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Background: Aortic stenosis (AS) is a common valvular abnormality and transcatheter aortic valve implantation (TAVI) is being increasingly used to treat patients considered too high risk for conventional surgery. We aimed to assess the prevalence of comorbid conditions in patients undergoing TAVI using the Charlson Comorbidity Index (CCI) and to assess their impact on clinical and procedural outcomes.Methods: We analysed 158 patients who underwent a TAVI at our institution between June 2009 and September 2015 to define their co-morbid burden as measured with CCI, and study its impact on procedural characteristics and mortality at 30 days.Results: One hundred fifty-eight (158) patients with a mean age of 82±8years and a mean CCI score of 2.67 underwent a TAVI. Only 12/158 patients had a CCI of 0. The commonest cardiovascular comorbidities were previous myocardial infarction (24%), congestive heart failure (15%) and diabetes mellitus (23%) whilst the commonest non-cardiovascular comorbidities were renal disease (46%) and chronic obstructive pulmonary disease (COPD) (29%). After multivariable adjustment, CCI was not independently associated with adverse clinical outcomes. The addition of CCI to scoring systems such as Logistic EuroScore (LES) and Society of Thoracic Surgeons (STS) risk models improved the area under the curve from 0.75 (95%CI: 0.44-1.00) and 0.83 (95%CI: 0.64-1.00) to 0.78 (95%CI: 0.53-1.00) and 0.89 (95%CI: 0.78-1.00) respectively.Conclusions: The burden of comorbid conditions in patients undergoing TAVI is significant. The CCI score was not independently associated with a higher risk of death but can be useful in addition to LES and STS risk models in informing decision making on the selection of patients for TAVI. [ABSTRACT FROM AUTHOR]

Over two decades, the Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) cardiac surgery database program has evolved from a single state-based database to a national clinical quality registry program and is now the most comprehensive cardiac surgical registry in Australia. We report the current structure and governance of the program and its key activities. [ABSTRACT FROM AUTHOR]

Background: The Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) Database collects and monitors preoperative, operative, and 30-day outcome data on patients undergoing cardiac surgery, and delivers regular performance feedback reports to key personnel with intent to drive quality improvement. The current feedback approach appears to be ineffective in driving change to minimise Unit performance variation. We sought to determine the acceptability and feasibility of providing structured feedback in addition.Methods: Cardiac surgeons were surveyed to assess their evaluation of the current feedback reports and assist in developing the content of structured feedback. We then assessed acceptability and performance outcomes of control Units receiving current feedback reports via email, versus intervention Units that in addition received structured feedback.Results: Survey respondents assessing the current feedback report agreed that the content is relevant (95%), key performance indicators (KPIs) are useful (85%), and that it would be beneficial to compare surgeons' KPIs (75%). Survey respondents rating method of feedback, requested structured feedback sessions one to two times annually (67%; control Units), and future structured feedback (83%; intervention Units). With combined report and structured feedback, improved performance was noted for an under-performing Unit. Limitations of feedback in driving quality improvement was high performance of Units at baseline, low surgeon participation, and scheduling challenges for structured feedback.Conclusions: In this pilot study, compared to the control method, structured feedback did not significantly improve communication. To maximise quality improvement efforts, a collaborative feedback approach that fosters a climate of continuous performance improvement, is recommended. [ABSTRACT FROM AUTHOR]

Background: The results from the PARTNER 2 trial showed the feasibility of transcatheter aortic valve replacement (TAVR) in intermediate surgical risk patients. Although low risk clinical trials will take time to conclude, some data has emerged comparing TAVR with surgical aortic valve replacement (SAVR) in lower risk patients.Methods: A Medline search was conducted using standard methodology to search for studies reporting results comparing TAVR and SAVR. Studies were included if the overall mean Society of Thoracic Surgeons Score was less than 4% (or equivalent Euroscore). A meta-analysis comparing the 30-day risk of clinical outcomes between TAVR and SAVR in the lower surgical risk population was conducted.Results: A total of four studies, including one clinical trial and three propensity-matched cohort studies met the inclusion criteria. Compared to SAVR, TAVR had a lower risk of 30-day mortality (RR 0.67, 95% CI 0.41, 1.10), stroke (RR 0.60, 95% CI 0.30, 1.22), bleeding complications (RR 0.51, 95% CI 0.40, 0.67) and acute kidney injury (RR 0.66, 95% CI 0.47, 0.94). However, a higher risk of vascular complications (RR 11.72, 95% CI 3.75, 36.64), moderate or severe paravalvular leak (RR 5.04, 95% CI 3.01, 8.43), and permanent pacemaker implantations (RR 4.62, 95% CI 2.63, 8.12) was noted for TAVR.Conclusion: Among lower risk patients, TAVR and SAVR appear to be comparable in short term outcomes. Additional high quality studies among patients classified as low risk are needed to further explore the feasibility of TAVR in all surgical risk patients. [ABSTRACT FROM AUTHOR]

Background: The aortic root replacement procedure (ARR), is often considered the gold standard in the management of aortic root and ascending aorta aneurysms. Our aim was to review the Australian experience with this procedure to ascertain early and late outcomes of mortality and morbidity.Methods: We reviewed the Australian and New Zealand Society of Cardiac and Thoracic Surgeons' (ANZSCTS) database for patients undergoing ARR. Preoperative, intraoperative and postoperative variables were analysed. Multiple regression was performed to determine independent predictors of 30-day mortality and permanent stroke, and predictors of late death. Survival estimates were obtained by cross-linking the ANZSCTS database with the Australian Institute of Health and Welfare's National Death Index database.Results: Between January 2001 and December 2011, 954 patients underwent ARR with a mean age of 56±15.2 years. The overall 30-day mortality was 5.9% (n=56) with a permanent stroke rate of 2.3% (n=21). The elective surgery mortality was 3.6%. Long-term survival was estimated as 84.4% and 68.7% at 5 and 10 years, respectively.Conclusions: Aortic root replacement surgery reveals acceptable early mortality, low postoperative stroke rates, and acceptable long-term survival. [ABSTRACT FROM AUTHOR]

Background: Many patients classified as "urgent" in Australia New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) registry contradict the prescribed definition (surgery within 72hours of angiogram or unplanned admission). The aim was to examine the impacts of this misclassification on the prediction of 30-day mortality following cardiac surgery.Methods: The 'reported clinical status' was compared with a 'corrected clinical status' following reclassification based on the standard definition calculated from raw data. Observed-to-predicted risk ratios (OPRs) of 30-day mortality were calculated for the model using reported status and corrected status and compared. A Bland-Altman plot was generated to examine the level of agreement between the two OPRs.Results: Of 18496 cases reported as urgent, 49.9% were operated after 72hours, leading to misclassification of 14.6% in the registry. Misclassified patients had significantly higher mortality (3.5%) than true urgent patients (2.9%). Underweight (OR:1.6,CI:1.2-2.1), dialysis (OR:1.4,CI:1.1-1.7), endocarditis (OR:2.1,CI:1.7-2.5), shock (OR:1.6,CI:1.3-2.0) and poor ejection fraction (OR:1.2,CI:1.1-1.4) were significant predictors of misclassification. Bland- Altman plot demonstrates significant disagreement between two risk estimates (P<0.001). Misclassification results in overestimation of risk by 9.1%. Observed-to-predicted risk increased with corrected definition (0.8975 vs 0.9875), suggesting poorer calibration with reported status.Conclusions: In the ANZSCTS database, misclassification prevalence is 14.6%. Misclassification compromises the discrimination capacity and calibration of the model and results in overestimation of mortality risk. [ABSTRACT FROM AUTHOR]