Degree of Change in Mitral Regurgitation (MR) Following TAVI

DEGREE OF MR No. of Pt Pre (%) No. of Pt Post (%) P.VAL.

No MR 3 (6%) 16 (32%) 0.001Mild MR 20 (40%) 22 (44%) NSModerate MR 21 (42%) 10 (20%) 0.001Severe MR 6 (12%) 2 (4%) NS

TF - TRANSFEMORALTA - TRANSAPICAL*NS - not significant*S - Significant

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observed at the 3 levels (AbsoluteD3.5％ to 5.4%, p<0.01). For the 23 mmvalve, D2 increased from 22.9�0.4 mm to 24.0�0.7, p<0.007. For the 26mm valve from 25.3�0.6 to 26.6�0.7, p<0.001. The occurrence ofannulus rupture (4.1 vs 1.2%, p¼0.240) and stroke ( 2.6 vs 2.4%, p¼NS)were similar. Kaplan-Meier analysis revealed no significant difference inthemid-term survival between PD and no PD patients (log-rank p¼0.593).

Conclusion: AR > grade 2 after Edwards valve implantation isobserved in about 10% of cases. The main cause is valve undersizing.Post dilatation seems to be safe and is able to increase the valve size andreduce AR by at least 1 grade in 88% of cases.

- AS-120

Predictor That Influence the Degree of Severity of MitralRegurgitation Post Trans Cath Aortic Valve Replacement UsingEdward Sapien Valve. Saad Mohamed Alkasab,Saeed Awadh Alahmari, Hussein Saeed Alamri, Ali Al Masood. PrinceSultan Cardiac Center, Riyadh, Saudi Arabia.

Background: Mitral Regurgitation (MR) is frequent finding in patient(Pt.) with Aortic stenosis (AS). The study objective is to know thepredictor that influence the change in degree of MR severity postTranscatheter Aortic Valve Implantation (TAVI).

Methods: Between April 2009 January 2012, 50 consecutivepatients with Aortic Stenosis underwent (TAVI) procedure withEdward-Sapien Valve in PSCC. MR assessed by visual mapping flow.

They were divided into two groups G1 (MR improved after TAVI)G2 (MR did not improved after TAVI).

Results: Procedural success 96%.Charchter of patient and Haemodynamic and Echocardiography

finding.

CHARCHTER G1 G2 P.V

Age 78.1 � 10 77 � 9Gender F / 15 10 NS

M / 12 13 NSEFIOLOGY OF MRFUNCTIONAL / 13 11 NSORGANIC / 12 9 NS

MEDICAL HITORYHYPERTENSION / 11 19 (S) (0.030)DM / 14 21 NSCAD / 12 17 NS

PROCEDUREAPPROACH

TF - FEMORAL 17 11 NSTA APICAL / 10 12 NSPRE-MEAN AV

GRADIENT50 48 NS

POST-MEAN AVGRADIENT

10 + 2 12 + 3 NS

DEGREE OF MEANAVERAGE

40 37.6 + 6 NS

CHANGE 53 + 5 54 + 6 NSPRE LV EJECTION

FRACTION /

54 + 6 50 + 7 NS

POST LV EJECTIONFRACTION /

44 + 6 4010 NS

PRE POSTPULMONARYARTERYPRESSURE /

375 3911 NS

POST PULMONARYARTERYPRESSURE(PAP)DEGREE OF PAPCHANGE /

8.310 18 S.041

(Continued)

The American Journal of Cardiology� APRIL 23e26, 2013 AN

Conclusion: Degree ofMR Improvement achieved in 56%patient. Thepredictor factor that influence the reduction of severity of MR Post TAVIare a) Hypertension b) change in the degree of Pulmonary Artery Pressurepost TAVI. However the eteology of MR, change in aortic gradientand change of LV function post TAVI were not significant predictor.

- AS-121

The Quality of Life of Patients After Transcatheter Aortic ValveImplantation (TAVI)- Hong Kong Experience. Miu Ching Chan.Queen Elizabeth Hospital, Hong Kong, China.

Background: Surgical aortic valve replacement (AVR) is regarded asgolden standard for symptomatic severe aortic stenosis. However, themortality will be greatly increased for patients over 80 years old. Due toshort- life expectancy and co- morbidity, AVR is declined for old age orhigh -risk patients. With the advancement of technology, an alternativetherapeutic option- TAVI is provided. Since the implantation inWestern countries, TAVI seem to be an effective procedure with highsuccess and low mortality rate. Quality of life (QoL) is used as one oftool to assess the efficacy of this novel procedure. In Hong Kong,Queen Elizabeth Hospital is the first hospital to perform TAVI. Since2010, 19 patients were recruited into the TAVI program.

Methods: From December 2010 to Oct 2012, 19 patients have under-gone TAVI. All of them were declined for AVR due to old age or poormorbidity. The SF-12, ejection fraction (EF), NewYorkHeart Association(NYHA), 6-minutes walk and 30-days mortality were measured.

Results: 19 patients with mean age 81.32 (SD 4.01), 8 female and 11male were recruited. The mean logistic Euro Score (13.61 +/- 8.29) andmean gradient (52.61 +/- 10.91) were high. All of them were old agepatients with high surgical risk that not fit for surgical valvularreplacement. The in-patient and 30 days mortality was 0 %. One patientwas admitted for mild right retinal artery occlusion with full recoverafter 4 days hospitalization. EF (p < 0.05) and 6- minutes walk (p<0.01) was significantly improved. Similar results were shown in NYHA,81.25 % increase 1 class, 12.5 % increase 2 classes and 6.25 % with nochange. At 1 year follow up, SF-12 also show profound results (Mentalcomponent, p¼ 0.014, and physical component, p¼ 0.005).

Conclusion: This group of high risk, old age patient showed shortterm significant improvement in quality of life and functional capacity.Long term results have to be monitored for evaluation in future.

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Safety and Efficacy of Transseptal Puncture in Dead Lateral Viewin Rheumatic Mitral Stenosis. Palamalai Arun Prasath,Pacckirisamy Gobu, Satheesh Santhosh, Ananthakrishna Ajith,Jayaraman Balachander. Jawaharlal Institute of Postgraduate MedicalEducation and Research, Pondicherry, India.

Background: Rheumatic heart disease with mitral stenosis is stillhighly prevalent in Asian countries. Balloon mitral valvotomy is aneffective first line treatment in suitable candidates. Interatrial septal

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anatomy is altered in such patients due to enlargement of left atrium andalso rheumatic activity involving the left atrial side of septum causingthickening and fibrosis. Technically the success of the procedure isdetermined by proper transeptal puncture, Balloon entry into leftventricle and underlying valve morphology. Transeptal puncture donein dead lateral view has added advantage of encountering the maximumstrech of interatrial septum for puncture between two fluoroscopiclandmarks with less foreshortening. This study analyse the incidence ofcomplications incurred in procedure of transeptal puncture in lateralview and subsequent successful completion of procedure in 785 patientsfrom our centre.

Methods: This retrospective study analysed 801 patients whounderwent percutaneous balloon mitral valvotomy for rheumatic mitralstenosis in our centre from 1995 to 2010. 359 patients are less then 20years of age. Balloon mitral valvotomy was done as a definitivetherapy, palliative relief and also as a part of multivalvular interven-tions. Pre procedure echocardiography is done for assessing valvesuitability for the procedure. 785 patients had transeptal puncture indead lateral view by modified inoue technique. Transseptal puncturewas done under fluoroscopic guidance only, using brokenboroughneedle assembly. The safety of the procedure is assessed by thecomplications incurred due to septal pucture. Known complicationslike pericardial effusion, cardiac tamponade, aortic puncture, stichingof pericardium, IVC puncture are noted. As the position of puncturesite in interatrial septum influences the subsequent balloon entry in toleft ventricle, the successful completion of procedure is considered asreflector of efficacy. High or low puncture in the interatrial septumposed difficulty in subsequent balloon entry in to leftventricle. Failedprocedure after entry into left ventricle due to other causes areexcluded.

Results: Out of 801 patients who underwent Balloon mitral valvot-omy, 785 patients (98%) had transeptal puncture by modified inouetechnique in dead lateral fluroscopic view. 44.89% of patients wereunder 20 years of age. The Transeptal puncture was uneventful in95.03% of patients. Overall complications incurred due to transeptalpuncture is 4.96%. Failed attempt of the septal puncture happened in2.29% of cases. Cardiac tamponade neccessiating urgent peri-cardiocentisis was encountered in 1.4% of patients. Mild pericardialeffusion (1%), Aortic and Leftatrial free wall puncture in 1 patient. 3patient had cardiac arrest and successfully resuscitated. Overallmortality in 0.1% of patients were noted. Failed balloon entry into leftventricle after a successful transeptal puncture was encountered in1.78% of cases. Finally 98.12% had a successful uncomplicatedpercutaneous Balloon mitral valvotomy in our case series.

Conclusion: Transeptal puncture done in dead lateralfluoroscopic viewfor percutaneous balloon mitral valvotomy in rheumatic mitral stenosis issafe and efficacious step of the procedure which largely determines theoverall success of the percutaneous balloon mitral valvotomy.

58B The American Journal of Cardiology� APRIL

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Outcome of Transcatheter Mitral Valve Clip for the Managementof Mitral Regurgitation in High Risk Group Patients Unsuitable forSurgical Intervention. Freidoon Keshavarzi, John Cleland,Angela Hoye, Farqad Alamgir. Castle Hill Hospital, Hull, UnitedKingdom.

Background: Mitral regurgitation (MR) can cause or complicate heartfailure, affecting patient quality of life and survival. Surgical mitralvalve (MV) repair or replacement is effective but associated withsubstantial morbidity and mortality in high-risk groups. MV clipping isa potential alternative, minimally invasive and lower risk procedure thathas been shown to have similar benefits to surgical repair in randomisedtrials. The aim of this study was to assess the impact of the MitraClipprocedure on MR and functional class in clinical practice in patientswho were refused MV surgery.

Methods: Patient demographics including age, gender, cardiac / valvestructure and function, aetiology of MR, duration of the procedure,complications, duration of hospital stay and the NYHA class pre andpost procedure were recorded. SPSS statistical tool was used to analysethe data.

Results: 30 patients unsuitable for surgery were referred to our centre.Twelve patients were excluded because of co-morbidities and wereconsidered clinically inappropriate MitraClip (n¼5; 42%) and/or becauseof unsuitable valve morphology (n¼7; 58%). Of 18 patients whounderwent the procedure, the mean age was 73 (range 5885) years and14 were men. MR was functional in 15 (83%), due to valve prolapse in 2and degenerative valve disease in one. Two clips were deployed in fourpatients. The median procedure time was 227 min (123380 min).Procedures longer than 2 h involved multiple clip application as well ascoronary angioplasty. Mean hospital stay was 6 days (118 days) and78% of patients were discharged within 1 week. Complications includedfailure to remove the catheter after the MitraClip application in onepatient with severe pre-existing heart failure who later died of heartfailure, bleeding from the groin and septicaemia. One patient who hadbeen hospitalised for 5 months with severe heart failure died frompericardial tamponade most likely due to atrial wall damage. Amongsurviving patients, MR severity improved to grade I/II in 84%, to gradeIII in 16%. Of patients initially in NYHA IV, one died, one improved toNYHA I, one to NYHA III and one did not improve. Of 14 patientsinitially in NYHA III, Nine (62%) improved to NYHA I/II, one died andfour did not improve substantially.

Conclusion: In high-risk patients who have been declined mitralvalve surgery, MV repair using the MitraClip procedure can be donewith a moderate risk and with a high procedural success rate.Advances in expertise and technology will improve efficacy andpatient safety.

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