Abstract Journal Cardiothoracic Surgery

Journal Cardiothoracic Surgery CS680 AVOIDING PATIENT-PROSTHESIS MISMATCH WITH PREOPERATIVE AORTIC ANNULUS MEASUREMENT MINESH PRAKASH, VARUN SHARMA, ALLYSSA LU, ADAM EL GAMEL, JEFF MACEMON, CASEY LO, ZAW LIN, NAND KEJRIWAL, DAVID MCCORMACK, PAUL CONAGLEN, FRANCESCO PIRONE, FELICITY MEIKLE AND GRANT PARKINSON Waikato District Health Board, Hamilton, New Zealand Introduction: Pre-operative echocardiography, computed tomography (CT), and MRI can measure the aortic root anatomy. An appropriate prosthetic aortic valve (PAV) size can therefore be determined and reduce patient-prosthesis mismatch (PPM) post-surgery. The aim of the study was to elucidate if preoperative valve sizing can forecast PPM. Methodology: Retrospectively, all patients undergoing PAVR at Waikato hospital between 1st May 2016 and 30th August 2017 were reviewed. Theoretical PAV size was calculated with preoperative CT and EOAi was calculated from the published EOA of the used valve and patients’ body surface area (BSA). Patients with diagnostic EOAi (<0.85cm/m) suggestive of PPM were analysed further in regards to the valve choice and post-op mean gradient (P-oMG). Results: Study included 139 patients: 54 (not imaged); 41 (non-contrast CT scan [NCCT]); and 42 (contrast CT [CCT]). Sizing accuracy was 56% (NCCT) and 69% (CCT). Nine cases had EOAi-based PPM: 6 [Mosaic valve (size 21, 23); 2 [SJM Trifecta valve (size 19)]; and 1 [Sorin Mitroflow valve (size 23)]. P-oMG averaged 20 mmHg in Mosaic and Trifecta group. Of this group, our calculated valve sizes were: same–sized (5); over-sized (3); and undersized (1). Conversely, 6 cases had P-oMG of >20mmHg and EOAi >0.85cm/m: 4 [Magna Ease (19, 21 and 23)]; and 2 [SJM Trifecta (19, 21)] valves. Perceval and Regent valves performed better overall. Conclusion: Aortic annulus sizing with pre-operative CT can help determine the best PAV for the patient especially those with smaller aortic annulus but greater BSA. These patients could benefit from mechanical or sutureless valve or even root enlargement. CS681 ETHNIC DISPARITY IN AORTIC VALVE REPLACEMENT FOR AORTIC INSUFFICIENCY IN THE WAIKATO REGION MINESH PRAKASH, VARUN SHARMA, ALLYSSA LU, ADAM EL GAMEL, ZAW LIN, PAUL CONAGLEN, DAVID MCCORMACK, FELICITY MEIKLE AND NAND KEJRIWAL Waikato District Health Board, Hamilton, New Zealand Introduction: Ethnic disparity in health is still prevalent worldwide. Indigenous people have poor health status from multifactorial causes resulting in late presentations, severe disease states with associated higher treatment risks. In Cardiothoracic surgery validated EuroSCOREII assesses these risks and therefore the aim of the study was to compare pre-operative risk of ethnically diverse Waikato population undergoing aortic valve replacement (AVR) for aortic insufficiency (AI). Methodology: Retrospectively, all patients undergoing AVR at Waikato hospital for AI between 1st May 2016 and 31st May 2019 were included in the audit. The primary outcome was the average EuroSCOREII among the different ethnic groups. The secondary outcomes were the left ventricular size and function, concomitant surgeries and length of admission (LOA). Results: A total of 124 patients underwent AVR: Maori (61); European (53); Samoan (7); and Cook Island Maori (CKM) (3). Males accounted for 75% of AI cases. Maori (55.6years) were 10 years younger compared to Europeans (66.3years). The EuroSCOREII on average was higher in Maori (6.75) versus European (5.12) and around 2.1 for both Samoan and CKM. The LV end-diastolic and end-systolic diameter was larger in Samoans (6.74 and 4.76 cm respectively) followed by Maori, Europeans and CKM. LVEF values were not available. Operatively, Maori had twice as many simultaneous procedures with their AVRs which was 12% more than the Europeans and stayed extra 2 days as inpatient. Conclusion: Ethnic disparity exists in AI and AVR surgery. Maori and Pacific Islanders presented with larger ventricles with higher risk profile at a younger age for dual procedures than European population and had longer LOA. CS682 PREOPERATIVE AND INTRAOPERATIVE PROGNOSTIC FACTORS OF THE PROLONGATION ICU OCCUPANCY TIME AFTER MITTRAL VALVE REPLACEMENT SURGERY IN DR. SARDJITO HOSPITAL, YOGYAKARTA, INDONESIA HERPRINGGA LARA SAKTI AND SUPOMO Universitas Gadjah Mada, Yogyakarta, Indonesia Purpose: To obtain preoperative and intraoperative prognostic factor of the prolongation ICU occupancy time after Mitral Valve Replacement (MVR) surgery Methodology: A retrospective cohort study of 70 MVR surgery patients at Sardjito Hospital Yogyakarta Indonesia from January 2013 to December 2018. Preoperative independent variables (age,gender,ejection fraction,NYHA functional class, renal insufficiency, pulmonary hipertension,chronic pulmonary disease, active endocarditis), intraoperative independent variables(duration of Aortic cross clamp (AOX) time and Cardiopulmonary bypass (CPB) time) and the dependent variable (ICU occupancy time>96 hours) were analysed in the multivariate analysis using SPSS 22.0 and expressed in the odds ratio (OR) with 95% Confidential Interval. Result: The cut-off AOX time is 96.5 minutes (AUC:0,756) and CPB time is 130 minutes (AUC:0.753), which are determined based on the ROC curve using the Youden index method. Mean of ICU occupancy time is 55 hours and there were 15 patients with prolong ICU occupancy time (>96hours). Logistic regression analysis showed Age >50 years old was at a 6-time risk (OR:6.4 95% CI=1.26-15.3), NYHA functional class III-IV was at a 9-time risk (OR: 9.8 95% CI=1.4-67.2), and duration of CPB Time >130 minutes was at a 5 time-risk (OR: 5.7 95% CI = 1.8-38.1) for experiencing of the prolongation ICU occupancy time Conclusion: Age >50years old, NYHA functional class III-IV and CPB Time >130 minutes are the preoperative and intraoperative prognostic factors of the prolongation ICU occupancy time CS683 VALUE OF MANDATED EDUCATION IN FOCUSED ULTRASOUND EXAMINATION DURING CARDIOTHORACIC TRAINING: IS IT TIME TO FORMALLY INCORPORATE THIS SKILL? VICTOR AGUIRRE, KIRSTIN MARCHAND, ROBERT STUKLIS AND MICHAEL WORTHINGTON The Royal Adelaide Hospital, SA Introduction: The use of focused clinical ultrasound (US) in assessing cardiac, respiratory, and abdominal pathologies has been mandated and is considered standard of care across multiple surgical specialties. In addition, vascular and regional access procedures are routinely done with real-time ultrasound. Cardiothoracic surgery has yet to incorporate this skill into routine clinical assessment as well as endorsing it as a mandatory requirement for training. Discussion: Ultrasound has been increasingly used by multiple specialties since its introduction 50 years ago. In surgery, a simple concept has popularized its use: “If you can identify the anatomy with ultrasound, then you are more likely to successfully cannulate vessels, drain effusions, harvest conduits and confirm diagnosis”. The College of Surgeons does not support mandating specific ultrasound qualification or credentialing. However, other colleges and specific societies acknowledge its extensive use and the need for formal education. Recent advances in simulator and eLearning technologies facilitate training in theoretical and skill-based learning. Conclusion: 1. Focused ultrasound examination during cardiothoracic training is feasible to learn. 2. Focused ultrasound examination should be a mandatory part of the training curriculum. 3. The use of focused ultrasound assessment at different stages of cardiothoracic patients reduces comorbidity and hospital length of stay associated with preventable complications. 4. Surgical societies are becoming more interested in the education of ultrasound technologies with an interest in MBS reimbursements. Editorial material and organization © 2020 Royal Australasian College of Surgeons. Copyright of individual abstracts remains with the authors. ANZ J. Surg. 2020; 90 (S1) 28–29