Page 84 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
146
111. Figure 1.
septum. Over next two years tumor was progressively increasing in size with increasing atrioventricular con- duction delay and ventricular tachycardia. At 25 months of age when she was 13 Kg, she underwent median ster- notomy. An epicardial echocardiogram was then used to visualize the mass. Multiple biopsies were obtained with 16F trocar needle, Cook Quick-CoreTM biopsy needle (Cook,Bloomington, Indian) as well as aspiration of tumor content with a 22G ChibaTM needle (Cook,,Bloomington, Indiana) under ultrasound guidance. (Fig).A pacemaker was implanted after biopsy; histopathology from the biopsy sample confirmed the diagnosis of teratoma.
Conclusion: We suggest that this novel technique may be an option in specific cases of cardiac tumors where tissue diagnosis is important but surgical resection is deemed too risky or impossible. This is also the first report of ven- tricular tachycardia and use of a pacemaker placement for an intracardiac teratoma. A&B. MRI of the teratoma in ventricular septum. C. Echocardiogram of the tumor. D. Intra-operative needle biopsy of the tumor by ultrasound guidance. Needle marked by black arrow head.
112. TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) VS SURGICAL AORTIC VALVE REPLACEMENT (SAVR) IN PATIENTS WITH PREVIOUS CARDIAC SURGERY.
Janine Anita Miranda1, Joseph Chen2, Elizabeth Wilson1, Sanjeevan Pasupati1, Rajesh Nair1
1Waikato Hospital, Hamilton, New Zealand. 2University of Auckland, Auckland, New Zealand
Background: Despite higher risks of redo cardiac surgery, “low risk” patients are still offered SAVR using bioprosthesis in the era of TAVR. This retrospective study set out to deter- mine differences in clinical outcomes between SAVR and TAVR in patients who have had previous cardiac surgery in a tertiary centre.
Method: Patients who received SAVR and TAVR between July 2008 – July 2018 with previous history of cardiac sur- gery were identified from the hospital database. Mortality, length of stay in intensive care unit (ICU), duration of hos- pital stay, stroke and pacemaker implantation prior to dis- charge were studied.
Results: With the history of prior cardiac surgery, 67 patients underwent SAVR and TAVR was performed on 53 patients. There was one patient who received a SAVR followed by TAVR and was included in both categories. 1 further patient had two redo SAVRs within the study time.
“Valve-in-valve”TAVR was performed for previous bio-pros- thetic valve failure in 12 (23%) patients. 30 (45%) patients underwent redo SAVR with no other concomitant surgical procedure.
Results: 30-day mortality was 7/67 (10%) for patients undergoing SAVR vs 1/53 (2%) in TAVR arm (p=0.104). 1-year mortality was 8/67 (12%) in SAVR compared to 2/53 (4%) in those with TAVR (p=0.134). All SAVR patients stayed in ICU whereas only 1 patient who received TAVR stayed in ICU for 4 days. Average ICU stay was 2.96 days in patients with SAVR. Average length of hospital stay was 15±1.72 days for SAVR vs 7±0.76 days after TAVR (p<0.0001). Pacemaker implantation prior to discharge was 2/67(3%) and 6/53(11%) patients post-procedure in SAVR and TAVR respectively (p=0.09). Change in mean aortic valve gradi- ent following SAVR was -21±4.4mmHg and following TAVR was -44.4±3.52 (p=0.00019 ).
Average age of patients receiving redo SAVR was 59.5±13 years. 30-day and 12-month mortality for redo SAVR were 2(6.7%). Average age of patients undergoing “valve-in- valve” TAVR was 76±7 years. There was 0% surgical and 1-year mortality.
5-year mortality was 4(13%) for redo SAVR vs 3 (25%) for “valve-in-valve” TAVR; in line with TAVR being offered for the sicker patient group. This was confirmed with the
Journal of Structural Heart Disease, August 2019
Volume 5, Issue 4:75-205