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Abstracts
803
804
The Impact of Slender Sheaths on the
Incidence of Early Radial Artery Occlusion
Post-Transradial Coronary Procedure: A
Prospective Cohort Study
The Incidence of Delayed High-Grade
Atrioventricular Block After Transcatheter
Aortic Valve Implantation: A Systematic
Review of 15,626 patients
I. Rubenis 1,*, C. Wong 1, H. Lowe 1,2,
L. Kritharides 1,2, A. Yong 1,2, D. Brieger 1,2,
P. Roy 1
K. Rao 1,2,*, A. Baer 2, H. Peter 1,2, R. Bhindi 1,2
1
Concord Repatriation General Hospital, Sydney,
NSW, Australia
2
University of Sydney, Sydney, NSW, Australia
Introduction: Radial artery occlusion (RAO) is an underrecognised complication of trans-radial coronary procedures.
We prospectively assessed the impact of standard sheath
selection compared to 6Fr slender sheath use on the incidence of early (,24 hours) RAO.
Methods: A total of 560 consecutive patients were included.
The first 280 procedures were performed with 5Fr or 6Fr non-slender sheaths, and the subsequent 280 procedures were performed using 6Fr slender sheaths. We recorded baseline
characteristics, RAO risk factors, intraprocedural radial artery
spasm (RAS) and post-procedural arm pain. Radial artery
patency was assessed within 24-hours via the Reverse Barbeau
(RB) test.
Results: The mean age overall was 66612.4 years, 73% of
which were male. Stable angina was more common in the
slender cohort (48.6% vs 57.2%, p=0.03). In the non-slender
cohort, 75% (214) of cases were performed with 6Fr sheaths,
and 6Fr catheters were used in 75% of both cohorts. Percutaneous coronary intervention was performed in 25%. RAO
was present in 28 patients (9.9%) with non-slender sheaths
and 25 (9.1%) with slender sheaths (p=0.75). Patients with
RAO were younger (59.6 vs 67.0 years), had a higher incidence of smoking and prior trans-radial procedure, and were
more likely to have RAS and post-procedural pain (p,0.05
all). Adjusted multivariate predictors of RAO were radialartery spasm (adjusted-hazard-ratio [aHR] 4.31, 95% confidence interval [CI] 1.83–10.1, p,0.001), and post-procedural
pain (aHR 3.04, 95%CI 1.35–6.85, p,0.01).
Conclusion: The use of slender sheaths did not reduce the
incidence of early RAO post-trans-radial coronary procedure. The occurrence of intraprocedural arterial spasm, and
presence of post-procedural arm pain, should alert clinicians
to assess for this under-recognised complication.
https://doi.org/10.1016/j.hlc.2023.06.709
1
Royal North Shore Hospital, Sydney, NSW,
Australia
2
North Shore Private Hospital, Sydney, NSW,
Australia
Background: High-grade atrioventricular (HGAVB) block
is common after TAVI, often necessitating permanent pacemaker (PPM) implantation. Delayed HGAVB generally refers
to an onset at least 24 hours following the procedure and can
lead to syncope and sudden cardiac death. This systematic
review estimates the incidence of delayed HGAVB after
TAVI based on published literature.
Methods: A systematic review was performed of the
following online databases: MEDLINE, Cochrane, Web of
Science, and Scopus. Studies which labelled the outcome of
“delayed” or “late” atrioventricular block after TAVI were
included, patients with prior PPM or aortic valve surgery
were excluded. Initial search yielded 775 studies, which, after
screening, was narrowed to 21 studies.
Results: A total of 21 studies totalling 15,626 patients were
included. Participants mean age was 82 years, whilst 47% were
male. Mean STS score was 5.6%, and 31.3% of patients had preexisting atrial fibrillation. The most common access site was
transfemoral (84.8%), whilst balloon-expandable valves were
used in 62.1%, self-expanding valves in 34.0%, and mechanically expanding valves in 3.9% of cases. The incidence of
delayed HGAVB ranged from 1.4%–14.6% (overall incidence
4.1%). A sub-analysis of five prospective studies with the
lowest assessed risk of bias, yielded an incidence of 5.4%
Conclusions: Delayed HGAVB is a common and potentially serious complication of TAVI. Specific conclusions are
difficult to draw due to the significant methodological heterogeneity amongst studies. With a move towards minimalist
TAVI and earlier patient discharge, further prospective study
of delayed HGAVB is warranted to improve understanding of
predisposing factors, incidence, timing, and implications.
https://doi.org/10.1016/j.hlc.2023.06.710
805
This abstract has been withdrawn
806
The Use of a Pulmonary Embolism Response
Team (PERT) and Catheter-Directed Treatment
in a Far North Queensland Regional Centre
J. Pleash *, A. Helms, G. Starmer
Cairns Hospital, Cairns, Qld, Australia
Background: The establishment of multidisciplinary pulmonary embolism response teams (PERTs) for the management of patients with pulmonary embolism (PE) is becoming
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increasingly more common worldwide. Percutaneous catheter-directed treatment is a potential therapeutic option for
patients with PE, however this requires local expertise and
resources that are often only available in major metropolitan
tertiary centres. Cairns Hospital is currently the only
Queensland hospital outside the southeast corner to offer this
service. This audit aims to review the safety and feasibility of
providing this service in a regional centre.
Methods: We performed a retrospective review of all patients undergoing pulmonary angiography +/- catheterdirected treatment of PE following PERT activation between
January 2016 and December 2022 at Cairns Hospital, evaluating intervention success, complications and 30-day mortality.
Results: There were four cases resulting in pulmonary
angiography following PERT activation, of which three underwent catheter-directed thrombolysis +/-thrombectomy for
the treatment of PE. One individual had near complete resolution of pulmonary emboli on pulmonary angiography
following therapeutic anticoagulation and subsequently did
not undergo catheter-directed therapy. Overall procedural
success rate (defined as reduction in mean pulmonary artery
pressure, haemodynamic stabilisation, correction of hypoxia,
and survival to hospital discharge) was 100% with no procedural complications. Two of the three patients attended followup locally. Both individuals had resolution of right ventricular
dysfunction on transthoracic echocardiogram following catheter-directed treatment. There were no mortality events.
Conclusion: This audit has demonstrated the safety and
success of a pulmonary embolism response team and catheter-directed treatment in a regional hospital.
https://doi.org/10.1016/j.hlc.2023.06.712
Abstracts
807
This abstract has been withdrawn
808
This abstract has been withdrawn
809
This abstract has been withdrawn
810
Trends and Outcomes in the Use of Adjunctive
Fractional Flow Reserve From a Large MultiCentre PCI Registry
E. Quine 1,2,*, A. Ajani 1, D. Clarke 5, A. Brennan 3,
D. Dinh 3, J. Lefkovits 3,4, C. Reid 3, D. Stub 2,3,
C. Hiew 1
1
Department of Cardiology, Barwon Health, Geelong,
Vic, Australia
2
Department of Cardiology, Alfred Health,
Melbourne, Vic, Australia
3
School of Public Health and Preventive Medicine,
Monash University, Melbourne, Vic, Australia
4
Department of Cardiology, Royal Melbourne
Hospital, Melbourne, Vic, Australia
5
Austin Health, Melbourne, Vic, Australia
Background: Increasing evidence supports the use of
fractional flow reserve (FFR) to accurately determine which
coronary artery lesions are appropriate for intervention. We
aim to describe the use of FFR guided PCI in a large
Australian PCI registry.
Methods: We evaluated data from consecutive patients in
the VCOR registry from 2014 to 2020 who presented with
stable coronary artery disease or NSTEACS and underwent
FFR-guided PCI in a single procedure. They were compared
to a cohort who underwent standard angiographicallyguided PCI over the same period.
Results: A total of 59,401 patients were included in the
study with 2,455 (4.1%) undergoing FFR-guided PCI. FFRguided PCI patients less often presented with a NSTEACS
(22% vs 39%, p,0.001), were less likely to have their procedure out-of-hours (4.8% vs 10.6%, p,0.001) and more
likely to have radial access (70% vs 59%, p,0.001). The use of
FFR increased over the study period (2.8% of all cases in 2014
vs 4.7% in 2020, p,0.001). FFR-guided PCI was more often
performed on the LAD (65% of all cases vs 42%, p,0.001).
30-day mortality was less in the FFR-guided group (0.2% vs
0.6%, p=0.005) but overall rates were very low.
Conclusion: This observational study demonstrates that
FFR is underutilised in the Australian context however use is
increasing. Lower rates of ACS presentation in the FFR
guided group corresponds with the established evidence
base in patients with stable coronary disease. Given guideline recommendations and strong trial evidence FFR should
be utilised more often to guide revascularisation.
https://doi.org/10.1016/j.hlc.2023.06.716