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AFRICA
Cardiovascular Journal of Africa • ABSTRACTS – SA HEART
®
CONGRESS 2019
S40
SHARE-TAVI registry: TAVI outcomes in a low volume setting
Elizabeth Schaafsma*, Jacques Scherman
#
, Hellmuth Weich
†
and Mpiko Ntsekhe
‡
*SA Heart® Association, Tygerberg Hospital, Bellville, South Africa.
#
Department of Cardiothoracic Surgery, Groote Schuur Hospital and University of Cape
Town, Observatory, South Africa.
†
Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and
Tygerberg Hospital, Bellville, South Africa.
‡
Department of Cardiology, Groote Schuur Hospital and University of Cape Town, Observatory, South Africa
Introduction:
SA Heart®’s prospective multi-centre observational registry, SHARE-TAVI, captures data as part of funding approval processes for all
SA TAVI patients and to compare outcomes to international data to thus define local variations in clinical presentation and outcomes.
Methods:
From September 2014 - June 2019 inclusive, 1 093 potential TAVI patients were evaluated at 9 Private and 3 State TAVI centres which, combined,
implanted >200 patients in 2018. Procedural and complications data were entered according to VARC-2 criteria as well as post-operative follow-up 30 days
and yearly.
Results:
A total of 145 patients await outstanding funding decisions (0 - 1 176d), average wait 96 days. Delayed funder responses resulted in mortality in
26 patients awaiting decisions and in 11 prior to approved TAVI date. A total of 798 patients (15% in State) received implants (68% with newer generation
devices) and are comparable to similar registry and trial populations (GARY, SOURCE 3, and US Corevalve Pivotal) mean age 80.01 ± 7.2 years, 54.1% male,
mean risk predictions 6.8 ± 7.0% (STSPROM), 23.2 ± 15.4 (logEuroSCORE) and 6.7 ± 6.0% (EuroSCORE 2). Differences in presentation of risk factors (dialysis,
prior CVA/TIA, frailty) at evaluation occur between Private patients (3.7%, 8.9%, 28.1%) and State (0%, 2.82%, 21.1%) but procedural success similar (State
94.0%, Private 94.9%). Mean ICU and total length of stay similar in State (ICU 1.22 ± 1.33d, LOS 4.86 ± 4.12d) and Private (ICU 2.60 ± 3.9d, LOS 5.04 ± 4.96d).
Transfemoral access in 91.7% of patients, procedural complications in 30d cohort include vascular (7.66%), bleeding (5.2%), MI (0.38%), conversion to open
heart (0.89%). New PPM at 30d in 7.4% (n=58/783) and 1-year in 10.1% (n=56/557), stroke at 30d in 3.58%. Peri-procedural mortality 2.68% (n=21/783), at
1-year the all-cause mortality of 10.6% (n=59/557) compares favourably to published TAVI populations (14.2% US Corevalve, 12.6% SOURCE 3, 20% GARY),
non-cardiac mortality at 31% (n=18/59).
Conclusion:
Restrictive funding limits volumes, but TAVI at State and Private centres still compare favourably to international best practice standards. Funding
resistance and cumbersome funding approval processes contribute to mortality in appropriately selected patients.
The cardiac effects of pectus excavatum
Ivan Schewitz
Waterfall City Hospital, Johannesburg, South Africa
Introduction:
Pectus excavatum has been recognised since its description by Leonardo Davinci. By and large it has been considered a cosmetic condition
and the cardiac effects have been ignored. Since 1949 the Ravitch procedure has been the standard operation to correct the condition.
This is an invasive, destructive procedure which yields average cosmetic results. As such, the procedure is seldomly performed. However, with the minimally
invasive endoscopic Nuss procedure, the number of procedures performed has increased exponentially. The marked cardiopulmonary improvement in
patients soon led clinicians to investigate the reason for the improvement, demonstrating that cardiac compression of the right ventricle effects cardiac
output.
Methods:
This is a literature search based on the work of Drs Pilegaard, Satur and Jaroszewski. Interpretation of cardiopulmonary exercise testing will be
presented as well as the cause of exercise dysfunction.
Results:
The pre-operative cardiac index was below the control group, normalising 3 years after repair. Echocardiography demonstrated an increase in the
right atrial size and in the right ventricular ejection fraction.
Conclusion:
Increased severity of a pectus excavatum leads to a progressive decrease in cardiac output. Repair of a pectus excavatum leads to early
improvement in cardiac function which is sustained in long-term follow-up.
Retrospective study of radio frequency ablation for accessory pathways at Groote Schuur Hospital
Azhar Seedat, Charle Viljoen, Max Rath, Andrew Beeton and Ashley Chin
Division of Cardiology, Groote Schuur Hospital and the University of Cape Town, Observatory, South Africa
Introduction:
Patients with accessory pathways (AP) are at risk of becoming symptomatic [palpitations and/or syncope from atrioventricular re-entrant
tachycardia (AVRT)] and may rarely suffer from sudden cardiac death. Radiofrequency ablation (RFA) is a curative procedure for AP.
Methods:
We conducted a retrospective folder review of all patients who underwent RFA of AP at Groote Schuur Hospital between 2007 and 2016. We
studied their clinical characteristics, AP location, RFA procedures and outcomes.
Results:
This cohort of 104 patients had a median age of 36 years (IQR 25 - 44). The most common presenting symptoms included palpitations (87.5%)
and syncope (26.0%). However, 2 patients were asymptomatic and were identified on screening ECGs. Analysis of pre-procedure ECGs showed Delta wave
morphology in 73 patients, of which 15 had a QRS width of <120ms. Only 1 patient presented with pre-excited atrial fibrillation. The most common AP
locations were left lateral (25.0%) and right posterior-septal (19.2%). The RFA procedure required a median of 5 deliveries of radiofrequency energy, which was
similar for left- and right-sided AP. RFA was largely successful (94.2%) at first attempt. However, in 6 patients we could not permanently eliminate antegrade
and retrograde AP conduction. Another 5 patients had recurrence of symptoms at follow-up. Of these 11 patients, 1 patient declined further intervention, but
9 had a successful second RFA procedure (3 had more than 1 AP, and in another patient left- and right-sided AP were found). In 1 patient RFA was successful at
the third attempt. Though there were more right-sided AP (7 vs. 3) amongst patients that required more than one RFA procedure, there were no demographic
or clinical predictors of successful RFA at first attempt. Complications were uncommon (1 sub-epicardial aneurysm, 1 haematoma at puncture site).
Conclusion:
RFA is a successful procedure for the treatment of AP in our setting.