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

P01:44
SUBCLAVIAN ARTERY APPROACH IN TRANSCATHETER AORTIC VALVE IMPLANTATION
Holm Peter 1 , Jönsson Anders 1
1) Karolinska University Hospital, Sweden
Objectives
Transcatheter aortic valve implantation (TAVI) has evolved as a therapeutic option with reproducibly good results in
patients (pts) considered to be at high risk for complications from conventional surgical valve replacement. Several
thousands of pts have been treated with TAVI worldwide. The experience at our centre since February 2008 is
limited to the CoreValve system. The purpose of this study was to report our experience with TAVI using the left
subclavian artery as vascular access.
Methods and Results
A total of 55 pts with a mean age of 82±6 years and a logistic EUROSCORE of 24±11% underwent TAVI using the
CoreValve prosthesis. In 50 pts the prosthesis was delivered using a transfemoral approach. In 5 pts (3 male) the
left subclavian artery was used for access. The decision to use the subclavian artery approach was based on severe
aortic angulations in two patients and inability to create femoral access because of small, calcified or tortuous
femoral arteries in three pts. There was no 30-day mortality in any of the pts operated on using the subclavian artery
as vascular access.
Conclusions
The left subclavian artery can be used as an alternative to create access in patients unsuitable for TAVI via the
femoral arteries. This access has in our initial experience some advantages when compared to the femoral artery
approach. The short and straight distance from the introducer positioned in the subclavian artery down to the aortic
annulus offers enhanced stabilization during the expansion of the valve.
P01:45
CAN A PHYSICAL MOBILISATION PROGRAM FOLLOWING OPEN HEART SURGERY INFLUENCE ON
POSTOPERATIVE ROUTINES?
Haukeland Unni Kleppe 1 , Oterhals Kjersti 1 , Drevdal Julie 1 , Lygren Heidi 1 , Njåstad Anita 1 ,
Segadal Leidulf 1 , Haaverstad Rune 1
1) Haukeland University Hospital, Norway
Background and objectives
Pulmonary complications are frequent following open heart surgery. Physical mobilisation is of prime importance
to prevent postoperative respiratory complications. The main objective was to study whether a standard nursing
protocol for mobilising patients could stimulate active and early mobilisation in general, and additionally reduce
postoperative pulmonary complications.
Methods
According to the new protocol, minimum mobilisation of 57 patients (intervention group) included sitting in a chair
30 min x 3 1. po. day and 60 min x 3 the 2. day. From day 3 patients should walk about and stay out of bed most
of the day. Retrospectively complications were compared with a matched group of 59 patients (control group) with
routine treatment. The mobilisation was registered in a data form. Clinical and demographic data were collected
from patient files.
Results
The groups were similar with regards to age, gender and preop. risk factors (EuroScore). Mean age of all patients
was 68 ± 12 years, range 27-89 years, and 72 % were men. The study revealed that systemizing respiratory
complications is a difficult task and this will be further analyzed. No differences were found between the groups with
respect to how many times patients were mobilised the first three po. days. However, patients in the intervention
group stayed out of bed for longer periods both on day 1 (p = 0.018) and day 2 (p < 0.0001).
Conclusions
A postoperative nursing protocol may improve mobilisation of patients following heart surgery. Increased knowledge
and focus on mobilisation may have influenced positively on mobilising routines on the ward.
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