Auckland City Hospital Research Articles

Contemporary Outcomes of Infrainguinal Vein Bypass Surgery for Chronic Limb-Threatening Ischaemia: A Two-Centre Cross-Sectional Study.

Background/Objectives: Chronic limb-threatening ischaemia (CLTI) is a significant life and limb-threatening condition. Two recent seminal trials, BEST-CLI and BASIL-2, have provided seemingly conflicting results concerning the optimal treatment modality for patients with CLTI. We sought to investigate the outcomes of patient undergoing infrainguinal bypass at two centres in Aotearoa New Zealand. Methods: A cross-sectional retrospective review of all patients who underwent infrainguinal bypass grafting for CLTI at Auckland City Hospital and Waikato Hospital between January 2020 and December 2021 was performed. The primary outcome was a composite of death, above-ankle amputation, and major limb reintervention. The secondary outcome was minor limb reintervention. Kaplan-Meier survival analysis was performed to determine time to the primary and secondary endpoints. Demographic factors were examined using the log-rank test to examine the effect on the outcome. Results: One hundred and nineteen patients who underwent infrainguinal bypass for CLTI in the study period were identified. Of these, 93 patients had a bypass with ipsilateral or contralateral GSV. The median follow-up time was 1.85 years. The most common indication for surgery was tissue loss (69%, n = 63), with the most common distal bypass target being the below-knee popliteal artery (45%, n = 41). The primary composite outcome occurred in 42.8% of the cohort (n = 39). Death was the most common component of the primary outcome (26%, n = 24). Male sex (HR 0.48, 95% CI 0.26-0.88, p = 0.018) and statin use (HR 0.49, 95% CI 0.24-0.98, p = 0.044) were independent predictors of protection from the composite outcome on multivariate analysis. Dialysis dependence (HR 3.32, 95% CI 1.23-8.99, p = 0.018) was an independent predictor for patients meeting the composite outcome. Conclusions: This study's results are consistent with the published outcomes of BEST-CLI. The patient cohorts examined, anatomical disease patterns, and conduit use may explain some of the differences observed between this study, BEST-CLI and BASIL-2. Further work is required to define the specific patient populations who will benefit most from an open surgical or endovascular first approach to the management of CLTI.

A Cross-Sectional Survey Investigating Māori and Non-Māori Cancer Patients' Views on Psychedelic-Assisted Therapy in Aotearoa New Zealand.

People with cancer experience higher rates of psychological dysfunction than the general population, with extreme inequity among indigenous people. Psychedelic-assisted therapy (PAT) is a reemerging area with promising evidence as a treatment for mental health difficulties. The current study aimed to investigate the perceptions of PAT in indigenous (Māori) and non-indigenous cancer patients in Aotearoa, New Zealand. Eighty-five cancer patients (Māori n = 32, non-Māori n = 53) completed a brief anonymous survey assessing demographics, psychological factors, and awareness and perceptions of PAT. Participants were recruited online (via social media and cancer support e-mail lists) and in person at Auckland City Hospital. Maori had significantly poorer psychological well-being than non-Māori. All participants had low awareness of this novel treatment and held largely neutral attitudes. Regression analyses revealed that predictors of more favorable attitudes toward PAT included greater awareness of psychedelics, advanced cancer stage, younger age, poorer holistic well-being, greater demoralization, and prioritizing treatment effectiveness over possible risks and uncertainty. The current study provides a foundational step in exploring perceptions toward PAT in indigenous and non-indigenous groups. These results have the potential to shape future research trials investigating PAT and further highlight the importance of indigenous involvement in the psychedelic research space.

Improving Equity of Access to a Publicly Funded Bariatric Surgery Programme by Removal of Mandatory Weight Loss Targets.

Obesity disproportionately affects 50.8% of Māori and 71.3% of Pacific adults in New Zealand, and these groups also have reduced access to bariatric surgery. Mandatory preoperative weight loss targets are a requirement of many bariatric surgery programmes globally; however, the evidence supporting their efficacy is inconclusive. In 2017, mandatory preoperative weight loss targets were eliminated from the bariatric surgery programme at Auckland City Hospital in New Zealand, with the aim to improve equity of access to bariatric surgery. This study will review postoperative patient outcomes following the elimination of preoperative weight loss targets from the programme. A retrospective analysis of 231 patients who underwent bariatric surgery at Auckland City Hospital from 2018 to 2021 was performed. Nineteen patients were lost to follow up and 12 were excluded (revision surgery or pregnancy). The comparison group of 100 consecutive patients, retrospective from 2017, had been required to lose 10% of excess body weight preoperatively to qualify for surgery. Outcomes assessed were weight loss and diabetes resolution at 12months, and postoperative complications within 90days. Elimination of preoperative weight loss targets was associated with greater numbers of Māori and Pacific patients undergoing bariatric surgery. There was no significant difference in weight loss outcomes or postoperative complications. Elimination of preoperative weight loss targets improves access to bariatric surgery for Māori and Pacific patients, inequitably affected by obesity. Removal of preoperative weight loss targets does not adversely affect weight loss outcomes, or postoperative complications, thus supporting their elimination.

Intentional physical self-injury in Auckland: patterns, associations and clinical implications in a single-centre cross-sectional study

introduction: Intentional physical self-injury (IPSI) is a pressing health challenge and there is little awareness of injury patterns, management and outcomes. This study examines IPSI’s epidemiological and clinical aspects in one major Auckland hospital, highlighting demography, injury patterns and implications for clinical practice and prevention. methods: Using Auckland City Hospital Trauma Registry data, a retrospective, descriptive study was conducted covering adult patients admitted from January 2015 to December 2019. It assessed demographic characteristics, injury patterns and outcomes, using Mann–Whitney U tests, Fisher’s exact tests and Chi-squared tests. results: Among 137 IPSI admissions, 92 (67%) required surgery, and 24% experienced post-operative complications. Major trauma was identified in 39 (28.5%) admissions. Discharge destinations varied, with only 64 (47%) patients returning home unassisted. Injury severity did not significantly vary across sex, age or injury event location. Major injuries often resulted from falls (19 of 39) and minor injuries from lacerations/stabs (73 of 98). conclusions: IPSI represents a significant challenge to Auckland health services, with a notable burden of care. The study highlights the need for targeted interventions to reduce the incidence of IPSI and improve outcomes. It underscores the importance of multidisciplinary approaches to care, integrating surgical, mental health and rehabilitative services.

Accuracy of MRI in predicting deep myometrial invasion in endometrial cancer and the influence of leiomyoma, adenomyosis and the microcystic elongated and fragmented tumour pattern.

The most common form of endometrial cancer is Type 1 endometrioid adenocarcinoma. Depth of myometrial invasion is the most important prognostic factor correlating with overall patient survival. The objective was to investigate how accurate magnetic resonance imaging (MRI) is in predicting the depth of myometrial invasion in preoperative assessment, and the influence of leiomyoma and/or adenomyosis, or microcystic, elongated and fragmented (MELF) pattern of invasion on MRI diagnostic performance. Retrospective audit of 235 endometrial cancer patients from the regional Gynaecology Oncology multidisciplinary meeting at Auckland City Hospital, between January 2020 and January 2021. Radiologist assigned stage was compared to histopathology. Presence of leiomyoma, adenomyosis andMELF pattern evaluated followed by analysis under a Biostatistician's supervision. Overall MRI diagnostic accuracy for depth of myometrial invasion was 86%. For deep myometrial invasion, MRI had a sensitivity of 72% and specificity 91%. Out of the misreported 32/235 cases, 16 demonstrated fibroids and/or adenomyosis leading to a sensitivity of 57% and specificity 93% for deep invasion, compared with 94% and 74% respectively in the population without, demonstrating statistical significance. Thirty seven cases with MELF pattern of invasion showed a sensitivity of 81% and specificity 80% for deep invasion, compared with 63% and 92% respectively in the group without, demonstrating no statistical significance. MRI assessment of the depth of myometrial invasion in endometrial cancer has high accuracy. In the presence of background uterine fibroids/adenomyosis, pre-operative MRI accuracy of evaluating deep invasion shows a statistically significant reduction.

Empowering Pacific Patients on the Weight Loss Surgery Pathway: A Co-designed Evaluation Study

PurposeDespite having the highest medical needs by population for weight loss treatment, Pacific patients in Aotearoa New Zealand face substantial levels of attrition in publicly funded weight loss surgery programs. In collaboration with the Auckland City Hospital bariatric surgery team, a Pacific-led preoperative weight loss surgery program was co-designed, delivered, and evaluated between 2020 and 2023.Materials and MethodsThis was a single-arm, prospective co-designed evaluation study that took place at Auckland City Hospital in Aotearoa New Zealand. Participants were Pacific patients (n = 14) referred to the weight loss surgery program. Survey and video diaries were analyzed to determine if the program had the potential to increase Pacific patient retention through the preoperative stage of weight loss surgery, increase surgery completion rates, and improve the quality of treatment experiences.ResultsNine out of 14 participants attended all preoperative sessions. Six participants subsequently underwent weight loss surgery. Program components that had positive impacts on patient success and satisfaction were accessibility, information quality, having Pacific role models, cultural safety, and the group support system. The patients found the program to be culturally anchored and there was support for the implementation of the program going forward.ConclusionThis study demonstrated how a culturally anchored intervention can increase patient retention for those patients who may not respond to mainstream treatment. Adjusting existing preoperative weight loss surgery programs to integrate Pacific-led models of healthcare has the potential to increase Pacific patient resiliency to follow through with surgery.Graphical

Curds in the way: A milk curd obstruction review and normal sonographic bowel appearances using a novel scoring system in neonates on fortified breast milk feeds.

Fortified expressed breast milk (FEBM) is a standard of care for premature and low birth weight neonates, but comes with an elevated risk of a rare but re-emergent pathology called milk curd obstruction (MCO). Little is known about normal sonographic appearances of bowel contents in this feeding setting, making the recognition of abnormalities difficult. Thus, we aimed to describe appearances that may be considered typical pre- and post-fortifier inclusion. Ten neonates of <32 weeks' gestation or a birth weight of <1,800 g recruited from Auckland City Hospital Neonatal Intensive Care between 1/5/2019 and 10/9/2019 received bowel ultrasounds within 24 h before and 10-14 days after starting FEBM. Bowel contents in six abdominal regions were assigned scores of 1-6 based on increasing solidification. Lower gestational age was correlated with more solid contents on the pre-fortifier ultrasound (P = 0.02). Fortifier was significantly associated with increasing solidity, particularly in the left abdomen (P < 0.001). The left lower quadrant and rectum accounted for much of this change (P = 0.012 and P = 0.002). One subject who subsequently developed a clinical picture consistent with early MCO had uniquely demonstrated non-rectal solid contents (score 6). The interobserver kappa score for two assessors was 0.91 (95% CI 0.94-0.99) on still images. This small cohort demonstrated increasing bowel content solidification after breast milk fortification using a novel ultrasound scoring system with good interobserver agreement. Non-rectal solid contents (score 6) appeared atypical. Ultrasound shows promise for its non-irradiating diagnostic utility in the setting of early milk curd disease evaluation of the premature neonate.

An audit of the use of CT pituitary scans to exclude a pituitary macroadenoma

BackgroundPituitary imaging is often required to exclude an adenoma suspected clinically or biochemically. Although magnetic resonance (MR) is the gold standard, computerised tomography (CT) is faster, cheaper and induces less claustrophobia. Our audit at Auckland City Hospital, New Zealand, investigated whether the use of CT of the pituitary as the first line imaging to assess for a pituitary macroadenoma reduces the need for MR.MethodsWe investigated the usefulness of CT pituitary imaging in the exclusion of pituitary macroadenoma between 2012 and 2020. A re-audit was then undertaken for a period of one year between March 2021 and March 2022 to assess outcomes once a departmental policy change was implemented. At Auckland City Hospital, 32 patients across eight years were eligible for this analysis, of which 31 had data available. In our re-audit, 29 patients were eligible for this analysis. We collected data on patient demographics, relevant hormone levels, indication for imaging and imaging results and subsequent management.ResultsAfter CT pituitary imaging, 28/31 (90%) of patients did not require further imaging because the clinical question had been addressed. One year after routine initial CT pituitary imaging was implemented by the Auckland City Hospital Endocrinology Department, 29 CT pituitary scans were performed to exclude a pituitary macroadenoma. Of these patients one required further imaging due to the finding of an expanded pituitary sella but not a pituitary macroadenoma.ConclusionCT pituitary imaging to exclude a pituitary macroadenoma is a useful test that may reduce the need for MR pituitary scans.Trial registrationNot applicable. This was an audit as defined by the New Zealand National Ethics Advisory Committee guidelines. Please see ‘Declarations’ section.

Cascade of care and rapid treatment pathway at Auckland City Hospital for patients with a new diagnosis of HIV infection, 2015-2019.

Legislative changes in 2017 enabled subsidised HIV care for all people living with HIV in New Zealand. This enabled a rapid treatment pathway (RTP) to be developed at Auckland City Hospital (ACH). Our aims were to document the cascade of care for people referred with newly diagnosed HIV infection and evaluate the effect of the RTP. People with newly diagnosed HIV infection in New Zealand referred to ACH between 2015 and 2019 were included in the cascade of care. The 2-year periods before (2015 and 2016) and after (2018 and 2019) the RTP were compared for initiation of antiretroviral therapy (ART) and attainment of HIV viral suppression. There were 240 people with newly diagnosed HIV infection referred. Of these, 197/200 (98.5%) were on ART and 195/197 (99%) had documented viral suppression. ART was initiated within 6 weeks of referral for 41/120 (34.2%) in the pre-RTP and 76/79 (96.2%) in the RTP periods (p<0.0001). Viral suppression was achieved within 6 months of diagnosis for 66/118 (55.9%) in the pre-RTP and 73/75 (97.3%) in the RTP periods (p<0.0001). A high proportion of people referred with newly diagnosed HIV infection were commenced on ART and achieved viral suppression. The RTP facilitated earlier initiation of ART and achievement of viral suppression.

Transvenous Lead Extraction: Outcomes From a Single Centre Providing a National Service for New Zealand.

With increasing demand for cardiac implantable electronic devices there is a parallel increase in the need for transvenous lead extraction (TLE). Due to its small population, all TLE procedures in New Zealand are currently performed in a single centre, Auckland City Hospital. We analysed the clinical characteristics and outcomes of those undergoing TLE since this service was established. We performed a retrospective, single-centre cohort study of all TLE procedures between October 2015 and December 2021. Definitions from the European Lead Extraction Controlled study, Heart Rhythm Society, European Heart Rhythm Association consensus documents were used. A total of 247 patients had 480 leads extracted, averaging 40 TLE procedures annually. Patients had a median lead dwell time of 6 (interquartile range [IQR] 3-11) years, 60 (13%) of leads had been in-situ >15 years, median age 61 (IQR 48-70) years, 73 (30%) female, 28 (11%) Māori, 23 (9%) Pasifika. Lead dysfunction (115 patients, 47%) and infection (90 patients, 37%) were the most common indications for TLE. Complete clinical and radiological success was achieved for 96% and 95%, respectively. Procedure-related complications occurred in 16 (7%) patients. Major intra-procedure complications occurred in 5 patients (2%), including 2 (1%) deaths. Death within one year of TLE occurred in 13 (26%) with systemic infection, 5 (3%) with local infection, and 5 (3%) with non-infection indications for TLE, p <0.01. TLE is associated with high radiographic and clinical success, low complication, and low mortality rate. At our single centre providing a national service, TLE outcomes are comparable with those achieved internationally.

Pancreatic and Duodenal Injuries: Experience at A Single Trauma Centre

Background: Pancreatic and duodenal injuries are uncommon due to relative protection by their posterior anatomical position and have an incidence of less than 1% of all hospital admissions for trauma. Auckland City Hospital is a tertiary referral hospital in New Zealand with Trauma and Hepatopancreatobiliary units and admits approximately 384 patients with major trauma per year, predominantly from blunt mechanisms. This study is used to assess the incidence, diagnosis and clinical management of pancreatic and duodenal injuries in trauma patients at a single trauma centre. Method: A retrospective study was undertaken using data from a prospectively collected trauma registry. Inpatient notes including all patients admitted from 2007 to 2020 were reviewed. Pancreatic and duodenal injuries were graded using the American Association for the Surgery of Trauma (AAST) organ injury scale (OIS) grading system. Investigations including radiology and biochemistry and clinical management were noted. Results: A total of 45 trauma patients admitted to Auckland City Hospital had sustained pancreatic or duodenal injuries. Six patients had combined pancreaticoduodenal injuries, 16 had duodenal and 23 had pancreatic injuries. Grade I organ injuries were the most common in pancreatic (19/29) and duodenal injuries (9/22). Majority of patients underwent laparotomy (33/45) for associated haemodynamic instability. All organ specific indications for surgery occurred in Grade II and higher injuries. 10/45 patients were managed non-operatively, of which the majority had Grade I or II organ injuries (9/45). 3/45 patients died. Conclusion: The incidence of pancreaticoduodenal injuries is rare (45 patients in 13 years) and in keeping with trauma literature. In our series, haemodynamically stable patients with Grade I - II pancreatic and Grade I - II (non-laceration type) duodenal injuries did not require operative management. Endoscopic pancreatic stenting may facilitate selective non-operative management in some patients with pancreatic injury or complications.

Incidence and predictors of new-onset atrial fibrillation after cardiac surgery at Auckland City Hospital.

To describe the incidence, ethnic differences in incidence, and predictors of post-operative atrial fibrillation (POAF) after cardiac surgery in a New Zealand hospital. Analysis of registry data on 1,630 adults without previous atrial fibrillation having coronary artery bypass grafting and/or valve surgery was used to determine the incidence of POAF. Univariate analysis identified risk factors and stepwise logistic regression was used to create the most parsimonious model to predict POAF. Overall POAF incidence was 29% (n=465) and differed by surgery type (25% after isolated coronary artery bypass surgery (CABG) vs 42% after combined CABG+valve). Incidence was highest in Māori (35%) and NZ/Other Europeans (32%). Māori and Pasifika with POAF were on average ten years younger than NZ/Other Europeans. Independent risk factors were age (OR 1.05, 95%CI 1.04-1.06), body mass index (OR 1.04, 95%CI 1.02-1.06), history of heart failure (OR 2.08, 95%CI 1.47-2.95), and valve surgeries (isolated valve OR 1.51, 95%CI 1.16-1.95; CABG+valve OR 1.59, 95%CI 1.11-2.28), but the model had poor discrimination (AUC 0.67). POAF in a New Zealand hospital occurs at comparable rates to international settings. Risk models using routinely measured factors offer poor predictive accuracy, meaning risk stratification is unlikely to adequately inform targeted POAF prevention in clinical practice.

Risk factors for readmission in patients with acute diverticulitis: a retrospective study at Auckland City Hospital.

Approximately one in five patients with acute diverticulitis (AD) will experience a recurrence. This study aimed to investigate the factors at AD admission that correlate with recurrence and test the proposed risk of recurrence-score according to Sallinen et al. method: This retrospective study followed patients for five years who were admitted with operatively or computed tomography (CT)-verified AD at Auckland City Hospital from January 2012-June 2013. Demographic, laboratory, radiological and patient-related factors at initial admission were analysed in relation to readmission with recurrent AD and to test a risk score presented by Sallinen et al. results: In the adjusted analyses, previous diagnosis of AD (OR, 7.3; 95% CI, 3.1-16.9), Māori ethnicity (OR, 5.7; 95% CI, 1.4-22.7) and complicated AD at index admission (OR, 2.5; 95% CI, 1.0-6.2), were all independent factors associated with readmission with recurrence. High-risk versus low-risk groups, according to the risk score, showed 71.4% and 18.6% recurrence rates, respectively. History of diverticulitis and complicated AD are risk factors for recurrence. The finding of higher recurrence rate in Māori requires further investigation utilising appropriate research methodologies. The risk score presented by Sallinen et al. may be a useful predictor of recurrent AD.

First Experience of Measuring Index of Microcirculatory Resistance at Auckland City Hospital

Patients with angina and non-obstructive coronary artery disease (NOCAD) present an important diagnostic and management challenge. Measurement of the index of microcirculatory resistance (IMR) with a coronary pressure wire at the time of invasive coronary angiography can help distinguish between microvascular angina and non-cardiac chest pain. A retrospective audit was undertaken of consecutive patients with NOCAD and measurement of microvascular indices from the Northern region between March 2020 and January 2023 at Auckland City Hospital (ACH). Coronary flow reserve, IMR, and fractional flow reserve were measured, as shown in the Table. Sixty-two patients had IMR measured and seven were excluded as they were out of area; 75% were male and the mean age was 65 (SD 8.6) years. An elevated IMR was found in 24 (43%); 47% had history of smoking, 24% previous myocardial infarction, 7% previous stroke, and 51% diabetes; 52% presented with stable angina, 24% with unstable angina, and 22% with non-ST elevation myocardial infarction; and 70% were on aspirin, 44% on beta blockers, 18% on calcium channel blockers, 31% nitrates, 38% statins, and 2% nicorandil.TableMedianInterquartile rangeHeart rate (per minute)75.9(64.6, 87.2)Coronary flow reserve (CFR)3.51(2.18, 4.79)Index of microcirculatory resistance (IMR)22.8(14.8, 39.8)Fractional flow reserve (FFR)0.85(0.81, 0.90)Gensini score7.5(2.6, 18.6) Open table in a new tab This study describes initial experience in measuring IMR amongst patients with NOCAD at ACH. This cohort had a low burden of coronary disease. IMR provides useful diagnostic information that informs management.

Diagnostic Electrophysiology Study: The Auckland Regional Experience

Auckland City Hospital provides electrophysiology (EP) procedures for people residing in the Northern Region and is a national service for paediatric and congenital cardiac patients. Electrophysiology procedures are primarily therapeutic and typically undertaken with a view to ablation. When ablation is not delivered, these procedures are considered diagnostic. This retrospective study was undertaken to explore the clinical characteristics and outcomes of patients who underwent diagnostic EP study. The Auckland City Hospital Electrophysiology Registry was reviewed and patients who underwent an EP procedure without ablation from 1 June 2020 to 31 December 2021 were included. Patient characteristics, indications, procedure prioritisation, study indication, reason for no ablation, antiarrhythmic medications, procedure outcomes, and complications were reviewed. There were 912 procedures, 79 (8.7%) were diagnostic EP studies alone. Patients were aged 3–83 years (median, 41). Ethnicities included NZ European (54%) and Māori (18%). The indication in 56 patients was for an assessment of palpations. The most common reason for no ablation undertaken was no inducible tachycardia (n=36). Other reasons included no accessory pathway identified, high-risk procedure due to proximity to the AV node, and no ablation was intended (i.e., for VT stimulation). There were three reported complications: one moderate pericardial effusion that did not require intervention, one VT/VF arrest, and one access site haematoma. Diagnostic EP studies remain common with acceptable complication rates.

Developing an Extracorporeal Cardiopulmonary Resuscitation Programme for New Zealand: Emergency Department Perspectives

Extracorporeal cardiopulmonary resuscitation (ECPR) is a promising adjunct to routine advanced cardiac life support. Growing worldwide interest in ECPR use has seen more tertiary centres offering ECPR programs. New Zealand’s nationwide extracorporeal cardiopulmonary membranous oxygenation service is provided at Auckland City Hospital (ACH). Despite the potential benefits of ECPR, it is currently only offered on an ad hoc basis. It remains unknown whether ACH would manage enough patients to warrant an ECPR program.

Not Fasting Before Cardiac Catheterisation: An Observational Cohort Study of Patient Experience and Adverse Events

To describe the patient experience and incidence of adverse events in unfasted patients undergoing coronary angiography and angioplasty. To identify any association between duration of fasting and adverse events. Patients have historically fasted before cardiac catheterisation. Routine fasting was not evidence-based and many centres, including ours, have discontinued the practice. Patients undergoing cardiac catheterisation at Auckland City Hospital were invited to participate in a prospective observational cohort study documenting the duration of fasting and incidence of adverse events (n=508). Of these participants, 257 also completed a survey that captured perspectives regarding not fasting. The mean time since last fluid was 1.9±2.2 hrs and for food was 3.9±3.7 hours. The most common adverse event was hypotension (10%). Rates of nausea (3.9%) and vomiting (0.6%) were low, and there were no episodes of aspiration. No associations were identified between the time since the last food or fluid and any adverse events. Thematic analysis of survey data yielded three themes: 1) not fasting was preferable to fasting for most; 2) being able to eat and drink before the procedure positively affected wellbeing; and 3) one-fifth of the cohort expressed no preference between fasting and non-fasting. Not fasting before cardiac catheterisation is favourably viewed by patients. While this study provides additional evidence that not fasting is safe and event rates are low, larger, multicentre studies are needed for confirmation.

Ethnicity Based Outcome Differences Following Cardiac Surgery in Australia and Aotearoa New Zealand

Aboriginal and Torres Strait Islanders in Australia, and Māori and Pacific Islanders in Aotearoa New Zealand experience worse outcomes in cardiovascular health compared with non-indigenous people. Flinders Medical Centre (FMC) and Auckland City Hospital (ACH) provide cardiothoracic services to the Northern territory and South Australia and Northern region of New Zealand, respectively. Both countries have implemented policy to achieve health equality for indigenous peoples. This study aimed to compare practices and outcomes for Aboriginal and Torres Strait Islanders, Māori and Pacific Islanders with non-indigenous patients receiving cardiac surgery requiring cardiopulmonary bypass.

Four of Five Patients With Chest Pain and Non-Obstructive Coronary Artery Disease who had a Microvascular Assessment had Microvascular Angina

Patients with chest pain and non-obstructive coronary artery disease (NOCAD) may have microvascular disease. Measurement of the index of microcirculatory resistance (IMR) with a coronary pressure wire at the time of invasive coronary angiography identifies those with microvascular disease. This helps to correctly diagnose these patients and tailor their therapeutic strategy. A retrospective audit was undertaken of consecutive patients with NOCAD and measurement of microvascular indices from the Northern region between March 2020 and January 2023 at Auckland City Hospital. Coronary flow reserve, IMR, and fractional flow reserve were measured. Fifty-six participants were included. Seven were excluded as they resided outside the Northern region. Forty-one (75%) were male with mean age of 65 (SD 8.6) years. A total of 47% had a history of smoking, 24% previous myocardial infarction, 7% previous stroke, 51% diabetes; 52% presented with stable angina, 24% with unstable angina and 22% with non-ST elevation myocardial infarction (NSTEMI); 70% were on aspirin, 44% on beta blockers, 18% on calcium channel blockers, 31% nitrates, 38% statins, and 2% nicorandil. Normal IMR (<25) was seen in 24% of patients with an initial diagnosis of stable angina, 15% with unstable angina, and 17% with NSTEMI. Amongst those with chest pain and NOCAD, who had a microvascular assessment, four of five had an elevated IMR, suggesting significant microvascular disease. The remaining patients were reassured that their chest pain was not due to coronary disease. These data reinforce the diagnostic value of IMR in this patient cohort.

Initial Experience With Leadless Cardiac Pacemakers at Auckland City Hospital

Leadless cardiac pacemaker (LCP) therapy is a relatively new technology introduced to address lead-related and pocket-related complications seen with traditional transvenous and epicardial pacemakers. These differ from traditional pacemakers as they are much smaller and directly implanted into the right ventricle via percutaneous femoral approach. Ten patients underwent LCP implantation with a Medtronic Micra device over a 2-year period from 29 October 2020; four of these were Micra VR and six Micra AV. These patients were followed in clinic with device checks at a maximum of 6-monthly intervals. All 10 patients had a successful device implant procedure. Post-procedure follow-up data were available for all patients and ranged 5–24 months. Mean age was 63.7 years (range 52–81) and 70% were male. Procedure duration was 47.8±13.9 minutes, fluoroscopy time was 6.2±3.5 minutes, and contrast volume was 45±29.7 mL. There were no procedural or in-hospital procedure-related complications. Two deaths were recorded post implant, which were both unrelated to the LCP implant. The electronic pacing performance showed all capture thresholds remained at <1V @ 0.24 ms. Initial experience with a leadless cardiac pacemaker shows successful implantation, with no adverse events and satisfactory procedural data. Pacing performance post implant is stable with acceptable parameters and device function.