Abstract Journal Cardiothoracic Surgery

Abstract

Journal Cardiothoracic Surgery CS001 LONG-TERM OUTCOME OF CORONARY BYPASS SURGERY WITH UNGRAFTED LEFT ANTERIOR DESCENDING ARTERY KAUSHALENDRA RATHORE, WILLIAM WEIGHMAN, JAMES CAUDLE, DAMIAN GIMPEL AND MARK NEWMAN Sir Charles Gairdner Hospital, WA Purpose: Use of Left Internal Mammary Artery (LIMA) to bypass Left Anterior Descending Artery (LAD) confers survival benefit after Coronary Artery Bypass Grafting (CABG). We are analysing long-term outcomes of the CABG cases performed without grafting LAD artery. Methodology: It is a retrospective non-interventional study of 85 cases of primary CABG performed from 1998 to 2020. Sub-analysis was done by making three groups, Complete Revascularization (CR) vs. Incomplete Revascularization (IR) where CABG was done with or without LAD graft, Use of LIMA vs. Saphenous Vein Graft (SVG), and Onpump vs. Onpump CABG. Results: All-cause mortality was 41%, with a median follow-up of 13.87 years in the LAD disease group (IR) and14.74 years in the Nondiseased LAD group (CR) respectively. Cox proportional hazard survival analysis had suggested age > 65 years (p-value 0.001), diabetes (p-value 0.05) and peripheral vascular disease (p-value 0.001) were variables for the poor outcomes in long follow-up. The Log-rank test showed significant 10-year survival difference between CR and IR cases (78% vs. 59%) but after a decade of follow-up, no survival difference amongst CR vs. IR, LIMA vs. SVG and offpump vs. onpump cases. Follow-up CT angiogram showed significant progression of atherosclerosis in all native coronary segments in IR or CR patients. Conclusion: CR cases had better survival at a decade follow-up but after that, other comorbidities take the precedence and they affect the outcome. Use of LIMA as a conduit reduces coronary re-intervention rates but in the long-term follow-up there was no survival difference and it warrants further research with bigger cohort of cases. CS002 TRANSCATHETER AORTIC VALVE IMPLANTATION AT TOWNSVILLE UNIVERSITY HOSPITAL; AN INSTITUTIONAL EXPERIENCE FRAZER KIRK, SUMIT YADAV, PALLAV SHAH AND LIM ENG Townsville University Hospital, QLD The introduction of Transcatheter Aortic Valve Implantation (TAVI) has transformed interventional cardiology and minimally invasive cardiac surgery. De-centralisation of this previously supra-specialized, quaternary level procedure can be done safely and efficaciously, to improve the health inequalities across metropolitan and regional/remote Australia. The purpose of this study is to detail the introduction of the TAVI program at Townsville University Hospital (TUH), a geographically isolated tertiary centre. Illustrating the safe introduction of a TAVI program in Townsville aims to guide future TAVI proceduralists in adapting this technology to the wider healthcare community of Australia. CS004 PULMONARY CARCINOID TUMOURS: A MULTI-CENTRE ANALYSIS OF SURVIVAL AND PREDICTORS OF OUTCOME FOLLOWING SURGICAL RESECTION SAMEER THAKUR, DANIEL FLORISSON, STACEY TELIANIDIS, NIMA YAFTIAN, JEAN LEE, SIMON KNIGHT, STEPHEN BARNETT, SIVEN SEEVAYAGAM, PHILLIP ANTIPPA, NAVEED ALAM AND GAVIN WRIGHT St Vincent’s Hospital Melbourne, VIC Background: Pulmonary carcinoids are rare neoplasms, accounting for approximately 1–2% of all lung malignancies. A retrospective analysis was undertaken of all patients who underwent surgical resection of pulmonary carcinoid tumours across multiple institutions in Melbourne, Australia. Methods: From May 2000 through April 2020, 241 patients who underwent surgical resection of pulmonary carcinoid tumours were retrospectively reviewed. Patient demographics, pathologic data and long-term outcomes were recorded. Results: Median age was 57.7 years and the majority of patients were female (58.9% versus 41.1%). Typical carcinoid was present in 77.1%. Histological subtype was associated with several factors. Atypical carcinoid was more likely to have larger tumour size and nodal involvement. Overall survival for typical carcinoid at 5, 10 and 15 years was 98%, 95%, and 84%, and for atypical carcinoid was 88%, 82%, and 62%, respectively. Histological subtype and age were found to be independent predictors of overall survival, with worse outcomes for atypical and those above 60 years of age. Disease-free survival was related to sublobar resection (p < 0.001, SHR 6.89), lymph node involvement (p = 0.022, SHR 3.18), and atypical histology (p < 0.001, SHR 9.89). Conclusion: Excellent long-term outcomes can be achieved following surgical resection of pulmonary carcinoids. Atypical histology and lymph node involvement are significant prognostic factors, and sublobar resection should not be considered in patients with either of the above features. Typical carcinoid tumour without nodal involvement may be appropriate for sublobar resection. Typical and atypical carcinoid tumours should be considered distinct disease entities, and as such treated accordingly. CS005 RENAL ARTERY STENOSIS IS THE INDEPENDENT RISK FACTOR OF POSTOPERATIVE ACUTE KIDNEY INJURY IN ACUTE STANDFORD A AORTIC DISSECTION LI LEI, ZHANG HONGJIA, SUN LIZHONG, WANG MAOZHOU, GONG MING AND GUAN XINLIANG Beijing Anzhen Hospital, Beijing, China Background: Acute kidney injury (AKI) has a high mortality rate after Stanford A aortic dissection (STAAD) surgery, Renal artery involvement (RAI) and renal artery stenosis (RAS) may cause renal malperfusion in STAAD. Methods: From January 2015 to January 2019, A total of 292 acute Stanford type A aortic dissection patients underwent Frozen elephant trunk surgery in Beijing Anzhen hospital. RAS and RAI were mainly diagnosed by preoperative Contrast-enhanced computed tomography. We divided these 288 patients into 4 types: Type 1: patients without RAS and renal artery involvement (RAI); Type 2: patients with RAI but without RAS; Type 3: patents with RAI combined RAS; Type 4: patients with RAS but without RAI. Results: AKI occurred in 162(55.5%) patients and postoperative dialysis was presented in 54(18.8%) patients. There were 98(33.6%) patients with Type 1, 130(44.5%) patients with Type 2, 18(6.2%) patients with Type 3 and 44(15.1%) patients with Type 4. AKI occurred in 41 (41.8%) patients in Type 1, 67(51.5%)patients in Type 2, 18(70%) patients in Type 3 and 36(81.8%) patients in Type 4. Postoperative dialysis were significantly more in Type 3 and type 4 compared to Type 1 (Type 3 vs. Type 1:p = 0.020; Type 4 vs. Type 1:p = 0.016). In multivariate regression analysis, RAS was the independent risk factor for postoperative dialysis (p = 0.021). Conclusion: RAS combined RAI is the main cause of postoperative AKI and the need for dialysis. The treatment of restoring renal perfusion before operation should be taken into consider for these patients in STAAD. CS006 CAN WE BETTER PREDICT TYPE A AORTIC DISSECTION? VARUN SHARMA, RILEY KANG, JEGATHEESAN GANESH, NISHITH PATEL AND ADAM EL GAMEL Waikato District Health Board, Waikato, New Zealand Purpose: Type A aortic dissection is seen as a progression of aneurysmal dilation. However, in the IRAD registry 60% of patients had a maximum aortic diameter (MAD) less than 55 mm, suggesting guidelines would fail to Editorial material and organization © 2021 Royal Australasian College of Surgeons. Copyright of individual abstracts remains with the authors. ANZ J. Surg. 2021; 91 (S1) 25–28