Oral Presentations - Pathology and Laboratory Medicine - University ...

OtherLise Matzke, Fabian Nietlspach, John Webb, Sam Lichtenstein, Michael Allard1James Hogg Research Centre Biobank, Heart and Lung Insitute, St. Paul’s Hospital/University of British Columbia; 2 Interventional Cardiology, St. Paul’s Hospital Heart Centre;3Cardiovascular Surgery, Paul’s Hospital Heart CentreAbstract # 28Elisabeth Anne Marie Matzkecardiac amyloid in the setting of transcatheter valveimplantation: a possible contributor of post-operativedeath?Backround/ObjectivesAging of the population and greater age-related aortic valve disease has led to an increasing number of elderly patientswho are referred for heart valve surgery. Many of these individuals are not suitable for open heart valve replacementsurgery and, instead, undergo transcatheter aortic valve replacement (tAVR). As many of these patients are beyondtheir seventh decade of life, certain conditions become increasingly common. One such condition is amyloidosis.Amyloidosis is characterized by the deposition of insoluble fibrillar protein aggregates in the heart and other tissue andis classified according to the protein precursor as immunocyte dyscrasia-related, hereditary, isolated atrial, reactive, andsenile systemic amyloidosis (SSA) The SSA type is reportedly present in approximately one-quarter of autopsy casesin those over 80 to 85 years and, as such, is predicted to be a common finding in individuals undergoing tAVR thatmay contribute to post-operative mortality In this report, we describe a series of autopsy heart cases from patients thatunderwent transcatheter valve implantation .MethodsIn this study, we characterized autopsy heart case materials from seventeen (17) patients that underwent transcathetervalve implantation at St. Paul’s Hospital between 2005 and 2010. Each case was accessioned in the James HoggResearch Centre Cardiovascular (CV) Biobank at St. Paul’s Hospital/University of British Columbia by the samecardiovascular pathologist. During pathologic evaluation, heart cases were routinely photographed and selectivelyradiographed. All hearts were assessed for their macroscopic and microscopic features in a standard manner, includingdetailed assessment of the stented prosthetic valve. Formalin fixed and paraffin embedded sections of myocardium werestained with hematoxylin and eosin and other special stains including congo red and sulfated alcian blue for amyloid. Ifappropriate, immunohistochemistry was performed with commercially available monoclonal antibodies directed againstlambda (λ) and kappa (κ) light chains as well as against amyloid A protein.ResultsOver this time period, the 17 cases had a sex distribution of 10 males and 7 females with an overall mean age of 78.3years (range: 57 to 99 years). The time from tAVR to death ranges from