Calcium Sensitiser in Cardiac Surgery – The Central New Zealand Experience

ObjectiveTo determine the proportion of patients surviving their cardiac surgery who experienced non-home discharge (NHD) over a 16-year period in Australia and New Zealand (ANZ).DesignRetrospective, multicentre, cross-sectional study over the time period 01 January 2004 to 31 December 2019.SettingAdult patients who underwent cardiac surgery from the Australia New Zealand Intensive Care Society Adult Patient Database (APD).ParticipantsAdult patients (age 18 and above) who underwent index coronary artery bypass grafting, cardiac valve surgery or combined valve/coronary surgery.ExposureThe primary exposure variable was the calendar year during the which the index surgery was performed.OutcomeThe primary outcome was NHD after the index surgery. NHD included discharge to locations such as nursing home, chronic care facility, rehabilitation and palliative care.ResultsWe analysed 252 924 index cardiac surgical admissions from 101 discrete sites with a median age of 68 years (IQR 60–76), of which 74.2% (187 662 out of 252 920) were males. Of these, 4302 (1.7%) patients died in hospital and 213 011 (84.2%) were discharged home, 18 010 (7.1%) were transferred to another hospital and 17 601 (7%) experienced NHD. In Australia, 14 457 (6.4%) of patients progressed to NHD, compared with 3144 (11.7%) in New Zealand. The rate of NHD increased significantly over time (adjusted OR per year=1.06, 95% CI, 1.06 to 1.07, p<0.001). Increasing age, female sex, non-elective surgery, surgery type and Acute Physiology and Chronic Health Evaluation III Score were all associated with significant increase in NHD.ConclusionsThere was significant increase in NHD after cardiac surgery over time in ANZ. This has significant clinical relevance for informed consent discussions between healthcare providers and patients, and for healthcare services planning.

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The First New Zealand Experience of Percutaneous Coronary Intervention Without Onsite Cardiac Surgery

Heart Lung and Circulation ◽

10.1016/j.hlc.2009.04.004 ◽

2009 ◽

Vol 18 ◽

pp. S2

Author(s):

P Adamson ◽

J Ayling ◽

J Gillespie ◽

J Walker ◽

A Hamer ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Cardiac Surgery ◽

New Zealand ◽

Coronary Intervention ◽

Percutaneous Coronary

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Dr. Hugh C. Cullen green lane hospital Auckland, New Zealand Predictors of hospital stay after cardiac surgery

The Asia Pacific Journal of Thoracic & Cardiovascular Surgery ◽

10.1016/s1324-2881(96)90045-3 ◽

1996 ◽

Vol 5 (1) ◽

pp. 56

Keyword(s):

Cardiac Surgery ◽

New Zealand ◽

Hospital Stay

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A levoszimendán perioperatív alkalmazása a szívsebészetben. Magyar ajánlás

Orvosi Hetilap ◽

10.1556/650.2018.31083 ◽

2018 ◽

Vol 159 (22) ◽

pp. 870-877

Author(s):

László Szudi ◽

László Székely ◽

Erzsébet Sápi ◽

Zsolt Prodán ◽

Jenő Szolnoky ◽

...

Keyword(s):

Cardiac Surgery ◽

Supply And Demand ◽

Cardiac Complications ◽

Expert Opinions ◽

Device Implantation ◽

Valvular Surgery ◽

Literature Evidence ◽

Calcium Sensitiser ◽

Hospital Stays ◽

Cardiac Surgeon

Abstract: Low output syndrome significantly increases morbidity and mortality of cardiac surgery and lengthens the durations of intensive care unit and hospital stays. Its treatment by catecholamines can lead to undesirable systemic and cardiac complications. Levosimendan is a calcium sensitiser and adenosine triphosphate (ATP)-sensitive potassium channel (IK,ATP) opener agent. Due to these effects, it improves myocardium performance, does not influence adversely the balance between O2 supply and demand, and possesses cardioprotective and organ protective properties as well. Based on the scientific literature and experts’ opinions, a European recommendation was published on the perioperative use of levosimendan in cardiac surgery in 2015. Along this line, and also taking into consideration cardiac surgeon, anaesthesiologist and cardiologist representatives of the seven Hungarian heart centres and the children heart centre, the Hungarian recommendation has been formulated that is based on two pillars: literature evidence and Hungarian expert opinions. The reviewed fields are: coronary and valvular surgery, assist device implantation, heart transplantation both in adult and pediatric cardiologic practice. Orv Hetil. 2018; 159(22): 870–877.

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The Use of Recombinant Activated Factor VII in Australia and New Zealand.

Blood ◽

10.1182/blood.v108.11.4025.4025 ◽

2006 ◽

Vol 108 (11) ◽

pp. 4025-4025

Author(s):

Scott Dunkley ◽

Peter A. Cameron ◽

Louise E. Phillips ◽

James Isbister

Keyword(s):

Cardiac Surgery ◽

New Zealand ◽

Adverse Events ◽

Factor Vii ◽

Recombinant Activated Factor Vii ◽

Safety And Efficacy ◽

Activated Factor Vii ◽

Wide Range ◽

Life Threatening ◽

New Treatments

Abstract Introduction: The role of Recombinant activated factor VII (rFVIIa, NovoSeven) for off-label indications, including trauma, cardiac surgery and other critical bleeding episodes, remains controversial. Through the Haemostasis Registry, we report on the Australian and New Zealand experience of using rFVIIa. Methods: Monash University has established the Haemostasis Registry (with an educational grant from NovoNordisk Pharmaceuticals) to monitor the use of rFVIIa throughout Australia and New Zealand. More than 50 hospitals are contributing data to the Registry. Results: Over 600 cases have been reported to the Register. In those where complete data has been received, major areas of use are cardiac surgery (~42%), other surgery (~19%) and trauma (~13%). The reported efficacy of rFVIIa was high (where reported, in >70% cases bleeding decreased or stopped after first dose of rFVIIa) while the reported Adverse Events “possibly” or “probably” linked to rFVIIa use were relatively low (~6%). There were no directly linked adverse events. Despite suffering from conditions where mortality is high, the survival rate in rFVIIa recipients was 69% at 28 days post treatment. These results will be compared with international experience and published trials. Conclusions: Although randomized controlled trials are important in establishing the safety and efficacy of new treatments, they do not replace the need for registries, especially for treatments where clinicians believe that withholding treatment may be unethical because of potential life threatening consequences. This problem is made more difficult where there are a wide range of applications. As more data becomes available, the Haemostasis Registry data will help to elucidate the safety and efficacy of rFVIIa and provide important feedback to doctors and hospitals.

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Ten Years and Over 3600 Cases of Recombinant Activated Factor VII Use: What Does the Haemostasis Registry Data Tell Us?

Blood ◽

10.1182/blood.v116.21.3352.3352 ◽

2010 ◽

Vol 116 (21) ◽

pp. 3352-3352

Author(s):

Louise E Phillips ◽

Amanda J Zatta ◽

James Isbister ◽

Scott Dunkley ◽

John McNeil ◽

...

Keyword(s):

Cardiac Surgery ◽

New Zealand ◽

Adverse Events ◽

Cardiac Patients ◽

Factor Vii ◽

Stepwise Logistic Regression ◽

Recombinant Activated Factor Vii ◽

Activated Factor Vii ◽

Educational Grant ◽

Critical Bleeding

Abstract Abstract 3352 Background: Recombinant activated factor VII (rFVIIa, NovoSeven®) is approved for the treatment of spontaneous and surgical bleeding in patients with haemophilia A or B and with antibodies to either factor VIII or factor IX. However rFVIIa has increasingly been used for indications outside the approved areas as a last resort treatment in trauma, cardiac surgery and other critical bleeding episodes despite the absence of conclusive randomized clinical trial (RCT) data. Aims: The aim of the Haemostasis Registry was to collect data (including dose, adverse events and outcome) on the off-license use of rFVIIa in Australia and New Zealand. Methods: Monash University established the Haemostasis registry in 2005 with an educational grant from Novo Nordisk Pharmaceuticals. More than 100 hospitals (including all major users of rFVIIa in Australia and New Zealand) contributed data to the Registry covering a ten year period (2000 to 2010). Results: More than 3600 off-license rFVIIa cases have been reported to the Registry. 65% of cases were male and the median age was 56 years. Major areas of use were cardiac surgery (∼43%), other surgery (18%) and trauma (13%). The majority (∼77%) of patients received a single dose of rFVIIa with a median (IQR) dose of 91 (73-103) mcg/kg. Seventy-four percent of cases documented a response (decrease or cessation of bleeding) following rFVIIa. Patient mortality rate at 28 days was lower if bleeding was reportedly stopped or decreased (88% or 82% vs. 39% no change, respectively) (χ22=533, p<0.001). Stepwise logistic regression analysis identified the number of units of RBC's, pH and context of bleeding as significant independent predictors of patient response to rFVIIa administration and pH, context of bleeding and units of FFP were included in the best predictive model of patient outcome at 28 days. Thromboembolic adverse events were reported in 7.5% of all patients however risk-adjusted adverse event rates in Haemostasis Registry cardiac patients were not significantly different from those seen in non-rFVIIa treated cardiac patients recorded in the ASCTS registry (www.ascts.org). Conclusions: The Haemostasis Registry is the largest dataset of its kind and provides critical observational data on the importance of pH, temperature and coagulopathic state in determining the response to rFVIIa. Although the role of rFVIIa in critical bleeding is still not clear, the Haemostasis Registry has been an invaluable resource for rigorously tracking adverse events and helping to guide clinical practice in an arena unlikely to be supported by new RCT data. Disclosures: Phillips: Novo Nordisk: Educational Grant. Off Label Use: rFVIIa; used for the treatment of critical bleeding in trauma, cardiac surgery, liver and obstetrics. Zatta:Novo Nordisk: Educational Grant. McNeil:Novo Nordisk: Educational Grant. Cameron:Novo Nordisk: Educational Grant.

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