogram. Of these relatives, 13 (16%) had been diagnosed with HCM following screening. Conclusions: Recommended family screening for HCM is performed in only a quarter of at-risk first-degree relatives. As a result, a significant number of cases of subclinical HCM are missed, leading to potentially preventable instances of serious morbidity and mortality. A co-ordinated screening approach via a specialised HCM service may improve adherence to CSANZ guidelines. http://dx.doi.org/10.1016/j.hlc.2013.05.010 10 TRPC6 (Canonical Transient Receptor Potential Ca2+ Channel 6) is An Important Mediator of Mechanical Stretch Responses in the Atrial Endocardial Endothelium V. Nikolova-Krstevski 1,∗ , S. Wagner 2 , I. Bowman 1 , O. Friedrich 2 , D. Fatkin 1 1 Victor
Chang Cardiac Research Institute, Australia of Erlangen, Germany
2 University
Atrial fibrillation (AF) is the most common heart arrhythmia and a major risk factor for hearth failure. Atrial pressure and/or volume overload are the common features of the diseases that cause AF suggesting that mechanical stress has a major role in the pathogenesis of AF. The atrial endocardial endothelium (AE) is the interface between the myocardium and the circulating blood but its role in the mechanotransduction in the atrium is unknown. We investigated the AE responses to increased mechanical stretch by subjecting novel primary AE cells to mechanical stretch. The mechanical stretch conditions included cyclic stretch of 30 cycles/min at 10% displacement. Changes in the cell shape with elongation, hypertrophy and re-alignment of the cells and their stress fibres in a direction perpendicular to the lines of stretch were first observed after 1 h of stretch. Redistribution and changed levels of expression of the stretch-sensitive Ca2+ channel TRPC6 in the stretched AE was a major finding. The latter suggested changed TRPC6 activity in the stretched AE, which was evaluated by measuring the levels of intracellular Ca2+ in the cells under baseline and stretch conditions. We found that short-stretch (1–10 min) increased TRPC6 activity, while the long stretch (1–24 h) silenced it. These findings suggest that TRPC6 is an important mediator of mechanical stretch responses in the AE;
ABSTRACTS
Heart, Lung and Circulation 2013;22:S1–S125
Prince Charles Hospital, Australia Spirit Northside Hospital, Australia
2 Holy
Background: Trans-catheter aortic valve replacement (TAVI) has been shown to improve outcomes in nonsurgical patients with severe aortic stenosis and be an alternative treatment option in patients with high surgical risk. Methods: We analysed demographics, procedural characteristics and outcomes of patients who underwent TAVI in our institute between January 2008 and January 2013. Results: A total of 204 patients underwent TAVI during this period: 197 patients for degenerated native aortic valve and seven for failed prosthetic valves. The mean age was 83.7 ± 6.5 years and 99 (49%) were males. The various valves implanted were: Medtronic-CoreValve (Medtronic, Minneapolis, Minnesota) in 84 (41.2%), Edwards-SAPIEN valve (Edwards Lifesciences, Irvine, California) in 101 (49.5%) and Sadra Lotus valve (Boston Scientific, USA) in 19 (9.3%) patients. The approach was trans-femoral in 138 (67.6%), trans-subclavian in 3 (1.5%), trans-aortic in 30 (14.7%), and trans-apical in 33 (16.2%) patients. The valve successfully implanted in 201 (98.5%) patients. The 30 day mortality was 10 (4.84%) and the one year mortality in those who had the valves done before February 2012 was 15 (7.53%). Conclusions: TAVI with various devices and through various approaches is feasible in high surgical risk/non surgical patients with severe aortic stenosis with acceptable outcomes at short and intermediate follow up. http://dx.doi.org/10.1016/j.hlc.2013.05.009 9 Family Screening for Hypertrophic Cardiomyopathy is Underperformed – A First Year Experience from the HCM Clinic @ The Alfred A. Olaussen 1,∗ , I. Macciocca 2,3 , A. Ellims 2,4 1 Monash
University, Melbourne, Australia Clinic @ The Alfred, Melbourne, Australia 3 Victorian Clinical Genetics Services, Murdoch Childrens Research Institute, Melbourne, Australia 4 Baker IDI Heart and Diabetes Institute, Melbourne, Australia 2 HCM
Background: Hypertrophic cardiomyopathy (HCM) is the most common genetically determined cardiac disease and can cause significant morbidity and sudden death. Relatives of affected patients are at risk of developing the disease due to its autosomal dominant inheritance. CSANZ guidelines strongly recommend clinical screening, including echocardiography, for all first-degree
CSANZ 2013 Abstracts
S5
relatives of HCM patients. We sought to determine the degree of adherence to these guidelines in patients referred to our newly established specialised HCM clinic. Methods: A detailed family pedigree was obtained from all patients referred to the HCM Clinic @ The Alfred during its first year of operation. For each patient with clinically diagnosed HCM, the number of living first-degree relatives was determined, as was whether they had previously been screened with echocardiography. Results: Sixty-one of 66 patients evaluated in our HCM clinic had a clinical diagnosis of HCM. These patients had a total of 302 living first-degree relatives, of whom only 80 (26%) had previously had a screening echocardiogram. Of these relatives, 13 (16%) had been diagnosed with HCM following screening. Conclusions: Recommended family screening for HCM is performed in only a quarter of at-risk first-degree relatives. As a result, a significant number of cases of subclinical HCM are missed, leading to potentially preventable instances of serious morbidity and mortality. A co-ordinated screening approach via a specialised HCM service may improve adherence to CSANZ guidelines. http://dx.doi.org/10.1016/j.hlc.2013.05.010 10 TRPC6 (Canonical Transient Receptor Potential Ca2+ Channel 6) is An Important Mediator of Mechanical Stretch Responses in the Atrial Endocardial Endothelium V. Nikolova-Krstevski 1,∗ , S. Wagner 2 , I. Bowman 1 , O. Friedrich 2 , D. Fatkin 1 1 Victor
Chang Cardiac Research Institute, Australia of Erlangen, Germany
2 University
Atrial fibrillation (AF) is the most common heart arrhythmia and a major risk factor for hearth failure. Atrial pressure and/or volume overload are the common features of the diseases that cause AF suggesting that mechanical stress has a major role in the pathogenesis of AF. The atrial endocardial endothelium (AE) is the interface between the myocardium and the circulating blood but its role in the mechanotransduction in the atrium is unknown. We investigated the AE responses to increased mechanical stretch by subjecting novel primary AE cells to mechanical stretch. The mechanical stretch conditions included cyclic stretch of 30 cycles/min at 10% displacement. Changes in the cell shape with elongation, hypertrophy and re-alignment of the cells and their stress fibres in a direction perpendicular to the lines of stretch were first observed after 1 h of stretch. Redistribution and changed levels of expression of the stretch-sensitive Ca2+ channel TRPC6 in the stretched AE was a major finding. The latter suggested changed TRPC6 activity in the stretched AE, which was evaluated by measuring the levels of intracellular Ca2+ in the cells under baseline and stretch conditions. We found that short-stretch (1–10 min) increased TRPC6 activity, while the long stretch (1–24 h) silenced it. These findings suggest that TRPC6 is an important mediator of mechanical stretch responses in the AE;
ABSTRACTS
Heart, Lung and Circulation 2013;22:S1–S125