ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy最新文献

{"title":"12 Transcatheter versus surgical approach for severe aortic stenosis with concomitant coronary artery disease: a systematic review and meta-analysis of early and mid-term outcomes","authors":"R. Kotronias, J. Bray, R. Scarsini, Skanda Rajasundaram, D. Terentes-Printzios, G. L. Maria, R. Kharbanda, M. Mamas, R. Bagur, Adrian Bannning","doi":"10.1136/HEARTJNL-2020-BCS.12","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.12","url":null,"abstract":"Introduction Coronary artery disease (CAD) is frequently encountered in patients undergoing transcatheter aortic valve replacement (TAVR). Contemporary recommendations advocate revascularisation of patients with severe aortic stenosis (AS) and concomitant significant coronary artery disease (CAD) by either a surgical or percutaneous approach. We undertook a systematic review and meta-analysis to evaluate the early and mid-term outcomes of patients who underwent surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG) against patients who had TAVR and percutaneous coronary intervention (PCI). Methods A search of Medline and Embase was performed to identify studies comparing transcatheter and surgical approaches. Our search was independently screened by two investigators. Random effects meta-analyses with the Mantel-Haenzsel method were performed to estimate the odds of adverse outcomes. Analyses were performed with RevMan (Review Manager version 5.3.5, Nordic Cochrane Centre, Denmark). Results 1770 participants from six studies (5 observational, 1 randomised) were included in the meta-analysis (631 TAVR and PCI, 1139 SAVR and CABG). The mean age of participants was 79.2 years and 58.9% were male. TAVR was performed via both transapical/transaortic and transfemoral routes, using both self-expandable and balloon expandable valve systems. PCI was conducted either concomitant to TAVR or up to a year before. Risk of bias assessed using the ROBINS-I tool, identified 1 study at low risk and 4 studies at high risk of bias, predominately due to selection bias. There were no significant differences in effect estimates for early and mid-term mortality (OR: 0.78; 95% CI, 0.50-1.20 and OR: 1.09; 95% CI, 0.80-1.49) or myocardial infarction (OR: 0.52 95% CI, 0.20-1.33 and OR: 1.34; 95% CI, 0.67-2.65) No significant difference was noted in early cerebrovascular accidents (OR: 0.80; 95% CI, 0.35-1.87). A transcatheter approach was associated with a higher rate of new permanent pacemaker insertion (OR: 3.47; 95% CI, 1.98-6.06) and major vascular complications (OR: 14.44; 95% CI, 4.42-47.16), but a lower rate of acute kidney injury (OR: 0.41; 95% CI, 0.19-0.91). Conclusion These data suggest that in patients with severe AS and CAD a transcatheter approach has comparable outcomes to a surgical approach. Pending high level evidence, surgical risk assessment should form the cornerstone of individualised decision making. Conflict of Interest None","PeriodicalId":152114,"journal":{"name":"ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116399344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"4 A prospective study of hypertrophic cardiomyopathy and sleep disordered breathing","authors":"S. Karim, Shreyas Venkataraman","doi":"10.1136/HEARTJNL-2020-BCS.4","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.4","url":null,"abstract":"Background Hypertrophic cardiomyopathy (HCM) represents the most common inherited cardiomyopathy characterized by otherwise unexplained left ventricular hypertrophy. Sleep disordered breathing (SDB) (including both central and obstructive sleep apnea) is considered to be an important and potentially reversible cause of cardiovascular disease progression. This prospective trial aims to define the prevalence of SDB within patients diagnosed with HCM using gold standard polysomnography (PSG). Previous studies have suggested a prevalence of SDB in the general population of 25.5%. Methods Previous trials have been retrospective studies and have used overnight oximetry analysis to find the prevalence of SDB in HCM using portable, at-home monitors, however overnight oximetry is unable to accurately delineate between central and obstructive sleep apnea – both of which vary significantly in terms of prognosis and management - and is not as sensitive nor specific in diagnosing or classifying SDB as polysomnography assessment. An ongoing prospective analysis of 85 patients diagnosed with HCM was performed at Mayo Clinic using PSG. Apnea is defined as the absence of inspiratory airflow for at least 10 seconds. Hypopnea is defined as a decrease in airflow lasting 10 seconds or longer associated with a desaturation >4%. Apnea Hypopnea Index (AHI) – the number of events per hour was assessed using PSG. SDB is defined as an AHI>5/hour of sleep. Results Of 85 HCM patients examined using PSG, 49 were found to have an AHI>5/hour. Average AHI was 20.0, Standard Deviation 23.3, Interquartile range 3.3-28.2. 15 patients had central sleep apnea defined as the absence of inspiratory effort for at least 10 seconds. 17 patients had obstructive apneas. 18 patients had severe SDB (AHI>30/hour). Conclusion Given the paucity of available treatments for HCM and noting that treatment of SDB in heart failure with CPAP has been shown to attenuate diastolic dysfunction, this represents a potentially novel avenue of treatment for patients diagnosed with HCM. OSA is known to increase risk factors that contribute to morbidity and mortality in HCM including arrhythmias, myocardial infarction and sudden cardiac death. Previous studies have suggested a higher prevalence of non-sustained ventricular tachycardia in HCM patients diagnosed with OSA likely explained by excessive sympathetic activation. Systemic blood pressure and sympathetic activity have also previously been seen to improve with CPAP therapy and there is evidence to suggest CPAP therapy may reverse or slow progression of left ventricular hypertrophy in HCM patients with SDB. Our study suggests a significantly higher prevalence of SDB in HCM patients when compared to the general population and whether treatment of SDB in HCM improves outcomes requires further investigation which our prospective study aims to answer. Conflict of Interest None","PeriodicalId":152114,"journal":{"name":"ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124938893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"1 Invasive and non-invasive quantification of myocardial fibrosis in primary mitral regurgitation: prognostic implications for post-operative remodelling, symptom burden and exercise capacity","authors":"Boyang Liu, K. Khin, D. Neil, M. Bhabra, Ramesh L. Patel, T. Barker, N. Nikolaidis, S. Billing, T. Treibel, J. Moon, Arantxa González, James Hodosn, N. Edwards, R. Steeds","doi":"10.1136/HEARTJNL-2020-BCS.1","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.1","url":null,"abstract":"Chronic primary mitral regurgitation (MR) exposes the left ventricle (LV) to volume overload and is associated with evidence of fibrosis on non-invasive imaging. It is not known whether fibrosis predicts outcome from surgery. This study aimed to 1) quantify myocardial fibrosis on histology and non-invasive imaging, 2) investigate any association between fibrosis and LV size and function, 3) determine the impact of fibrosis on post-operative outcome. Methods In a prospective observational multicentre study, 105 patients with severe MR (N=65/32/8 NYHA Class I/II/III respectively; mean age 63.1±13.4years; male 73%; VO2max 91.2±22.4%) had multiparametric cardiac magnetic resonance (CMR), symptom assessment (Minnesota Living with Heart Failure Questionnaire (MLHFQ)) and cardiopulmonary exercise testing before and at 6-9 months following repair. Patients consented for up to 3 intraoperative LV biopsies for histological collagen volume fraction (CVF) quantification. Results 234 LV biopsies were collected from 86 patients with median CVF of 14.6%[IQR 7.4-20.3]. Fibrosis was present even in NYHA Class I patients (13.6%[6.3-18.8]), and was significantly higher than the 3.3%[2.6-6.1] obtained from 8 autopsy controls without cardiac disease (P Pre-operatively, there was no relationship between CVF and LV size, systolic function, ECV, late gadolinium enhancement, although CVF did correlate with MLHFQ (R=0.23, P=0.034). Conversely, ECV correlated with systolic (LVEF Rho=-0.22, P=0.029; LVESVi Rho 0.22, P=0.025, GCS Rho=0.31, P=0.002) and diastolic function (E/e’ R=0.25, P=0.022), exercise capacity (%VO2max R=-0.22, P=0.030), with borderline correlation to MLHFQ (R=0.19, P=0.058). Following surgery, although LVEF remained >50% in all but 6 patients (LVEF pre 69.1±8.0 vs post 63.3±8.3%, P Conclusions Myocardial fibrosis is present in primary MR, before the onset of symptoms. Due to its patchy nature, ECV but not fibrosis on histology is a better marker of pre-operative myocardial function and symptom status. Despite ECV reduction following successful MR surgery, symptomatic patients fail to regain exercise fitness and symptom-free status – providing further support for the benefits of early surgery. Conflict of Interest None","PeriodicalId":152114,"journal":{"name":"ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy","volume":"85 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127587149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"15 Prevalence of ischaemic mitral regurgitation meeting coapt and mitra-fr criteria for mitraclip intervention – a cohort study of 1000 patients following myocardial infarction","authors":"H. Sharma, A. Radhakrishnan, S. Brown, J. May, N. Zia, R. Joshi, P. Ludman, J. Townend, S. Doshi, Sohail Q Khan, A. Zaphiriou, S. George, R. Steeds, A. Nadir","doi":"10.1136/HEARTJNL-2020-BCS.15","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.15","url":null,"abstract":"Background Ischaemic mitral regurgitation (IMR) confers a poor prognosis. Transcatheter mitral edge-to-edge repair may improve outcomes but MITRA-FR and COAPT trials have produced conflicting results, attributed to different patient selection criteria. Following acute myocardial infarction (MI), the number of patients eligible for transcatheter mitral repair using MITRA-FR and COAPT eligibility criteria is not known, nor whether these criteria produce cohorts with significantly different characteristics. Purpose To determine the number and characteristics of IMR patients qualifying for MITRA-FR and COAPT echocardiographic eligibility criteria amongst patients receiving coronary revascularization following acute MI. Methods 1000 consecutive patients admitted to the Queen Elizabeth Hospital Birmingham with acute MI who underwent coronary angioplasty were included. Early inpatient TTE was performed by accredited echocardiographers using standard multiparametric quantification, including (where possible) proximal isovelocity surface area (PISA), effective regurgitant orfice area (EROA), vena contracta (VC) regurgitant volume (RVol), regurgitant fraction (RF) and left ventricular ejection fraction (LVEF). Patients within our admission population fulfilling the following echo criteria were identified: MITRA-FR: LVEF 15-40% and EROA > 0.2cm2 or RVol > 30ml COAPT: LVEF 20-50% and either:\u0000 Tier 1: EROA > 0.3cm2 or pulmonary vein flow reversal Tier 2: EROA > 0.2cm2 and 45ml/beat;RF > 40%;VC > 0.5cm; Tier 3: EROA 2 of the following:RVol > 45ml/beat;RF > 40%;VC > 0.5cm;PISA > 0.9cm but continuous wave of MR jet not done;Large (> 6cm) holosystolic jet wrapping around left atrium;Peak E wave velocity > 150cm/s. Results MR was observed in 294/1000 patients (29.4%) post-MI, graded as mild (76%), moderate (21%) and severe (3%). Based on MR characteristics alone (not including LVEF), the number of patients fulfilling MITRA-FR and COAPT eligibility criteria were 23 (7.8% of all IMR) and 24 (8.1% of all IMR) respectively. Both groups had a similar ratio of moderate:severe MR (74:26% vs 75:25%), EROA (0.34+/-0.13cm2 vs 0.35+/-0.13cm2), VC (0.6+/-0.2cm vs 0.6+/-0.2cm), RVol (52+/-24ml vs 51+/-25ml), indexed LA volume (LAVi) (54+/-20ml/m2 vs 51+/-20ml/m2), indexed LV end-diastolic volume (LVEDVi) (62+/-17ml/m2 vs 63+/-18ml/m2), LVEF (48+/-13% vs 47+/-13%) and mortality (MITRA-FR: 23% vs COAPT: 29%, p=0.9243). After including LVEF as a criterion, the number of patients eligible for MITRA-FR and COAPT were just 5 (1.7% of all IMR) and 14 (4.7% of all IMR) respectively. As expected, COAPT patients had a higher mean LVEF (MITRA-FR: 33% vs COAPT: 40%; p=0.077). Both groups remained similar with respect to ratio of moderate:severe MR (60:40% vs 64:36%), EROA (0.40+/-0.13 vs 0.38+/-0.15cm2), VC (0.6+/-0.2cm vs 0.6+/-0.2cm), LAVi (56+/-20ml/m2 vs 50+/-19ml/m2), LVEDVi (69+/-25ml/m2 vs 67+/-19ml/m2) and mortality (MITRA-FR: 40% vs COAPT: 35%). Conclusion Post-acute MI, more pat","PeriodicalId":152114,"journal":{"name":"ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy","volume":"73 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114748737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"11 Impact of transthoracic versus transoesophageal echocardiography measurement of vegetation length in infective endocarditis on indications for surgery","authors":"D. Hoare, S. Bhattacharyya, G. Lloyd, W. Young, S. Woldman","doi":"10.1136/HEARTJNL-2020-BCS.11","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.11","url":null,"abstract":"Introduction Infective Endocarditis (IE) has high mortality. Longer vegetation length is associated with increased stroke risk and mortality. Guideline indications for surgery to prevent embolism are based on vegetation length. However they do not specify which modality should be used for the measurement. Transoesophageal echocardiography (TOE) imaging is only a Class I indication for prosthetic heart valves or where trans-thoracic (TTE) is inconclusive. Therefore, not all patients with IE will undergo TOE. We investigated whether there are differences in TTE and TOE measurement of vegetation length and the potential impact on indications for surgery. Methods This was a retrospective study of 68 patients with definite endocarditis that had undergone both TOE and TTE imaging. Vegetation length was measured on two dimensional images. Indications for surgery to prevent embolism using the ESC 2015 guidelines were compared for vegetation length on TOE and TTE. Results The median time between TTE and TOE was 2 days. 21/68 (30.8%) patients with vegetations identified on TOE were not identified on TTE. Of the remaining 47 patients, 27 (57.4%) had longer vegetations measured on TOE than on TTE with the mean difference being 7.8mm. 2/47 (4.3%) patients had the same vegetation length on TOE as on TTE. 18/47 (38.3%) patients had longer vegetations measured on TTE than on TOE with the mean difference being 4.3mm. The mean difference in vegetation length overall was 5.9mm. Of the 59 patients with left sided endocarditis, 16 cases (27.1%) would change their surgical indication based on using TOE vegetation length rather than TTE vegetation length. 11/59 (18.6%) cases would change from no indication for surgery to a class IIa indication and 5/59 (8.5%) cases would change from no indication for surgery to a class IIb indication. Conclusion TTE often underestimates vegetation length compared to TOE. The change in vegetation length recorded between the two modalities would have changed the indication for surgery to prevent embolism in 27% patients. Measurements of vegetation length to determine surgical intervention for the prevention of embolization should be taken from TOE imaging rather than TTE. Conflict of Interest None","PeriodicalId":152114,"journal":{"name":"ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy","volume":"96 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125983517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"16 Management of tricuspid valve regurgitation in congenital heart disease: a single centre experience","authors":"S. Caroli, H. Parry, K. English","doi":"10.1136/HEARTJNL-2020-BCS.16","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.16","url":null,"abstract":"Background Congenital anomalies of the tricuspid valve (TV), pose significant management challenges; when to intervene, what type of repair should be performed and when is TV replacement preferable. This observational study documents outcomes following TV repair versus replacement in a single centre. Methods A total of 73 patients underwent tricuspid valve surgery in our centre from January 2014 to November 2019. Patients with primary left heart lesions, AVSD repair or systemic right ventricle (RV) were excluded. The final study population included 57 patients. Ebstein anomaly was present in 16 patients (28%) and previous Tetralogy of Fallot repair in 12 patients (21%). Echocardiographic assessment of the degree of TV regurgitation pre and post-surgery and degree of RV dysfunction, was visually performed by a single operator accredited in congenital echocardiography (SC). Results TV replacement was performed in 12 patients (21%) and TV repair in 45 patients (79%). One patient with Ebstein anomaly initially underwent TV repair but required TV replacement one year later. The mean age was 46 ± 13.5 year in patients undergoing replacement and 33 ± 14 year in patient undergoing TV repair (p= 0.0081). The mean body mass index (BMI) in the TV replacement group was 29.9 ± 4.9 vs 23.8 ± 4 in the repair group (p=0.0037). Overall 30-day mortality was 1.7% due to the death of a patient with severe Ebstein anomaly undergoing TV replacement who died on ECMO two weeks post-operatively. Most patients (91%) who underwent TV replacement had a degree of RV impairment pre-operatively compared to the 29% of patients undergoing TV repair. All the patients with severe RV dysfunction post TV replacement had at least moderate RV dysfunction pre-operatively. Severe TR was present in 8 (66%) of the patients undergoing TV replacement and 20 (45%) who underwent TV repair. Three patients (25%) post TV replacement required re-admission for signs of RV failure compared to 1 (2%) in the TV repair group. Discussion Our data, in line with previous series, suggest patients undergoing TV repair have better outcomes compared to TV replacement, with lower mortality and re-admission with RV failure. Patients undergoing TV replacement were significantly older with higher body mass index than patients undergoing TV repair. It is likely these factors influenced decision making; greater peri-operative risk is associated with prolonged bypass time; bypass time is generally prolonged in TV repair relative to replacement. Older patients with raised body mass index may have been deemed too high peri-operative risk to undergo repair. Alternatively, it may be that delaying intervention in TV disease technically makes repair more challenging. This poses the questions whether outcomes would be better if intervention were performed earlier in TV disease and if we focused on optimising patients’ pre-operative fitness prior to surgery. We recognise this observational, retrospective study with small s","PeriodicalId":152114,"journal":{"name":"ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy","volume":"100 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114398210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"17 Real-world experience and outcomes after device-led patent foramen ovale closure","authors":"U. Khan, P. Brennan, C. Lockhart, C. Owens, M. Spence","doi":"10.1136/HEARTJNL-2020-BCS.17","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.17","url":null,"abstract":"Aims A patent foramen ovale (PFO) is a common defect that affects up to 34% of the population. Recent evidence has emerged supporting PFO closure in the event of cryptogenic ischaemic stroke, transient ischaemic attack (TIA), systemic embolism and migraine. We aimed to report real-world experience and outcomes for all consecutive patients that had PFO closure in our hospital between March 2009 and October 2019. Methods We retrospectively analysed baseline clinical characteristics, indications for PFO closure, procedural characteristics and long-term clinical follow-up using our dedicated hospital database and Northern Ireland Electronic Care Record. Results PFO closure was performed in 133 patients between March 2009 and October 2019. 59 (44%) of cases were performed between 2009-2016 with 74 (56%) cases performed between 2017-2019, coinciding with the publication of supporting randomized control trials. The mean patient age was 43 ±15 years and 69 (52%) patients were female. 16 (12.1%) of patients had a history of systemic hypertension, 4 (3%) diabetes mellitus and 35 (26%) had a smoking history. Only one patient had a thrombophilia diagnosis. Cerebrovascular events including ischaemic stroke and TIA’s were the leading indication for PFO closure in 123 (92.5%) cases. Systemic embolism, platypnea-orthodeoxia syndrome and decompressive illness were the indications in 4 (3%), 2 (1.5%) and 1(0.75%) case(s), respectively. ‘Other’ indications made up the remaining 3 patients. The majority of procedures were performed under general anaesthetic (GA) in 129 (97%) cases. All cases were performed using trans-oesophageal echocardiography guidance. The mean procedure time was 38 ± 23minutes and the mean size of percutaneous device used was 25mm. Gore (52%) and Amplatzer (35%) septal occluders were the most commonly used devices. There were no procedural deaths. Cardiac tamponade, major vascular injury, pulmonary embolism and/or device embolism did not occur in any patient. Only one patient had a new arrhythmia (atrial fibrillation (AF)) during the periprocedural period. The median length of stay was 1day. Antithrombotic data at discharge was available for 129 (97%) patients. The main antithrombotic strategy adopted was dual antiplatelets in 112 (87%) cases, single antiplatelet in 10 (8%) cases and oral anticoagulation +/- a single antiplatelet made up the remainder of cases, respectively. No patients were readmitted to hospital for bleeding events on interrogation of NIECR. The median follow-up duration after PFO closure was 31 months (range 2-1439months). 3 patients suffered a recurrent neurological event during follow-up, giving an event rate of 0.6/100 patient-years (PY). Infective endocarditis was not observed for any patients. 5 (3.8%) patients had a diagnosis of new AF or atrial flutter during follow-up, all of which occurred within three months of the procedure. 3 patients (2.3%) died during follow-up (median age 56 years (20-75years)) but all of thes","PeriodicalId":152114,"journal":{"name":"ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128995935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"9 Next-day discharge after transcatheter aortic valve implantation","authors":"J. Bates-Powell, Sophie Z Gu, R. Edwards, A. Zaman","doi":"10.1136/HEARTJNL-2020-BCS.9","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.9","url":null,"abstract":"Introduction Transcatheter aortic valve implantation (TAVI) is being used increasingly in patients with severe symptomatic aortic stenosis. Few studies focused on hospital length of stay (LOS) and feasibility of next-day discharge. This study aims to evaluate the feasibility and factors associated with next-day discharge post TAVI, which can be used to help selecting suitable patients for a ‘fast-track’ TAVI admission pathway. Methods Data from all TAVI procedures conducted at our centre from January 2014 to March 2019 were collected in our local TAVI registry, and analysed retrospectively. Patients discharged within 1 day of TAVI (early discharge group) were compared with consecutive patients discharged after 24 hours (late discharge group). Degree of frailty was assessed by the Canadian Study of Health and Aging (CSHA) frailty scale, and baseline functional status was assessed by Katz index of independence in activities of daily living. Results Of 502 patients, 274 (54.6%) were male, mean age 83.2±7.3 years, and 87 (17.7%) patients were considered frail by CSHA frailty scale. Median Katz index was 6 (i.e. functionally independent, interquartile range [IQR] 1), and mean logistic Euroscore 17.4±10.7. Percutaneous transfemoral access was performed in 468 (95.5%), and general anaesthesia was used in 64 (14.4%) patients. Early complications before discharge were comparable to national standards: death in 11 (2.3%), MI in 1 (0.2%), PPM in 20 (4.3%), gastrointestinal bleed in 3 (0.6%), and tamponade in 5 (1.1%). Median LOS post procedure was 2 (IQR 3) days, median length of total hospital stay was 3 (IQR 5) days. Early discharge was achieved in 213 (44.7%) patients. Multivariate logistic regression analysis showed that male gender (odds ratio [OR]: 2.81, 95% confidence interval [CI]: 1.68 to 4.7; p Conclusions Next-day discharge after TAVI can be achieved in nearly half of all patients. Male younger patients with minimal symptoms at baseline (NYHA Conflict of Interest None","PeriodicalId":152114,"journal":{"name":"ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy","volume":"356 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131650092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"5 Comparison of treatment outcomes in very elderly patients (>85years) with severe symptomatic aortic stenosis","authors":"D. Obaid, L. Roche, A. Yousaf, A. Hill, A. Hailan, F. Bhatti, S. Ashraf, A. Zaidi, Pankaj Kumar, A. Youhana, O. Aldalati, Dave Smith, Alexander J Chase","doi":"10.1136/HEARTJNL-2020-BCS.5","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.5","url":null,"abstract":"Introduction Due to the demographics of our patient population our institution has a high incidence of very elderly (>85 years) patients with severe symptomatic aortic stenosis. We examined the outcomes of these patients following trans-catheter aortic valve implantation (TAVI), surgical aortic valve replacement (SAVR) or medical therapy. Methods We included all patients >85 years of age with symptomatic severe aortic stenosis referred to our tertiary centre for consideration of aortic valve intervention between 2009 and 2016. Following assessment by the TAVI team (2 cardiologists and 2 cardiac surgeons) patients underwent SAVR or TAVI. Patients deemed unsuitable or refusing intervention had medical therapy. Data was obtained from electronic databases and clinical case notes. Results 309 patients were included (86 TAVI, 133 SAVR and 90 medical). Comparing patients undergoing TAVI and SAVR, TAVI patients were older (mean age 89.4 years vs. 86.9, p All TAVI patients had surgical access (86% trans-femoral, 8% trans-apical, 6% direct aortic), an Edwards (XT or Sapien 3) valve and general anaesthetic in 69% of cases. There were no intraoperative deaths but 3 conversions to sternotomy for bleeding. 68% of the surgical patients underwent isolated AVR and 32% AVR+CABG with 1 surgical intraoperative death. Medically managed patients had poor outcomes with a mortality of 49% at 1 year and 77% at 3 years. Survival of patients with either intervention was better, with no significant difference in 30-day mortality of SAVR and TAVI (5.3% vs 2.3%, p=049) or 3-year mortality (33% vs. 36%, p=0.66) respectively (figure 1). Compared with TAVI, SAVR patients spent significantly more days on ITU/HDU (8.31±12 vs. 0.96 ±1.7, p Conclusion The prognosis of patients >85 years of age with symptomatic severe aortic stenosis without intervention is poor. Aortic valve intervention in very elderly patients has acceptable mortality out to 3 years. In our early experience, using surgical access and high rates of general anaesthesia, TAVI in this group had similar mortality to SAVR but with significant reductions in both ITU and overall hospital stay. Conflict of Interest none","PeriodicalId":152114,"journal":{"name":"ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116175127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"7 Assessment of post heart valve surgery outcomes in tertiary center in Scotland","authors":"P. Bedi, J. Osmanska, Jacqueline N Adams","doi":"10.1136/HEARTJNL-2020-BCS.7","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.7","url":null,"abstract":"Introduction The European Society of Cardiology (ESC) 2017 guidelines on valvular heart disease recommend 30-days and 1-year echocardiography along with one year and then life-long annual follow up with cardiologist post heart valve surgery to detect early deterioration in prosthetic function or ventricular function or progressive disease of another heart valve. Aim: The aim of this study was to assess if the ESC guidelines were being adhered to after the heart valve surgery and if there was a difference in the outcomes of patients being followed up as per above guidelines compared to those who were not. Methods Data was collected retrospectively from tertiary centers in Greater Glasgow and Clyde health board region in Scotland from 2016 to 2018. Two independent clinicians checked electronic records for individual patients. Telephone calls were made to contact patients to confirm follow up arrangements if electronic records were unclear. Results 695 patients were included in the study. 58% were male (mean age 65.5 years - SEM 0.5) and 42% female (mean age 68 years - SEM 0.8). Of the total valves operated: 70% were aortic (44.9% of total were bioprosthetic AVR, 25.1% were metallic AVR), 22% mitral (12.3% of total were mitral valve repair, 9.7% were metallic MVR), 5% tricuspid and 3% pulmonary. At 30 days post-surgery, 24% of the patients had transthoracic echocardiogram done. At one year post-surgery, 66.6% had a follow up echocardiogram and 53% were clinically reviewed by a cardiologist. Death, major and minor complications as defined by the European Association of Cardiothoracic Surgeons were recorded at 1 year. Major complications recorded were thromboembolic disease, infective endocarditis and out of hospital cardiac arrests who survived. Minor complications recorded were sternal wound complications, suppurative complications, need for permanent pacemaker and new decompensated heart failure. 7% deaths (p=0.0004), 10.6% major complications (p=0.199) and 12.5% minor complications (p=0.160) were recorded in the group with no follow up, compared to 1.6%, 7.8% and 16.2% respectively in the group that was followed up (figure 1). Conclusion The mortality and morbidity rates are higher among patients not followed up regularly after heart valve surgery. The death rate is significantly higher in the group with no follow up while major and minor complications were statistically not significant between the two groups. Conflict of Interest None","PeriodicalId":152114,"journal":{"name":"ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128455392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}