Page 36 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
98
38. ASSESSING THE VALUE OF CORONARY ARTERY COMPUTED TOMOGRAPHY AS THE FIRST-LINE ANA- TOMICAL TEST FOR STABLE PATIENTS WITH INDI- CATIONS FOR INVASIVE ANGIOGRAPHY DUE TO SUSPECTED CORONARY ARTERY DISEASE. ECONOMIC OUTCOMES OF THE CAT-CAD RANDOMIZED TRIAL. Piotr Nikodem Rudziński1, Mariusz Kruk1, Cezary Kępka1, U. Joseph Schoepf2, Katharina Otani3, Mariusz Dębski1, Zofia Dzielińska1, Jerzy Pręgowski1, Adam Witkowski1, Witold Rużyłło1, Marcin Demkow1
1Institute of Cardiology , Warsaw, Poland. 2Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, USA. 3Siemens Healthineers, Tokyo, Japan
Background: Clinical and safety outcomes of the strategy employing coronary computed tomography angiography (CCTA) as the first-choice imaging test in this population have been recently shown in the published CAT-CAD randomized, prospective, single-center study. Based
on prospectively collected data we aimed to evaluate economic outcomes and cost-effectiveness of such innovative approach.
Methods: 120 participants of the CAT-CAD trial (age: 60.6±7.9 years, 35% female) were included in the eco- nomic analysis. During the diagnostic and therapeutic period we counted crucial medical resources. We prospec- tively estimated the cumulative cost for each strategy by multiplying the number of resources by standardized costs with accordance to medical database and 2015 Procedural Reimbursement Payment Guide.
Results: The total cost of coronary artery disease (CAD) diagnosis was significantly lower in the CCTA group as compared to the direct invasive coronary angiography (ICA) group ($50,176 vs $137,032) with corresponding per-patient cost of $836 vs $2,284, respectively. Similarly, the entire diagnostic and therapeutic course was sig- nificantly less expensive in the CCTA group ($227,622 vs $502,827) with corresponding per-patient cost of $4,630 vs $8,380, respectively. Overall, the application of CCTA as the first-line diagnostic test in stable patients with indica- tions to ICA resulted in 63% reduction of CAD diagnosis costs and 55% reduction of the composite of diagnosis and treatment costs.
Conclusions: Application of CCTA as the first-line anatomic test in patients with suspected significant CAD decreased the total costs of diagnosis. This benefit can be achieved by reducing the number of invasive tests and hospital- isations. Economic analysis of the CAT-CAD randomized trial suggests that this approach is cost-effective and
may provide significant cost savings for the entire health systems.
39. PERCUTANEOUS CLOSURE OF PROSTHETIC PARAVALVULAR LEAK : SINGLE CENTER EXPERIENCE
Sitaraman Radhakrishnan, Sushil Azad, Vikas Arya
Fortis Escorts Heart Institute, New delhi, India
Background: Clinically significant Paravalvular Leak (PVL) is an uncommon complication occurring up to 1-3% of patients following surgical valve replacement. Percutaneous device closure represents an alternative to high risk redo surgery which is associated with high mor- tality of up to 18%.
Aim: To evaluate clinical outcome of patients treated with Percutaneous closure of PVL at an Indian tertiary care center.
Methods: A retrospective analysis of patients who under- went PVL device closure during period of year 2011-2018.
Results: A total of 15 percutaneous closure of PVL pro- cedures were performed in 12 patients. Age range varied from 18- 70 years with 75% male patients. Heart failure was presenting symptom in majority (66%) and palpitation in 8.3% and combination of both in 25%. None of our patients presented with hemolysis. PVL in Mitral position was pres- ent in 6 patients and 5 patients had Aortic PVL. One patient was a case of Corrected Transposition of great arteries who had Prosthetic valve in Left AV valve position and presented with PVL. In the entire cohort clinical success was achieved in 91.6%. There was one patient in whom the procedure was unsuccessful and this patient died. There was no sig- nificant adverse procedure complication.
Conclusion: Patients with PVL represents a high risk Cohort. Percutaneous PVL closure offers a safe alternative to surgical PVL closure and is associated with less morbid- ity and mortality.
40. INTERMEDIATE AND LONG TERM FOLLOW UP OF PERCUTANEOUS DEVICE CLOSURE OF FOSSA OVA- LIS ATRIAL SEPTAL DEFECT BY LIFETECH (HEART R/CERATM) ASD OCCLUDER IN A COHORT OF 302 PATIENTS: OUR EXPERIENCE
Vikas Arya, Sitaraman Radhakrishnan, Sushil Azad
Fortis Escorts Heart Institute, New Delhi, India
Objectives: The aim of present study is to analyze the intermediate and long-term follow up results of percu- taneous closure of fossa ovalis atrial septal defect (ASD)
Journal of Structural Heart Disease, August 2019
Volume 5, Issue 4:75-205