Abstracts
863
Outcomes of Transcatheter Aortic Valve
Replacement in Oncology Patients With
Symptomatic Severe Aortic Stenosis
A. Murphy 1,2,3,*, A. Koshy 1,2, W. Cameron 1,
M. Horrigan 1, L. Kearney 1,2, B. Yeo 1,3,
O. Farouque 1,2, M. Yudi 1,2
1 2
Austin Health, Heidelberg, Australia
2
University of Melbourne, Parkville, Australia
3
Olivia Newton John Cancer Centre, Heidelberg,
Australia
Background: A history of cancer is incorporated into the
surgical risk assessment of patients undergoing surgical
aortic valve replacement through the Society for Thoracic
Surgeons (STS) score. However, the prognostic significance
of cancer in patients treated with transcatheter aortic valve
replacement (TAVR) is unknown. As the cancer survivorship
population increases, it is imperative to establish the efficacy
and safety of TAVR in patients with severe symptomatic
aortic stenosis (AS) and a history of malignancy.
Methods: A systematic review was conducted to identify
studies reporting outcomes in patients with a history of
malignancy undergoing TAVR. A meta-analysis was per-
formed using a random effects model with a primary
outcome of all-cause mortality and cardiac mortality at
longest follow-up.
Results: A total of 13 observational studies with 10,916
patients were identified in the systematic review. Seven
studies including 6,323 patients were included in the quan-
titative analysis. Short-term mortality (RR 0.61, 95% CI 0.36-
1.01; p=0.06) and long-term all-cause mortality (RR 1.24, 95%
CI 0.95-1.63; p=0.11) were not significantly different when
comparing patients with and without a history of cancer. No
significant difference in the rate of peri-procedural compli-
cations including stroke, bleeding, acute kidney injury and
pacemaker implantation were noted.
Conclusion: In patients with severe AS undergoing TAVR,
a history of cancer was not associated with adverse short or
long-term survival. Based on these findings, TAVR should be
considered in all patients with severe symptomatic aortic
stenosis, and a life expectancy of greater than 12 months,
irrespective of their history of malignancy.
https://doi.org/10.1016/j.hlc.2020.09.870
S425
864
Outcomes of Transcatheter Versus Surgical
Aortic Valve Replacement in Low-Risk
Patients
A. Koshy 1,2,*, A. Murphy 1,2, O. Farouque 1,2,
M. Horrigan 1, M. Yudi 1,2
1
Austin Health, Melbourne, Australia
University of Melbourne, Melbourne, Australia
Background: Transcatheter aortic valve replace-
ment(TAVR) has revolutionized the treatment of severe
aortic stenosis(AS), though its safety and efficacy in low-risk
patients remains to be established.
Methods: A systematic review identified four randomised
controlled trials comparing TAVR to surgical aortic valve
replacement(SAVR) in patients at low surgical risk. A meta-
analysis was performed with a primary outcome of a com-
posite of all-cause mortality and stroke.
Results: Overall, 2,836 patients were included
(SAVR:1,363 TAVR:1,473). The composite of all-cause
mortality and stroke was significantly lower in patients un-
dergoing TAVR compared with SAVR (OR 0.59, 95% CI 0.37-
0.95, p=0.03) with low heterogeneity(I2=31%). The difference
in the primary composite outcome was driven by a differ-
ence in mortality (OR 0.66, 95% CI 0.44-0.98, p=0.04) without
significant differences in stroke(OR 0.75 95% CI 0.45-1.26,
p=0.28). Absolute risk difference of the primary outcome also
favoured TAVR(-2.0% 95% CI -3.3 to -0.7%, p=0.002) with a
number needed to treat (NNT) of 50 to prevent one death or
stroke. Patients undergoing TAVR had a higher risk of per-
manent pacemaker implantation(OR 3.9, 95% CI 1.8-8.4,
p,0.001) and moderate/severe paravalvular leak(OR 5.0,
95% CI 1.6-15.7, p=0.01).
Conclusions: In patients with severe AS at low surgical
risk, the rate of the composite of death and stroke was
significantly lower with TAVR than with SAVR. Longer-
term follow-up with a focus on the impact of PPM implan-
tation, PVL and structural valve deterioration is essential
before the use of TAVR can be generalized to the broader
population of patients with AS.
https://doi.org/10.1016/j.hlc.2020.09.871
865
Outcomes With Accelerated TR Band Removal
Time for Trans-Radial Cardiac Catheterisation
R. Krishnamoorthy *, S. Norman, N. Mohd Zaki,
T. David, A. Lee, P. Shetty, T. Nguyen-Dang,
E. Danson, A. Yeung
Wollongong Hospital, Wollongong, Australia
Introduction: With the increasing popularity of trans-
radial approach in interventional cardiology it is important
to consider the optimal time for TR band removal in patients
undergoing coronary artery catheterisation (CA) or percu-
taneous coronary intervention (PCI). The recommended
removal time according to the Terumo Medical Corporation
S426
is a minimum of 120 minutes of haemostasis. However
studies have shown that increasing haemostasis times are
associated with increased incidence of radial artery
occlusions.
Methods: The departmental policy at Wollongong Hos-
pital is for a TR band removal time of less than 120 minutes.
A retrospective analysis of a registry-style database of 730
cases of trans-radial haemostasis (CA n=590, PCI n=140)
radial artery approach cardiac catheterisation were analysed
according to the band times and outcomes including
bleeding complications in patients.
Results: The average time of band removal was 62.7 mi-
nutes overall (PCI t=79.2 minutes, CA t=46.2 minutes) with
80% (n=670) of cases recorded to have no complications.
Overall 20% of PCI (n=27) and 21.2%of CA (n=124) were
noted to have bleeding events ranging from slight to large
haematoma or bruising. The overall incidence of large hae-
matoma or bruising was 0.8% (n=6). There were no docu-
mented cases of radial artery occlusion in our dataset.
Conclusion: Accelerated band removal time may be
justified but with careful consideration in regards to accept-
ing risk of minor bleeding complications. Our study can be
expanded to prospectively assess for hypoplastic radial ar-
tery in conjunction with accelerated removal times.
https://doi.org/10.1016/j.hlc.2020.09.872
866
Percutaneous Closure of Large Aortocaval
Shunts
J. Riskallah 1,*, G. Ison 1, V. Hsieh 1,2, M. Sader 1,2
1 formed on 48 individuals at Cairns Base Hospital over 48
St George Hospital, Kogarah, Australia
2
University of New South Wales, Sydney, Australia
We discuss the feasibility of the percutaneous closure of large
aortocaval shunts and present two rare cases which were
successfully closed with vascular occluder devices.
The two cases were aged in their fifties and had similar
presentations of progressive exertional dyspnoea. The large
aortocaval shunts were identified on CT coronary angiog-
raphy, which were haemodynamically significant (Qp:Qs
.2) on cardiac catheterisation. In the first case the shunt
originated from the proximal right coronary artery and
drained at the right atrial-superior vena caval (RA-SVC)
junction via a network of vessels. The shunt anatomy did not
Abstracts
allow retrograde device delivery, however there was no
potential for distal device embolisation using an antegrade
approach. In the second case, the shunt originated from the
coronary sinus and drained at the right atrial-inferior vena
caval (RA-IVC) junction. The shunt was a tubular structure
allowing for retrograde device delivery. Successful percuta-
neous shunt closure was performed in each case after heart
team discussions involving a cardiothoracic surgeon.
Amplatzer occluder devices were successfully delivered us-
ing an antegrade approach in the first case and a retrograde
approach in the second case.
These cases demonstrate the feasibility of percutaneous
closure of large aortocaval shunts. The technical approaches
differ depending on shunt anatomy. Adequate planning and
heart team discussions are highly recommended.
https://doi.org/10.1016/j.hlc.2020.09.873
867
Percutaneous Intervention to Saphenous Vein
Graft in Far North Queensland; Feasibility and
Safety in a Regional Centre
A. McMaster 1,*, A. Helms 1, S. Nguyen 1,2,
S. Preston 1, A. Brazzale 1, G. Starmer 1
1
Cairns Base Hospital, Cairns, Australia
2
Princess Alexandra Hospital, Brisbane, Australia
Background: Percutaneous coronary intervention (PCI) on
patients with previous coronary artery bypass grafting
(CABG) represents 17.5% of all PCI volume [1]. Within this
group, 13.0% of all cases are PCI to saphenous vein grafts
(SVG).1 As such SVG failure remains a significant clinical
concern, in particular due to the relatively high mortality rate
associated with redo CABG ( 6.2% at 30-days) [2]. PCI to
SVG has thus become an increasingly important tool in
managing SVG failure with generally favourable survival
outcomes [3]. We sought to assess the safety and outcomes of
PCI to a SVG at a regional centre.
Methods: Retrospective analysis of PCI to SVG that
occurred between January 2015 and December 2018 was
conducted. Electronic medical records were used to assess
patient characteristics, procedural complications and major
adverse cardiovascular outcome data.
Results: 55 separate PCI to SVG interventions were per-
months. Patient mean age was 68.9 years (Standard devia-
tion 10.0), women made up 18.2% of cases studied and
Aboriginal or Torres Strait Islanders 18.8%. Procedural
complications were low with a single SVG perforation and
no cases of distal embolisation, no-reflow and no stent
thrombosis within thirty days. Excluding a single fatal
salvage case, mortality rates were acceptable both at thirty
days (3.6%) and at one year (10.5%).
Conclusion: Despite being a comparatively high-risk
intervention our data suggests that PCI to SVG is both a
feasible and safe procedure in a regional centre with no
cardiothoracic surgical support on site.