Golden Jubilee National Hospital Research Articles

Weekly social gatherings to improve cardiothoracic trainee satisfaction at Golden Jubilee National Hospital

Weekly social gatherings to improve cardiothoracic trainee satisfaction at Golden Jubilee National Hospital

Validation of a new and pre-validated set of non-invasive optical trackers used on the image-free physiopilot navigation system

s / International Journal of Surgery 23 (2015) S15eS134 S85 Aim: This study aimed to validate the repeatability of the assessment of anteroposterior (AP) knee joint laxity using a non-invasive image free navigation system in normal, healthy subjects. Validation of this technology could aid clinicians in identifying and quantifying ligamentous injuries in a clinical setting. Methods: Twenty-five healthy volunteers were recruited and examined in a single centre. The Lachman test was performed through flexion on both knees of each volunteer. AP translation was measured by an infrared camera and externally mounted optical trackers which transferred the data into the computer. Coefficients of Repeatability (CR) and Interclass Correlation Coefficients (ICC) were used to validate AP translation. Results: Themost reliable and repeatable AP translation assessments were at 30 and 45 , demonstrating good reliability (ICC 0.82, 0.82) and good repeatability (CR 2.5, 2.9). The AP translation assessment at 0 , 15 , 75 and 90 demonstrated moderate reliability (ICC 0.75), and poor repeatability (CR 3.0 mm). Conclusion: The non-invasive systemwas able to reliably and consistently measure AP knee translation between 30 and 45 flexion, the clinically relevant range for this assessment. This system could therefore be used to quantify abnormal knee laxity and improve the assessment of knee instability in the clinical setting. 0541: VALIDATION OF A NEW AND PRE-VALIDATED SET OF NONINVASIVE OPTICAL TRACKERS USED ON THE IMAGE-FREE PHYSIOPILOT NAVIGATION SYSTEM R. Alho , F. Henderson , J. Clarke , F. Picard , A. Deakin . Golden Jubilee National Hospital, UK; 2 Strathclyde University, UK Aim: The investigation aimed to validate a new set of optical trackers against a pre-validated set of optical trackers, and to determine the repeatability of the new optical tracker set. Methods: Two examiners assessed the supine mechanical femoro-tibial alignment (MFTA) and Lachman test on each other. The assessments were performed 10 times with each tracker on each knee. The non-invasive system consisted of an infrared camera, externallymountedoptical trackers and computer software. Validation of each tracker setwas assessed through inter-examiner repeatability, with the acceptable limits of agreement set at 2 for the supine MFTA, and 3mm for anteroposterior (AP) translation. Results: The pre-validated optical trackers demonstrated a more consistent supine MFTA acquisition in coronal alignment compared to the new tracker, with a range of +/ 2 and +/ 6 respectively. The pre-validated tracker set recorded higher levels of AP translation than the new tracker set, however the results were more consistent with the pre-validated set, with smaller standard deviation per knee. Conclusion: The optimal tracker set was the pre-validated set, which demonstrated better repeatability and comparability between both examiners at acquiring supine MFTA, and AP translation assessments than the new tracker set. 0548: THE QUALITY OF ANATOMICAL RESTORATION FOLLOWING DISTAL RADIUS FRACTURE FIXATION USING VOLAR PLATING SYSTEM Z. Sajjad , S. Ismael , S. Mahmoud , A. Logan . Glangwili General Hospital, UK; University Hospital Wales, UK Aim: Aim of the study is to evaluate the quality of distal radius anatomical restoration following distal radius fractures fixation. Methods: We carried out a retrospective observational study evaluating anatomical measurements, using x ray films at (0 and 6 weeks). A cohort of 120 cases distal radius fractures between May 2011 and January 2013 treated with volar plating system at University Hospital of Wales were reviewed. Only 73 cases were considered to fit the inclusion and exclusion criteria of distal radius fractures. The distal radius anatomical measurements; were calculated both pre and post-operatively. A basic statistical analysis was carried out. Results: 72.6% of fractures involved the dominant hand. 71% of our cohort was female. The majority of fractures were type C (42%), followed by Type A (32.9%) and B (24.7%). The mean agewas 56 years old for both genders. In all cases, radial height improved from (mean) 10.2 mm preoperatively to 11.3 mm post-operatively. The palmar tilt had acceptable results from a mean of 2.4 to 5.9 post-operatively. The average time from injury to operation was 5.14 days. Conclusion: At the University Hospital of Wales, the main anatomical measurements closely linkedwith good outcomes have been acceptably restored in most cases of distal radius fractures that have been plated. 0578: SOFT TISSUE INFECTIONS ASSOCIATED WITH LEGAL HIGHS: AN INCREASING PROBLEM L. Robiati, A. Vats, K. Bugler, T. White, J. Reid. Royal Infirmary of Edinburgh,

Device-Measured Rapid Shallow Breathing With Exertion Worsens Prior to Heart Failure Decompensation

Device-Measured Rapid Shallow Breathing With Exertion Worsens Prior to Heart Failure Decompensation Seth Rials, Bela Merkely, Roy Gardner, Viktoria Averina, Robert Sweeney, Yi Zhang, Qi An, John Boehmer; Grant Medical Center, OhioHealth, Columbus, OH; Semmelweis University Heart Center, Budapest, Hungary; Golden Jubilee National Hospital, Glasgow, United Kingdom; Boston Scientific, St. Paul, MN; Penn State Milton S. Hershey Medical Center, Hershey, PA

22 Retrospective Regional Audit of In-Patient Assessment of Left Ventricular Systolic Function and Guideline-Recommended Prescription of Eplerenone following St-elevation Myocardial Infarction

Introduction The Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) trial demonstrated that eplerenone reduces all-cause mortality and death or hospitalisation for cardiovascular events in patients with symptomatic left ventricular (LV) systolic dysfunction (ejection fraction ≤40%) or diabetes following ST-elevation myocardial infarction (STEMI). Current national and international guidelines recommend initiation of eplerenone in this patient group. We conducted a retrospective audit of assessment of LV systolic function and subsequent prescribing of eplerenone in eligible patients presenting with acute STEMI over a 4-month period. Aims and objectives 1. Establish what proportion of patients presenting with STEMI had in-patient assessment of LV systolic function 2. Identify whether LV systolic function assessment was performed qualitatively or quantitatively 3. Determine what proportion of eligible patients were prescribed eplerenone on hospital discharge Methods Patients from NHS Greater Glasgow and Clyde (GG&C) who underwent primary percutaneous coronary intervention (PPCI) for STEMI were retrospectively (01/08/13–30/11/13) identified using the coronary intervention patient-database at the West of Scotland Regional Heart and Lung Centre (Golden Jubilee National Hospital). Data were collected using electronic patient records and national radiology archive. Qualitative assessment was defined as a subjective description of LV systolic function (normal, mild, moderate or severe impairment). Quantitative assessment was defined as a documented ejection fraction (EF). Patients were considered eligible for eplerenone if they had a qualitative assessment of LV systolic function documented as moderately or severely impaired, or EF ≤ 40% on quantitative assessment, and symptomatic LV systolic dysfunction or diabetes. Results 172 patients were identified. 90% of the total population had in-patient assessment of LV systolic function ([Table 1][1]). All of these patients had qualitative assessment ([Table 1][1]). LV systolic function was quantitatively assessed in 27% (10% modified Simpson’s Biplane method, 11% estimated EF, 5% unspecified) ([Table 1][1]). 8% of patients were considered eligible for eplerenone ([Table 2][2]). Of those eligible, eplerenone was appropriately prescribed on discharge in 21% ([Table 2][2]). View this table: Abstract 22 Table 1 Assessment of LV systolic function View this table: Abstract 22 Table 2 Prescribing of eplerenone in eligible patients Conclusions This audit indicates that national and international guidelines for the assessment and management of LV systolic function post-STEMI are not being adhered to within this region. Identifying those with LV systolic dysfunction post-STEMI is not only of importance for the optimisation of drug therapy, but also for patient selection for implantable defibrillators. The wider implications of LV systolic dysfunction include DVLA-imposed restrictions on driving and critical illness policies. Potential barriers to compliance with guidelines include time-constraints, training and shorter inpatient stay since the adoption of PPCI. These factors may explain the low prescribing rate of eplerenone in eligible patients. [1]: #T1 [2]: #T2

110 Infarct Burden Following Multivessel PCI Vs. Infarct-Only PCI in Patients with Acute Stemi: The Glasgow Prami CMR Sub-Study: Abstract 110 Table 1

Background In the Preventive Angioplasty in Myocardial Infarction trial (PRAMI; ISRCTN73028481), immediate multivessel PCI (MV-PCI) of non-IRA lesions in patients with acute ST elevation myocardial infarction (STEMI) and multivessel coronary disease (MVD) improved long term prognosis. We assessed infarct distribution and size in a pre-specified cardiac magnetic resonance (CMR) sub-study. Methods In this single centre prospective sub-study, PRAMI participants were invited to undergo 1.5 Tesla CMR 1 week and 1 year after primary PCI. The CMR scans were analysed using semi-automated software by a clinician blinded to treatment group assignment and clinical outcomes. The presence and extent of infarction were assessed quantitatively with late gadolinium enhancement (LGE) imaging (Gadovist, 0.1 mmol/kg). The infarct was delineated as an area of myocardial enhancement (cm 2 ) using a signal intensity threshold of >5SDs above a remote region, and expressed as a% of total LV mass. The incidence of new LGE in non-infarct related artery territories at baseline and 1 year were assessed. Data were analysed by an independent statistician. Results Of 465 randomised trial participants in 6 UK hospitals, 138 (30%) were enrolled in Glasgow. Of these 80 patients underwent CMR 1 week post primary PCI of whom 41 (51%) were in the multi-vessel PCI group and 39 (49%) were in the IRA-only group. At 1 year, 69 (86%) patients had a follow up CMR scan. Infarct size and distribution are described in Table 1. Conclusion Infarct size and distribution were similar in patients treated by MV-PCI or IRA-only PCI. MV-PCI is not associated with additional MI acutely which supports the safety of this procedure in line with the benefits observed with preventive PCI in PRAMI. Funding Golden Jubilee National Hospital; PRAMI was funded by Barts and the London Charity.

109 Left Ventricular Outcomes Following Multivessel PCI Vs. Infarct -Only PCI in Patients with Acute Stemi: The Glasgow Prami CMR Sub-Study: Abstract 109 Table 1

Background In the Randomised Trial of Preventive Angioplasty in Myocardial Infarction (PRAMI; ISRCTN73028481), compared with infarct-related artery (IRA)-only PCI, additional immediate multivessel PCI (MV-PCI) of non-IRA lesions in patients with acute ST elevation myocardial infarction (STEMI) and multivessel coronary disease (MVD) improved long term prognosis. We studied left ventricular (LV) outcomes in a pre-specified cardiac magnetic resonance (CMR) sub-study. Methods In a single centre prospective sub-study, PRAMI participants were invited to undergo CMR at 1.5 Tesla 1 week and 1 year after primary PCI. LV volumes and function were analysed using semi-automated software by a clinician blinded to treatment group assignment and clinical outcomes. The statistical analyses were performed by an independent statistician. Results Of 465 randomised trial participants in 6 UK hospitals, 138 (30%) were enrolled in Glasgow. Eighty patients (17%) (mean age 60 years, 76% male) underwent CMR initially (n = 41 (51%) in the multi-vessel PCI group; n = 39 (49%) in the IRA-only group). 69 (86%) of these patients had a follow up CMR scan at 1 year (n = 7 lost to follow-up, n = 4 deceased). Mean (and SD) LVEF and volumes at 1 week post-MI and their change at 1 year from baseline were similar (Table 1). Conclusion The CMR sub-study participants represented the majority of all randomised participants in our hospital, which included one third of the PRAMI trial population. Random treatment group assignment in this CMR study was evenly balanced. LV function and volumes were similar at 1 week and 1 year post-intervention in survivors. The CMR sub-study suggests that the benefit of the preventive PCI strategy in PRAMI may not be mediated by any effects on LV function and remodelling. Funding Golden Jubilee National Hospital; PRAMI was funded by Barts and the London Charity.

20 A Minap-Like e-registry for the First Time in NHS Scotland? A Proof-of-Concept Report from the Pilot Project

Background The Myocardial Ischaemia National Audit Project (MINAP) provides data on national standards of care for patients with myocardial infarction (MI) in England and Wales but not in Scotland. In the West of Scotland (WoS), electronic patient records are being implemented in place of paper records. We aimed to record-link hospital patient episodes using the new e-systems in order to develop a secondary care e-registry for hospitalised patients with an acute coronary syndrome (ACS), including suspected STEMI, NSTEMI or unstable angina (UA). Methods The systems are (1) Trakcare Patient Admin System with extracts data based on ICD-10 diagnosis codes, (2) SCI-Gateway e-referrals for invasive cardiovascular procedures, (3) a hospital-level integrated patient record including cardiac catheter laboratory data (CATHI), (4) the WoS NHS Safe Haven for healthcare data including hospitalisation and mortality. We implemented a pilot study with data extraction for 1 Oct – 31 Dec 2013 for all admissions with an ICD-10 diagnosis of angina (I200-I209), MI (I210-I229), Other Ischaemic Heart Disease (IHD) (I240-I249), and heart failure (I50). The project involved identification of the NHS referral pathways, case e-record linkage, and quality assurance. Results The regional ACS network involves 7 acute hospitals in WoS (population 2.2 million) including the Golden Jubilee National Hospital, a regional hub for invasive cardiology. During the 3-month pilot, 930 unique patients had 1090 admissions involving 969 distinct spells (i.e. index admission and early out-patient re-admission for angiography). Of these spells, the final diagnosis was IHD in 775 (80%) patients, including 164 (16.9%) with STEMI, 287 (29.6%) with NSTEMI, 26 (2.7%) with unstable angina, 249 (25.7%) with stable angina, 5 with other IHD (0.5%), 43 (4.4%) with ‘other chest pain’ and 194 with a non-IHD final diagnosis (20%) (e.g. pericarditis). The pathways were mapped in 100% of the patients including 25.8% admitted directly to the invasive centre, 5.6% via local A&E to the invasive centre, 22.3% via the local hospital followed by in-patient transfer to the invasive centre, 8.9% discharged from the local hospital then readmitted to the invasive centre for planned early out-patient angiography, 4.6% within the local hospital only (no transfer), and 32.8% directly admitted on an elective basis to the invasive centre (non-acute). The mean duration of stay was similar for patients with a diagnosis of STEMI (5.2 days) or NSTEMI (4.6 days), but less for patients with UA (2.2 days) and more for other IHD diagnosis (9.1 days). Data on health outcomes will be presented at the conference. Conclusions For the first time, the pilot e-Registry has generated MINAP-like data in NHS Scotland. Information on admissions with or without a final ACS diagnosis is collected. NHS Scotland has emerging potential to contribute to MINAP.

Left ventricular outcomes following multivessel PCI vs. infarct artery-only PCI in patients with acute STEMI: the Glasgow PRAMI CMR sub-study

Background In the Randomised Trial of Preventive Angioplasty in Myocardial Infarction (PRAMI; ISRCTN73028481), compared with infarct-related artery (IRA)-only PCI, additional immediate multivessel PCI (MV-PCI) of non-IRA lesions in patients with acute ST elevation myocardial infarction (STEMI) and multivessel coronary disease (MVD) improved long term prognosis. We studied left ventricular (LV) outcomes in a pre-specified cardiac magnetic resonance (CMR) sub-study. Methods In a single centre prospective sub-study, PRAMI participants were invited to undergo CMR at 1.5 Tesla 1 week and 1 year after primary PCI. LV volumes and function were analysed using semi-automated software by a clinician blinded to treatment group assignment and clinical outcomes. The statistical analyses were performed by an independent statistician. Results Of 465 randomised trial participants in 6 UK hospitals, 138 (30%) were enrolled in Glasgow. Eighty patients (17%) (mean age 60 years, 76% male) underwent CMR initially (n = 41 (51%) in the multi-vessel PCI group; n = 39 (49%) in the IRA-only group). 69 (86%) of these patients had a follow up CMR scan at 1 year (n = 7 lost to follow-up, n = 4 deceased). Mean (and SD) LVEF and volumes at 1 week post-MI and their change at 1 year from baseline were similar (Table 1). Conclusion The CMR sub-study participants represented the majority of all randomised participants in our hospital, which included one third of the PRAMI trial population. Random treatment group assignment in this CMR study was evenly balanced. LV function and volumes were similar at 1 week and 1 year post-intervention in survivors. The CMR sub-study suggests that the benefit of the preventive PCI strategy in PRAMI may not be mediated by any effects on LV function and remodelling. Funding Golden Jubilee National Hospital; PRAMI was funded by Barts and the London Charity.

NHS Scotland reduces the postcode lottery for hip arthroplasty: an ecological study of the impact of waiting time initiatives

Following the election of the Labour government in 1997, policies were developed in England to reduce waiting times for NHS treatment with commitments to reduce health inequalities. Similar policies were adopted in Scotland but with less emphasis on the use of the private sector to deliver NHS treatments than in England. This study uses routinely collected NHS Scotland data to analyse geographical and socioeconomic inequalities in elective hip arthroplasty treatment before and after the introduction of the waiting time initiatives in Scotland in 2003. Ecological study design. Scotland. NHS-funded patients receiving elective hip arthroplasty delivered by the NHS and private hospitals between 1 April 1998 and 31 March 2008. Directly standardised treatment rates and incidence rate ratios calculated using Poisson regression. There was a 42% increase in NHS-funded hip arthroplasties carried out in Scotland from 4095 in 2002-2003 (1 April 2002-31 March 2003) to 5829 in 2007-2008. There is evidence of a statistically significant reduction in geographical inequality (likelihood ratio test p < 0.001) but no evidence of any statistically significant change in socioeconomic inequality (p = 0.108), comparing the 5 years after 1 April 2003 with the 5 years before 1 April 2003. The number of NHS-funded hip arthroplasties undertaken privately rose from 1.1% in 2002-2003 to 2.9% in 2007-2008, whereas the NHS Golden Jubilee National Hospital increased its share from 3.3% to 10.6% over the same period. The reduction in geographical inequality, or 'postcode lottery', in hip arthroplasty treatment in Scotland may be due to increased NHS capacity, in particular the development of the NHS Golden Jubilee National Hospital in Clydebank, Greater Glasgow as a dedicated centre to reduce surgery waiting times.

Interview: New treatment approaches in coronary heart disease

Colin Berry speaks to Caroline Telfer, Assistant Commissioning Editor. Professor Colin Berry holds a Senior Fellowship from the Scottish Funding Council and a Chair in Cardiology and Imaging at the University of Glasgow. He is a Fellow of the Royal College of Physicians and Surgeons of Glasgow and Fellow of the American College of Cardiology. He is an Honorary Consultant Cardiologist at the Golden Jubilee National Hospital and Western Infirmary, Glasgow. His subspecialty interests are interventional cardiology and imaging. Professor Berry jointly founded the Scottish Heart Disease Research Collaboration and the Scottish Cardiovascular Imaging Network.

Journal of Rare Cardiovascular Diseases: After one year of life we are growing out from infancy

Dear Readers, Dear Friends and Colleagues, The fifth issue of the Journal of Rare Cardiovascular Diseases is now ready. At the end of the year 2013, being at the same time, the very first year of the Journal’s life, I want to give thanks first to all the authors and reviewers, who shared their time and resources to support this idea of creating a comprehensive mean for exchanging knowledge and experience on orpahn cardiovascular diseases. By your invaluable contribution the Journal is becoming a more and more audible voice in this field, the field of neglected diseases. Special thanks I direct to the team of the editorial office. Your dedication and enthusiasm make it all happening, and happening outstandingly. After this year of various ups and downs, turns and twists we are stronger and ready… for the next one to come. Introducing to you this issue containing a great deal of interesting articles and case reports, we are hopeing it will not only be a good way to expand your knowledge on rare cardiovascular dieseases but will also inspire you to share your experience in this Journal. First dr Marcin Waligóra et al. in the review article is focusing on the rythm disorders in the group of patients with pulmonary hypertension. It introduces an important topic, which is otherwise insubstantially represented in the literature. To highlight the importance of this article one should realize that as many as 80% of clinical deteriorations in patients with PAH are related to various types of arrhythmia. Dr Leszek Wrotniak et al. present a study of 20 patients with Takayasu arteritis undergoing endovascular procedures. They show that up to 70% of these patients have significant stenosis or occlusion in more than one major arterial territory. Majority of this lesions can safely be treated percutaneously, however close follow‑up has to be maintained since the restenosis may occure. Four case reports including: cavernous hemangioma of the heart in a 37‑years‑old patient, successful reversal of advanced heart failure in preipartum cardiomyopathy with aggressive pharmacotheraphy and continuous‑flow left ventricular assist device from the Scottish National Advanced Heart Failure Unit, Golden Jubilee National Hospital, Glasgow, desmin – related restrictive cardiomyopathy and anomalous left coronary originating from the pulmonary artery from the Institute of Cardiology in Warsaw provide a wide range of know‑how regarding rare clinical cases. Every case is assigned the RCD code according to the Classification of Rare Cardiovascular Diseases which was presented to the international audience for the first time during the ESC Congress in Amsterdam 2013. Following professor Ottavio Alfieri’s opinion (San Rafaele Hospital in Milan) as well as our classification consultant’s conviction expressed during the ESC presentation, it is a milestone in understanding and moving the important topic of rare cardiovascular diseases forward. At the end of this issue you will find a report from the biggest workshop on interventional cardiology in Central and Eastern Europe – the “New Frontiers in Interventional Cardiology”. It was organized for the fourteenth time this year, since 1999 in Krakow, Poland. With ca. 1200 participants from all over the World, live transmissions, EAPCI Fellow courses and many up‑to‑date discussions, it became a valuable event at the end of each year in Krakow. We look forward to your submissions in all available forms. Please visit our web page www.jrcd.eu to find more details about submissions of articles and find all issues of JRCD with free access including the most recent one. Piotr Podolec Editor‑in‑Chief Journal of Rare Cardiovascular Diseases

016 Young patients with heart failure often do not have major ECG abnormalities

BackgroundIt is commonly held that a normal ECG rules out the diagnosis of heart failure1; however this has only been demonstrated in the elderly.2 Do young people with heart failure...

The use of homografts in the operative management of infective endocarditis has lower short and medium-term mortality and improved overall outcome compared to prosthetic valves

s / International Journal of Surgery 10 (2012) S1–S52 S16 ABSTRACTS wiring. We found no correlation between glove perforation and sternal wound infection. 0153: DOES EXPLORATIVE THORACOTOMY FOR NON-SMALL CELL LUNG CANCER (NSCLC) ADVERSELY AFFECT PATIENTS’ OUTCOME POSTOPERATIVELY? James Rigby, Aiman Alzetani, Adam Lea, Shilajit Ghosh. University Hospital of North Staffordshire, Stoke-on-Trent, UK Aims: To determine our incidence of explorative thoracotomy for NSCLC and its influence on further management of patients & their survival. Methods: Retrospective review of patients referred for lung cancer surgery over 2.5 years. Clinical data were collected on radiological/pathological staging and post-operative management including survival status. Results: Between January 2008-August 2011, 418 patients underwent thoracotomy for primary lung cancer, of which 27 patients (6%) had inoperable disease. Of the inoperable cases, 4 (15%) had a pre-explorative mediastinoscopy and 22 (81%) were investigated with PET studies. Sixteen patients (59%) had radiological-advanced stage (IIIA-). Inoperability was due to stage migration, N2 disease, tumour invasion or poor physiological status intra-operatively. Subsequent treatments included adjuvant (chemotherapy/ radiotherapy /combined) in 16 patients (59%) of which 12 (75%) are still alive with an average length of survival of 9 months. Conclusion: Our incidence of explorative thoracotomy is well within those reported in the literature. Over half of patients were still suitable for radical adjuvant treatment and 44% survived for an average 9 months postsurgery. Surgery should not be denied for advanced NSCLC to avoid depriving patients the benefit of curative resection and if resection cannot be achieved then some patients are suitable for adjuvant treatments. 0308: THE USE OF HOMOGRAFTS IN THE OPERATIVE MANAGEMENT OF INFECTIVE ENDOCARDITIS HAS LOWER SHORT AND MEDIUM-TERM MORTALITY AND IMPROVED OVERALL OUTCOME COMPARED TO PROSTHETIC VALVES Abderahman Kamaledeen , Rizwan Q. Attia , James C. Roxburgh , Christopher P. Young , Christopher I. Blauth . King's College London, London, UK; Department of Cardiothoracic Surgery, St Thomas' Hospital, London, UK Aim: Infective endocarditis remains a challenging clinical entity, particularly with changing causative organisms. We aim to characterize the operative management, microbiology, operative mortality and long-term survival in a contemporary cohort of patients having surgery for IE. Methods: We reviewed the records of 125 consecutive patients who had surgery for IE over five years (2006-2011), at a large tertiary cardiovascular centre. The valve prosthesis, causative organism, in-hospital morality, long-term survival and need for repeat surgery were examined. Results: Cumulative Kaplan-Meier survival was 86.8% at one-year and 67.8% at five years. 101/125(80.8%) patients had isolated valve surgery, 13/ 125(13.6%) two valves and 7/125(5.6%) three valves. Of the aortic valve IE, 24/66(36.3%) patients had aortic homograft (LES 44.7%), 33/66(50%) had tissue valve (LES47.7%) and 9/66(13.6%) mechanical prosthesis (LES 23.3%). The use of Homograft as a valve substitute was more common in patients with annular involvement and intracardiac abscesses. In-hospital mortality for homograft was 4.5% vs. 8% for prosthetic valve p0.01. There were no re-infections in the homograft group vs. 4.5% for prosthetic valve p0.001. Conclusion: In patients having operation for infective endocarditis, homograft valve replacement provided excellent short and medium-term outcomes with superior survival and freedom from re-intervention compared with prosthetic valve replacement 0380: THE ROLE OF SURGICAL LUNG BIOPSY IN THE MANAGEMENT OF UNDEFINED PARENCHYMAL LUNG DISEASE Vivienne Blackhall, Felice Granato, Katrina Knight, Bernadette Quinn, Ali Jilaihaiwi, Alan Kirk, Mohammed Asif. Golden Jubilee National Hospital,

Kerry-Jane Hogg

The death of Dr Kerry-Jane Hogg at the age of 51 has robbed Scotland of one of its outstanding cardiologists. Dr Hogg, who was a consultant cardiologist at Stobhill Hospital...