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Validation of the Cardiac Prioritisation Score for Heart Valve Surgery
Results: Over the last 28 months, 50 patients with a PFO were identified, and 39 patients were included in follow up period. Average follow up was 263 days (25–680). PFOs were closed with a device in 22/39 (56.4%) patients while 17 (43.6%) were managed medically. Those who have their PFO closed with a device were more likely to have an atrial septal aneurysm (95.5% vs. 26.7%, p < 0.0001), a greater number of embolic events (1.9 vs. 0.7, p = 0.0003) and possibly a large shunt (63.6% vs. 40%, p = 0.19). Where attempted, a closure device was successfully implanted in all cases. There was no recurrence of an embolic event in either group. Prior to treatment, 40% of medically managed patients had migraines, none of them improved. 36.4% of PFO closure patients had migraine with significant improvement in 62%. Conclusion: Medium term follow up of our registry data demonstrates a good outcome in both medically and interventionally managed patients. doi:10.1016/j.hlc.2011.03.082 Validation of the Cardiac Prioritisation Score for Heart Valve Surgery A.S. Sasse 1,2,∗ , B.D. Mahon 3 , I. Wignall 1 , S. Burgess 2 , S.A. Harding 1,2 , P.D. Larsen 1,4 1 Wellington Cardiovascular Research Group, Wellington, New Zealand 2 Cardiology Department, Wellington Hospital, Wellington, New Zealand 3 Department of Cardiothoracic Surgery, Wellington Hospital, Wellington, New Zealand 4 University of Otago Wellington, Wellington, New Zealand
Background: The Cardiac Prioritisation Score (CPS) has been developed to assist in prioritisation of patients accepted for valve repair surgery, but CPS has not yet been validated. This retrospective study focuses on the potential of CPS to reduce major adverse cardiac events (MACE) in patients waiting for valve surgery in the New Zealand Central Region. Methods: The medical records of all patients accepted for valve surgery between July 1 2007 and July 29 2008 were retrospectively reviewed noting any MACE. CPS score was calculated and a corresponding recommended waiting time was determined. Results: A total of 137 patients were included in the study, 55% were listed for aortic valve surgery, 40% for mitral valve surgery and 5% for dual valve procedures. Median delay from listing to procedure was 146 days. CPS scoring recommended 65% of patients receive surgery within 90 days, 30% within 30 days and 5% within 10 days of listing. 23.4% of patients were operated within the CPS recommended timeframe. Seven patients experienced MACE (one death, four heart failure events and two arrhythmia events). In four of these cases the events occurred within the CPS recommended operation time. In three cases (including the death) the MACE occurred later than the CPS recommended timeframe to surgery.
Abstracts
407
Conclusion: While use of CPS would not have eliminated MACE in this population, 3/7 events would have been prevented if operated in the time frame recommended by their CPS score. Further evaluation of the CPS tool, including against additional endpoints, is required. doi:10.1016/j.hlc.2011.03.083 Radial vs Femoral Arterial Approach in Rescue Angioplasty – Wellington Regional Hospital Experience N.M. Shah 1,∗ , P.D. Larsen 2 , S.A. Harding 1 1 Cardiology
Department, Wellington Regional Hospital, Wellington, New Zealand 2 University of Otago, Wellington, New Zealand Background: Previous studies have suggested that radial access for percutaneous coronary intervention (PCI) results in fewer access site and bleeding complications. We sought to compare the radial and femoral approach in the setting of rescue PCI for failed thrombolysis. Method: We retrospectively evaluated 71 consecutive patients undergoing rescue PCI within 12 hours of thrombolysis at Wellington Hospital between January 2007 and September 2010. Patients requiring an intra-aortic balloon pump were excluded. Data was collected from the PCI database and medical records. Results: Radial access was used in 31 (43.7%) and femoral access in 40 (56.3%) patients. Demographic variables, clinical risk factors and infarction related arteries were similar. There were similar numbers of shocked patients in the femoral and radial groups (14.3% vs. 9.7%, p = 0.23). Access through the initial arterial site selected was100% in both groups. Thrombectomy catheter use was more common in the radial group (35.5% vs. 10%, p = 0.009). There were no significant differences in procedure duration, fluoroscopy time or contrast volume between the groups. Angiographic success was 100% in both groups and procedure success was similar (97.5% femoral vs. 93.5% radial). In hospital MACE occurred in one patient in both groups. There were 3 (7.5%) large haematomas in the femoral group and none in the radial (p = 0.27). Major bleeding occurred in 7 (17.5%) patients in the femoral and 6 (19.4%) in the radial group (p = 0.84). Conclusion: Radial access for rescue PCI has a similar success rate to femoral access and is associated with similar outcomes. doi:10.1016/j.hlc.2011.03.084 Implantable Cardioverter Defibrillator (ICD) and Cardiac Resynchronisation Therapy (CRT) Referrals and Survival Outcomes Over a Decade at a Secondary Level Hospital R. Sharma ∗ , T. O’Meeghan, T. Boga Hutt Valley District Health Board, Hutt Hospital, Lower Hutt, New Zealand Background: Device therapy using ICD or CRT has been shown to reduce morbidity and mortality in patients at high risk of sudden cardiac death (SCD). This study was
ABSTRACTS
Heart, Lung and Circulation 2011;20:376–419
Background: The Cardiac Prioritisation Score (CPS) has been developed to assist in prioritisation of patients accepted for valve repair surgery, but CPS has not yet been validated. This retrospective study focuses on the potential of CPS to reduce major adverse cardiac events (MACE) in patients waiting for valve surgery in the New Zealand Central Region. Methods: The medical records of all patients accepted for valve surgery between July 1 2007 and July 29 2008 were retrospectively reviewed noting any MACE. CPS score was calculated and a corresponding recommended waiting time was determined. Results: A total of 137 patients were included in the study, 55% were listed for aortic valve surgery, 40% for mitral valve surgery and 5% for dual valve procedures. Median delay from listing to procedure was 146 days. CPS scoring recommended 65% of patients receive surgery within 90 days, 30% within 30 days and 5% within 10 days of listing. 23.4% of patients were operated within the CPS recommended timeframe. Seven patients experienced MACE (one death, four heart failure events and two arrhythmia events). In four of these cases the events occurred within the CPS recommended operation time. In three cases (including the death) the MACE occurred later than the CPS recommended timeframe to surgery.
Abstracts
407
Conclusion: While use of CPS would not have eliminated MACE in this population, 3/7 events would have been prevented if operated in the time frame recommended by their CPS score. Further evaluation of the CPS tool, including against additional endpoints, is required. doi:10.1016/j.hlc.2011.03.083 Radial vs Femoral Arterial Approach in Rescue Angioplasty – Wellington Regional Hospital Experience N.M. Shah 1,∗ , P.D. Larsen 2 , S.A. Harding 1 1 Cardiology
Department, Wellington Regional Hospital, Wellington, New Zealand 2 University of Otago, Wellington, New Zealand Background: Previous studies have suggested that radial access for percutaneous coronary intervention (PCI) results in fewer access site and bleeding complications. We sought to compare the radial and femoral approach in the setting of rescue PCI for failed thrombolysis. Method: We retrospectively evaluated 71 consecutive patients undergoing rescue PCI within 12 hours of thrombolysis at Wellington Hospital between January 2007 and September 2010. Patients requiring an intra-aortic balloon pump were excluded. Data was collected from the PCI database and medical records. Results: Radial access was used in 31 (43.7%) and femoral access in 40 (56.3%) patients. Demographic variables, clinical risk factors and infarction related arteries were similar. There were similar numbers of shocked patients in the femoral and radial groups (14.3% vs. 9.7%, p = 0.23). Access through the initial arterial site selected was100% in both groups. Thrombectomy catheter use was more common in the radial group (35.5% vs. 10%, p = 0.009). There were no significant differences in procedure duration, fluoroscopy time or contrast volume between the groups. Angiographic success was 100% in both groups and procedure success was similar (97.5% femoral vs. 93.5% radial). In hospital MACE occurred in one patient in both groups. There were 3 (7.5%) large haematomas in the femoral group and none in the radial (p = 0.27). Major bleeding occurred in 7 (17.5%) patients in the femoral and 6 (19.4%) in the radial group (p = 0.84). Conclusion: Radial access for rescue PCI has a similar success rate to femoral access and is associated with similar outcomes. doi:10.1016/j.hlc.2011.03.084 Implantable Cardioverter Defibrillator (ICD) and Cardiac Resynchronisation Therapy (CRT) Referrals and Survival Outcomes Over a Decade at a Secondary Level Hospital R. Sharma ∗ , T. O’Meeghan, T. Boga Hutt Valley District Health Board, Hutt Hospital, Lower Hutt, New Zealand Background: Device therapy using ICD or CRT has been shown to reduce morbidity and mortality in patients at high risk of sudden cardiac death (SCD). This study was
ABSTRACTS
Heart, Lung and Circulation 2011;20:376–419