Venous–Pulmonary Artery ECMO for Right Heart Failure Post-centrifugal Continuous Flow LVAD Insertion

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Heart, Lung and Circulation 2009;18S:S1–S286

Abstracts

ABSTRACTS

public hospitals. Surveillance includes surgical site infections (SSI) and ICU acquired infections. Surveillance is conducted using the validated definitions, methodology including risk stratification from the US National Healthcare Safety Network (NHSN). Six large metropolitan hospitals have contributed data for CABG (chest and donor) procedures continuously over a six-year period, comprising more than 12,500 procedures. SSI rates are compared quarterly with state aggregate data. Over this period the aggregate risk stratified surgical site infection rates were 4.6% in risk category 1 and 6.8% in risk categories 2/3. Deep sternal rates were 1.3% in risk category 1 and 2.3% in risk category 2/3. NHSN SSI rates (for all infections) in 2007 were 3.0% in risk category 1 and 4.9% in risk category 2/3. A formal VCC multisite validation study demonstrated identification of sternal and deep wound infections was more consistent than superficial and donor site infections. Data were also collected on compliance with antibiotic prophylaxis guidelines, including antibiotic choice, timing of the first dose and duration of administration. Antibiotic choice and documentation have improved. The establishment and continuation of the VICNISS Coordinating Centre allows hospitals to regularly benchmark their infection rates against aggregate local and international data and to examine effectiveness of infection prevention interventions. doi:10.1016/j.hlc.2009.05.159 158 TRANSAPICAL AORTIC VALVE IMPLANTATION: NEW ZEALAND EXPERIENCE N. Kejriwal 1 , G. Devlin 2 , R. Fisher 2 , S. Pasupati 2 1 Cardiothoracic

Surgery, Waikato Hospital, Hamilton, New Zealand 2 Cardiology, Waikato Hospital, Hamilton, New Zealand Background: Patients with symptomatic severe aortic stenosis are conventionally treated with surgical aortic valve replacement (AVR). Transarterial aortic valve implantation is an emerging treatment option in patients with extremely high operative risk. Severe peripheral vascular disease precludes this in some cases with a transapical approach used as an alternative. We report our early experience with the transapical procedure at Waikato Hospital. Methods: Between November 2008 and March 2009, 4 patients (3 female) underwent transcatheter transapical aortic valve implantation. Left ventricle apex was accessed through a small anterolateral thoracotomy. Valves were deployed under rapid ventricular pacing. 3 patients received 26-mm and one 23-mm Edwards Sapien transcatheter bioprostheses. Results: The mean age was 83.2 years (range 78–89) with a mean logistic EuroSCORE of predicted mortality of 20%. Valve implantation was successful in all patients. The mean gradient decreased from 51 ± 9 to 15 ± 3 mmHg and the valve area increased from 0.5 ± 0.3 to 1.7 ± 0.2 cm2 .

There was no prosthesis migration or valve incompetence. One patient developed occlusion of the left main stem treated with stenting but died peri-procedurally due to related vascular complications. Two patients were extubated in the cath lab. One patient suffered a small CVA with resolved neurological deficit on follow-up. Atrial fibrillation occurred in 2 patients. No patient required permanent pacemaker implantation. All survivors had marked improvement in functional status. Conclusion: Our initial experience with transapical aortic valve implantation is encouraging. Long-term studies will be required to assess its durability as an alternative to conventional AVR in selected high-risk patients. doi:10.1016/j.hlc.2009.05.160 159 VENOUS–PULMONARY ARTERY ECMO FOR RIGHT HEART FAILURE POST-CENTRIFUGAL CONTINUOUS FLOW LVAD INSERTION E. Granger, P. Macdonald, P. Spratt, P. Jansz, C. Hayward, C. Soto Introduction: Acute right heart failure may complicate the insertion of an implantable left ventricular assist device (LVAD). Despite optimal medical therapy including intravenous inotropes and pulmonary vasodilators, right ventricle (RV) mechanical support is required in approximately 9–13% patients. This study reviews the use of venous-pulmonary artery ECMO (V-PA ECMO) for RV failure following insertion of a third generation centrifugal continuous flow rotary pump (VentrAssistTM , HeartWare® ). Methods: From January 2004 to March 2009 forty-four continuous flow rotary LVADs have been inserted; six patients required placement of V-PA ECMO for RV failure (13.6%). Data was compiled retrospectively. Results: Venous drainage for V-PA ECMO was via a percutaneous heparin coated cannula through the femoral vein. Circuit outflow was through an 8 mm graft anastomosed end to side to the main pulmonary artery trunk. The circuit was removed without reopening the sternum. The average duration of RV support was 6.6 days. Average patient age was 36.2; 4 patients were male. Three patients were diagnosed with dilated cardiomyopathy, one postpartum cardiomyopathy, one ischaemic cardiomyopathy and one post cardiac transplant acute allograft failure. The one death was secondary to multiorgan failure (acute allograft failure patient). Five patients were successfully weaned and removed from the V-PA ECMO and discharged home to await their cardiac transplant. Conclusion: Early mechanical RV support minimises end organ hypoperfusion by providing adequate RV output thereby maintaining appropriate LVAD flows. The V-PA ECMO circuit is technically simple to insert and remove, and provides good short term support to allow recovery of RV function. doi:10.1016/j.hlc.2009.05.161