SATS 2009 Final Program - Scandinavian Association for Thoracic ...

S01:3
30-DAY OUTCOMES IN HIGH RISK-PATIENTS RANDOMIZED TO OFF-PUMP OR ON-PUMP CORONARY
BYPASS SURGERY
Møller Christian H 1 , Perko Mario 1 , Lund Jens 1 , Andersen Lars W. 1 , Madsen Jan K. 2 ,
Gluud Christian 1 , Steinbrüchel Daniel A 1
1) Rigshospitalet, 2) Gentofte Hospital, Denmark
Background
Coronary artery bypass grafting (CABG) performed with (on-pump) and without (off-pump) cardiopulmonary bypass
seems safe and results in about the same outcome in low-risk patients. Observational studies indicate that off-pump
surgery may provide more benefit in high-risk patients. Our objective was to compare outcomes in high-risk patients
randomized to CABG with or without cardiopulmonary bypass.
Methods and Results
We randomly assigned 341 patients with a EuroSCORE ≥ 5 and 3-vessel coronary disease to undergo on-pump
versus off-pump CABG. Patients were followed up through the Danish National Patient Registry. The primary
outcome was a composite of adverse cardiac and cerebrovascular events (i.e., all-cause mortality, acute myocardial
infarction, cardiac arrest with successful resuscitation, low cardiac output syndrome/cardiogenic shock, stroke, and
coronary reintervention). An independent event committee blinded for treatment allocation assessed the outcomes.
Baseline characteristics were well balanced between groups, and the mean number of grafts per patient did not
differ significantly between groups (3.22 in off-pump and 3.34 in on-pump, P = 0.11). No significant difference in the
composite primary outcome (15% vs 17%, P = 0.48) or the individually components were found at 30-day follow-up.
Fewer grafts were performed to the lateral part of the left ventricle territory during off-pump surgery (0.97 vs 1.14
after on-pump surgery; P = 0.01). Conclusion - Both off- and on-pump CABG can be performed in high-risk patients
with low short-term complications. Off-pump surgery seems to be associated with a reduced number of grafts to the
lateral territory of the left ventricle.
S01:4
CATHETER BASED AORTIC VALVE IMPLANTATION – RESULTS FROM THE FIRST 50 PATIENTS
Nielsen Hans Henrik Møller 1 , Thuesen Leif 1 , Andersen Henning Rud 1 , Hjortdal Vibeke E 1 ,
Klaaborg Kaj-Erik 1 , Jakobsen Carl-Johan 1 , Böing Ingeborg 1
1) Aarhus University Hospital, Skejby, Denmark
Background
Aortic valve stenosis is a common cause of morbidity and mortality among the elderly population. Medical treatment
is often inadequate and most patients ultimately need aortic valve surgery (AVS). Up to one third of patients
requiring AVS is deemed inoperable due to co-morbidities and consequently high risk. At Aarhus University Hospital,
Skejby, catheter based stentvalve implantation have been used to treat selected highrisk patients with aortic valve
stenosis since 2006.
Aim
The aim of this study was to evaluate morbidity and mortality following catheter based aortic valve implantation.
Materials and methods: A total of 50 patients were treated with an aortic
stentvalve between february 2008 and february 2009. 15 were done via transfemoral (TFA-AVI) technique and
35 via transapical technique (TAP-AVI). Median age of the patients was 83+ 6, 7 and 62% females. Mean logistic
EUROscore was 19, 7% and 17, 5% in the TAP-AVI and TFA-AVI group respectively.
Results
Successful stent valve implantation were performed in 46/50 (92%) patients. The first two patients in this series
died during procedure TFA-AVI. There were no peroperative deaths in the TAP-AVI group. 30 days mortality rate
was 20% in TFA-AVI and 6% in TAP-AVI group. There was no incidence of peroperative MI or coronary occlusion
requiring PCI/CABG.
Conclusion
Catheter based aortic stent valve implantation is a feasible technique, requiring close co-operation between
surgeons, cardiologists and anesthesiologists. The procedure should be reserved for selected highrisk patients
deemed inoperable to conventional surgery, until further studies, preferably randomized trials, have documented
the technique.
STOCKHOLM, SWEDEN 39