Surgical Backup Research Articles

Outcome of cardiac tamponades in interventional electrophysiology.

The aim of this study was to analyse tamponades following electrophysiological procedures regarding frequency and mortality in a high-volume centre and to identify independent predictors for severe tamponades. We performed a retrospective study on 34982 consecutive patients undergoing diagnostic electrophysiological studies or catheter ablation of cardiac arrhythmias. The combined endpoint was defined as severe tamponade. Criteria for severe tamponade included surgical repair, repeat pericardiocentesis, cardiopulmonary resuscitation, intrahospital death or death during follow-up, and thrombo-embolic events or complications due to therapeutic management. Multivariate analysis was performed to identify independent predictors for severe tamponade. A total of 226 tamponades were identified. Overall frequency of tamponades was 0.6%. Procedures requiring epicardial approach had the highest rate of tamponades (9.4%). Twenty-nine patients with tamponade underwent surgery (12.8% of all tamponades and 21.4% of tamponades during epicardial procedures). Overall tamponade-related mortality was 0.03% (9 deaths). Fifty-six patients (24.8%) experienced severe tamponade. Independent risk factors for severe tamponades were endocardial ablation of ventricular tachycardia, epicardial approach, balloon device ablation, high aspiration volume during pericardiocentesis and structural heart disease. The frequency of tamponades is strongly dependent on the type of procedure performed. Overall tamponade-related mortality was low but significantly higher in patients undergoing epicardial procedures. Surgical backup should be considered for patients undergoing complex ventricular tachycardia ablation and left atrial ablation procedures.

Position paper concerning the competence, performance and environment required for the practice of ablation in children and in congenital heart disease

The population of patients with congenital heart disease (CHD) is continuously increasing, and a significant proportion of these patients will experience arrhythmias because of the underlying congenital heart defect itself or as a consequence of interventional or surgical treatment. Arrhythmias are a leading cause of mortality, morbidity and impaired quality of life in adults with CHD. Arrhythmias may also occur in children with or without CHD. In light of the unique issues, challenges and considerations involved in managing arrhythmias in this growing, ageing and heterogeneous patient population and in children, it appears both timely and essential to critically appraise and synthesize optimal treatment strategies. The introduction of catheter ablation techniques has greatly improved the treatment of cardiac arrhythmias. However, catheter ablation in adults or children with CHD and in children without CHD is more technically demanding, potentially causing various complications, and thus requires a high level of expertise to maximize success rates and minimize complication rates. As French recommendations regarding required technical competence and equipment are lacking in this situation, the Working Group of Pacing and Electrophysiology of the French Society of Cardiology and the Affiliate Group of Paediatric and Adult Congenital Cardiology have decided to produce a common position paper compiled from expert opinions from cardiac electrophysiology and paediatric cardiology. The paper details the features of an interventional cardiac electrophysiology centre that are required for ablation procedures in adults with CHD and in children, the importance of being able to diagnose, monitor and manage complications associated with ablations in these patients and the supplemental hospital-based resources required, such as anaesthesia, surgical back-up, intensive care, haemodynamic assistance and imaging. Lastly, the need for quality evaluations and French registries of ablations in these populations is discussed. The purpose of this consensus statement is therefore to define optimal conditions for the delivery of invasive care regarding ablation of arrhythmias in adults with CHD and in children, and to provide expert and - when possible - evidence-based recommendations on best practice for catheter-based ablation procedures in these specific populations.

ACUTE OUTCOMES AFTER CORONARY ORBITAL ATHERECTOMY AT CENTERS WITHOUT ON-SITE SURGICAL BACKUP: DIABETICS VERSUS NON-DIABETICS AND IMPACT OF ACCESS SITE

There is limited data available on atherectomy usage in hospitals or centers without on-site surgical backup. The purpose of this retrospective analysis was to gain further knowledge by analyzing the acute outcomes of complex percutaneous coronary intervention (PCI) patients (including diabetics)

Transvenous Lead Extraction SAFeTY Score for Risk Stratification and Proper Patient Selection for Removal Procedures Using Mechanical Tools

Background: To ensure the safety and efficacy of the increasing number of transvenous lead extractions (TLEs), it is necessary to adequately assess the procedure-related risk. Methods: We analyzed potential clinical and procedural risk factors associated with 2049 TLE procedures. The TLEs were performed between 2006 and 2016 using only simple tools for lead extraction. Logistic regression analysis was used to develop a risk prediction scoring system for TLEs. Results: Multivariate analysis showed that the sum of lead dwell times, anemia, female gender, the number of procedures preceding TLE, and removal of leads implanted in patients under the age of 30 had a significant influence on the occurrence of major complications during a TLE. This information served as a basis for developing a predictive SAFeTY TLE score, where: S = sum of lead dwell times, A = anemia, Fe = female, T = treatment (previous procedures), Y = young patients, and TLE = transvenous lead extraction. In order to facilitate the use of the SAFeTY TLE Score, a simple calculator was constructed. Conclusion: The SAFeTY TLE score is easy to calculate and predicts the potential occurrence of procedure-related major complications. High-risk patients (scoring more than 10 on the SAFeTY TLE scale) must be treated at high-volume centers with surgical backup.

877 Requirements for Surgical Bailout Following Transcatheter Aortic Valve Implantation

Vascular and cardiac complications during transcatheter aortic valve implantation (TAVI) are are rare but important complications. While cardiothoracic surgical backup is traditionally mandatory, the need for vascular surgical support may be underappreciated. We examined rates of surgical complications requiring bailout during TAVI in a single centre. All patients who underwent TAVI in a single centre were reviewed in a retrospective cohort analysis. Demographic data and outcomes according to the Valve Academic Research Consortium-2 (VARC-2) were collected in addition to specific data regarding vascular and cardiothoracic surgical bailout. From August 2008 - April 2020, 567 patients underwent TAVI in a single centre (mean age 82.4±7.6 years, 42% female, mean body mass index 28.1±12.5 kg/mˆ2). Femoral approach was used in 97% of cases with direct aortic, trans-apical, subclavian, carotid, and transcaval as alternate access methods. CoreValve/Evolut-R/Evolut-Pro, SapienXT/3, Symetis, and Lotus prostheses were implanted. Rates of VARC-2 major and minor vascular complications were 1.1% and 5.4%, respectively, and were similar across time periods. Vascular surgical bailout was required in 2.2% of all patients. In contrast major cardiac complications requiring consideration of urgent cardiac surgery which included tamponade, aortic dissection, and valve dislocation/embolisation was 0.7% in total, but 1.9% prior to 2016 and 0.3% from 2016-2020. The requirement for any form of surgical bailout was reassuringly low. Vascular surgical bailout was three times more common than cardiothoracic surgical bailout. Our results suggest routine inclusion of vascular surgeons in the heart team may be justified.

Etiology and Prognosis of Cardiogenic Shock in a Secondary Center without Surgical Back-Up.

Background Cardiogenic shock (CS) remains a major challenge in contemporary cardiology. Data regarding CS etiologies and their prognosis are limited and mainly derived from tertiary referral centers. Aims To investigate the current etiologies of cardiogenic shock and their associated short- and long-term outcomes in a secondary center without surgical back-up. Methods We performed an observational prospective monocenter study. All patients admitted for a first episode of CS related to left ventricular dysfunction were enrolled. The definition of CS was consistent with the European Society of Cardiology guidelines. Patients were followed for 6 months. Etiologies were analyzed, and survival rates derived from Kaplan-Meier estimates were compared with the log-rank test. Results Between January 2015 and January 2016, 152 patients were included. The first most common cause of CS was acute decompensation of chronic heart failure (CHF). Acute coronary syndromes (ACS) were the second most common cause of CS (35.4%). At one month, the all-cause mortality rate was 39.5% and was similar between ACS and CHF (43% vs 35%, respectively; p=0.7). In a landmark analysis between 1 and 6 months, we observed a significantly higher mortality in patients with CHF than in patients with ACS (18% vs. 0%; p=0.01). Conclusions In the present registry, acute decompensation of chronic heart failure was the most common cause of CS, while ACS complicated by CS was the second most common cause. Of importance, acute decompensation of CHF was associated with a significantly worse outcome than ACS in the long term.

Hands on: How to approach patients undergoing lead extraction.

Due to the growing number of patients treated with cardiac implantable electronic devices (CIEDs) there is an increased need for lead management, evaluation, and extraction. While CIED lead extraction has many indications, a consistent approach to preprocedural planning should be applied in all cases, including a thorough consultation with careful review of the patient's medical and device history, as well as a discussion of informed consent and shared decision-making with the patient and their loved ones. The use of chest X-ray, echocardiography, and computed tomography (CT) scan can further help with risk stratification and procedural planning. Intraprocedural echocardiography (transesophageal or intracardiac) is recommended and allows early recognition of cardiothoracic injury. Establishing an extraction team with cardiology/electrophysiology, anesthesiology, and CT surgery is is crucial to a successful and safe CIED extraction practice, including immediately available surgical backup. This hands-on review will address how to approach patients who are undergoing lead extraction, as well as several innovations in preprocedure and intraprocedural risk assessment.

Lead Location as Assessed on CardiacComputed Tomography andDifficulty ofPercutaneous Transvenous Extraction.

This study sought to retrospectively investigate outcomes of lead extraction by using pre-operative computed tomography (CT) scans to identify risk of complicated lead extraction to aid in pre-procedural planning. Transvenous lead extractions remain high-risk procedures requiring specialized operators, equipment, and surgical backup. Data are lacking for how to identify difficult lead extractions. CT scans, which can illustrate the proximity of the lead to adherent venous structures can potentially aid in identifying difficult lead extractions. All cases of patients who were undergoing transvenous lead extractions at the authors' institution between 2015 and 2018, who had a pre-operative CT scan prior to lead extraction, were reviewed. The images were retrospectively reviewed to examine adherence of leads to the surrounding vein and obtained procedural outcomes. A total of 203 cases were reviewed of patients undergoing transvenous lead extraction who had a pre-operative CT scan, and scans were separated based on lead location in the superior vena cava, as assessed by CT imaging. Scans were divided into 3 groups: those in a central location or <1cm adherence (n=28); those that had at least 1 lead with tip adherent >1cm (n=137); or those that had at least 1 lead outside the vein contour (n=38). Although there was only 1 serious complication requiring vascular surgery intervention, patients with at least 1 lead outside the vein contour required significantly longer procedural time (190.8 ± 86.6min vs. 158.1 ± 73.7min vs. 142.8 ± 52.2min; p=0.019) and fluoroscopy time (33.1 ± 24.2min vs. 19.6 ± 18.4min vs. 18.3 ± 16.4min; p=0.0006) than those with leads adhering >1cm and centrally located leads, respectively. Pre-operative CT scanning can identify difficult lead extractions prior to performing the procedure. This information may aid electrophysiologists in the planning of extraction procedures. Future prospective studies are needed to confirm these findings.

Comprehensive review on EUS-guided biliary drainage.

Feasibility of endoscopic retrograde cholangiopancreatography (ERCP) for biliary drainage is not always applicable due to anatomical alterations or to inability to access the papilla. Percutaneous transhepatic biliary drainage has always been considered the only alternative for this indication. However, endoscopic ultrasonography-guided biliary drainage represents a valid option to replace percutaneous transhepatic biliary drainage when ERCP fails. According to the access site to the biliary tree, two kinds of approaches may be described: the intrahepatic and the extrahepatic. Endoscopic ultrasonography-guided rendez-vous transpapillary drainage is performed where the second portion of the duodenum is easily reached but conventional ERCP fails. The recent introduction of self-expandable metal stents and lumen-apposing metal stents has improved this field. However, the role of the latter is still controversial. Echoendoscopic transmural biliary drainage can be challenging with potential severe adverse events. Therefore, trained endoscopists, in both ERCP and endoscopic ultrasonography are needed with surgical and radiological backup.

Abstract 213: Percutaneous Coronary Intervention at Centers with and without On-Site Surgical Backup: A Meta-Analysis and Meta-Regression

Background: Guidelines recommend that Percutaneous coronary intervention (PCI) should be performed in hospitals with onsite cardiac surgery (CS). However, emerging data suggest that there is no significant difference in clinical outcomes following primary, or elective PCI between the two groups. We performed a meta-analysis and meta-regression to assess the safety and efficacy of performing PCI in centers with, and without on-site CS. Methods: We conducted electronic database searches in PubMed, CENTRAL, EMBASE. The Cochrane Register, Google Scholar databases, and the scientific session abstracts were searched for eligible studies. Risk ratios and 95% confidence intervals were computed with the Mantel-Haenszel method. Fixed-effect models were used; if heterogeneity (I 2 )&gt;25 was identified, effects were obtained with random models. Meta-regression analyses were performed to determine whether the effects of PCI without on-site CS were modulated by pre-specified study-level factors Results: Twenty-seven studies were included with total n=8,558,618 patients. No significant difference was observed for all-cause mortality (RR 1.02, 95% CI 0.86-1.21, p=0.82, I 2 =97.2%), cardiovascular mortality rates (RR 1.18, 95% CI 0.93-1.50, p=0.17, I 2 2.98%), myocardial infarction rates (RR 0.89, 95% CI 0.62-1.29, p=0.55, I2= 88.5%), repeat revascularization (RR 0.87, 95% CI 0.43-1.76, p=0.69, I 2 =98.8%), stroke (RR 1.28, 95% CI 0.56-2.91, p=0.55, I 2 98.8%), shock (RR 0.76, 95% CI 0.43-1.35, p=0.35, I 2 = 93.7%), mechanical circulatory support (RR 0.83, 95% CI 0.46-1.50, p=0.53, I 2 99.8%), bleeding (RR 0.88, 95% CI 0.43-1.81, p=0.73, I 2 =99.6%), and emergency CABG (RR 0.97, 95% CI 0.64-146, p= 0.87, I 2 =84.1%). In a meta-regression analysis, the effect of PCI without on-site CS, baseline clinical features did not affect the long-term all-cause mortality outcome. Conclusion: There was no significant difference in complications rates, and clinical outcomes for PCI performed at centers without on-site CS compared to centers with on-site CS.

Percutaneous lead extraction and repositioning: An effective and safe therapeutic strategy for early ventricular lead perforation with dislocation both inside and outside the pericardial sac following a cardiac device implantation

Cardiac perforation of the right ventricle associated with pacemaker or implantable cardioverter defibrillator (ICD) leads' implantation is uncommon, albeit potentially life-threatening, complication. The aim of this study is to further identify the optimal therapeutic strategy, especially when lead dislocation has occurred outside the pericardial sac. The study population included 10 consecutive patients (six female, mean age: 66.5 years old) diagnosed with early ventricular lead perforation following a pacemaker or ICD implantation, with significant protrusion inside the pericardial sac (n = 2) or migration of the lead at the pleural space ( n = 3), the diaphragm ( n = 1), or the abdominal cavity ( n = 4), during the period 2013-2017. All patients were symptomatic; however, individuals presenting with hemodynamic instability were excluded. The outcome of the percutaneous therapeutic approach was retrospectively assessed. All patients underwent a successful removal of the perforating lead percutaneously at the electrophysiology lab, by direct traction, and repositioning in another location of the right ventricle. The operation was performed by a multidisciplinary team, under continuous hemodynamic and transesophageal echocardiographic monitoring and cardiac surgical backup. The periprocedural period was uneventful. Subjects were followed up for at least 1 year. Interestingly, all patients developed a type of postcardiac injury syndrome, successfully treated with a 3-month regimen of ibuprofen and colchicine. Percutaneous traction and repositioning of the perforating ventricular lead are effective, safe, and less invasive compared with the thoracotomy method in hemodynamically stable patients when dislocation has occurred outside the pericardial sac provided that there is no visceral organs injury.

Primary Endovascular Elective Repair and Repair of Ruptured Isolated Iliac Artery Aneurysms Is Durable—Results of 72 Consecutive Patients

PurposeTo evaluate outcome of endovascular elective repair and repair of ruptured isolated iliac artery aneurysms (IIAAs) as a primary treatment strategy. Materials and MethodsAll patients with an IIAA undergoing endovascular treatment were included. Aneurysms were classified according to an anatomic classification and treated with coiling of the internal iliac artery, stent graft placement in the common to external iliac artery, or placement of a bifurcated aortoiliac stent graft. Between November 1996 and November 2015, 72 patients with 85 IIAAs underwent endovascular repair. Mean age was 73.9 years ± 9.2. Common iliac artery was involved in 63 patients (74.1%), internal iliac artery was involved in 21 patients (24.7%), and external iliac artery was involved in 1 patient (1.2%). Mean diameter was 5 cm (range, 2.5–11 cm). Emergency repair was performed in 19 patients owing to rupture (26.4%). ResultsOverall primary technical success rate was 95.8% with conversion rate to open surgery of 4.2% (all in the emergency group) and in-hospital mortality rate of 1.4%. During mean follow-up of 4.3 years ± 3.3 (median 3.8 y; range, 0–14.2 y), 17 endoleaks were observed (6 type I, 10 type II, 1 type IIIa). Overall reintervention rate was 16.7%. Primary patency rate was 98.6%. During the follow-up period, 22 deaths occurred (30.6%), including 2 aneurysm-related deaths (2.8%). ConclusionsPrimary endovascular repair of IIAAs shows excellent results and should be considered as first-line therapy. Surgical backup should be available in emergency cases.

Introducing ERCP in a Low Income Country: A Case Series From Rwanda Endoscopy Week

Rwanda is an East African country of 12 million people with recent advances in access to diagnostic upper endoscopy. The burden of gastrointestinal disease in Rwanda is great and there is no availability of ERCP. Management of patients with biliary disease currently consists of either medical or surgical interventions. Rwandan endoscopy week was a collaborative effort between a US gastroenterology team and members of the Rwandan Society of Endoscopy (RSE) who have previously established a longstanding working relationship through a series of international physician exchanges. This series illustrates a proposed model for global health endeavors in advanced endoscopy. An advanced therapeutic team of two GI physicians, a nurse, two ERCP technicians and a biomedical engineer from the US worked in collaboration with members of the RSE. The visiting team donated side-viewing endoscopes and therapeutic supplies. The team consulted on patients with biliary pathology to determine which cases were appropriate for ERCP. Procedures were performed in the operating theater under general anesthesia. ERCP was facilitated by fluoroscopy using a C-arm typically used for surgical cases. A Rwandan biliary surgeon was available for surgical backup as needed. Five patients were selected for ERCP and consented to the procedure. Indication for ERCP in 4/5 patients was clinical suspicion for biliary obstruction from gallstone disease; one had suspected biliary obstruction from malignancy. Findings on ERCP included two patients with choledocholithiasis, one with a choledochoduodenal fistula and one with suspected cholangiocarcinoma. ERCP in the patient with biliary malignancy was complicated by perforation during palliative stent placement. Biliary perforation across the tumor was identified on fluoroscopy. The procedure was immediately converted to an open laparotomy and the defect was successfully repaired with a choledochojejunostomy. There were no other complications. The burden of GI disease in Rwanda is great and many patients may benefit from ERCP. This series of five cases were the first ERCPs ever performed in Rwanda. ERCP is possible in an under-resourced setting and would nicely complement the current capabilities in laparoscopic surgery. Challenges include obtaining and maintaining the advanced equipment and training physicians and advanced endoscopy staff. Support from a skilled surgical team is essential given the potential risk of complications.2158 Figure 1 No Caption available.

Acute Coronary Artery Dissection: A Review of the Literature and Current Evidence.

Acute coronary artery dissection is a rare, complex disease occurring particularly in young women without traditional cardiovascular risk factors. The pathophysiology and treatment are different from acute coronary syndrome caused by plaque rupture or erosion. Its clinical presentation may vary from unstable angina to sudden cardiac death. Hence, early detection is crucial to manage the dissection and reduce the mortality and morbidity rates. Most coronary dissections will heal spontaneously, and conservative treatment is recommended for uncomplicated cases. In the acute phase, primary percutaneous coronary intervention remains the reperfusion strategy of choice; however, in small- and medium-sized arteries with normalized blood flow, conservative treatment is beneficial. Medical therapy should be tailored to the individual depending on the underlying severity of the condition. Percutaneous coronary intervention should be performed by experienced operators, with the use of intravascular imaging, and preferably with on-site surgical back-up due to the increased risk of complications. The prognosis is favorable; however, patients have a high risk of recurrent dissections in other arteries several weeks after the first event, suggesting a general weakness of the arteries. In the recent past, optical coherence tomography has played an important role in the diagnosis of acute coronary artery dissection; however, its therapeutic potential is underestimated. We recommend that long-term clinical trials should be conducted to fully determine the long-term mortality and morbidity rates of these patients.

Impact of On-Site Surgical Backup on Periprocedural Outcomes of Primary Percutaneous Interventions in Patients Presenting With ST-Segment Elevation Myocardial Infarction (From the ORPKI Polish National Registry)

Conflicting data exist regarding the associations between on-site surgical backup and outcomes after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Thus, we sought to assess the impact of such a backup on periprocedural outcomes of primary PCI using data from the Polish National Registry of PCI. From 2014 to 2016 data on 66,707 patients presenting with STEMI undergoing primary PCI from 154 centers were collected. Patients were divided into 2 groups based on the presence of on-site surgical backup. Of 66,707 patients, 15,040 (22.6%) patients were treated in 28 centers with on-site surgical backup. On-site surgical backup was associated with a higher center PCI annual volume (662.4 ± 301.8 vs 1098.7 ± 483.5; p <0.001), but a lower operator PCI annual volume (226.7 ± 126.0 vs 207.8 ± 96.6; p <0.001). The periprocedural mortality (1.60% vs 1.09%; p <0.001) was lower in patients from centers with on-site cardiac surgery and both on-site surgical backup (odds ratio [95% confidence interval], 0.618 [0.517; 0.738]; p <0.001) and the mean number of PCIs by operator per year (odds ratio per 10 [95% confidence interval], 0.990 [0.984; 0.996]; p = 0.001] were independent predictors of periprocedural death. In conclusion, results of our study suggest that periprocedural mortality in patients undergoing primary PCI for STEMI is lower in centers than without on-site cardiac surgical backup. Whether this effect on mortality is attributable to such backup itself and/or whether surgical backup is a marker ofoverall better medical care and adherence to professional guidelines, this needs clarification in further studies.

Highlights From the Circulation Family of Journals

Highlights From the <i>Circulation</i> Family of Journals

Transvenous Lead Extraction: A Clinical Commentary for Anesthesiologists

With increasing use of cardiovascular implantable electronic devices, the need for lead extractions has increased to an annual volume of more than 10,000 extractions worldwide. This article provides a focused clinical commentary on the perioperative management, identification, and treatment of life-threatening complications associated with lead extractions. In addition, a summary of indications, techniques, and lead extraction complications is provided. Although uncommon, lead extractions are associated with a consistent rate of major procedure-related complications and mortality. Major life-threatening complications include vascular laceration, cardiac avulsion, hemothorax, pericardial effusion, and cardiac arrest. Comprehensive preoperative risk assessment and adequate planning and preparedness are crucial to decreasing all procedure-related adverse events. The location of the procedure (electrophysiology suite v hybrid operating room) and the nature of cardiac surgical backup are determined after meticulous risk stratification. In addition to decisions on vascular access, invasive monitoring, and modality of rhythm support, transesophageal echocardiography plays a crucial role in early diagnosis, timely management, and potential prevention of these complications.

VP33 Peroral Endoscopic Myotomy For Treating Achalasia: A Rapid Review

Introduction:The best available research and funding policy evidence regarding the regulatory status, patient selection criteria, safety, clinical effectiveness, and financial impact of peroral endoscopic myotomy (POEM) for the treatment of achalasia was synthesized for statewide decision making for a South Australian local health network.Methods:A comprehensive systematic search of twenty-three gray literature sources and three published literature databases for international evidence was conducted, based on a priori inclusion criteria. The methodological quality of the included studies was critically appraised. Data extraction and synthesis were conducted in narrative form.Results:Short-term safety and clinical data from very low-level studies showed that POEM appears to be a relatively safe and clinically effective endoscopic treatment for esophageal achalasia, compared with laparoscopic Heller myotomy (LHM). One primary safety concern consistently highlighted by the literature was gastroesophageal reflux (GER) after POEM, since no anti-reflux procedure is involved. Operative time and length of hospital stay for POEM were comparable with LHM and potentially favor POEM. The comparative long-term outcomes for the POEM procedure are not known. No studies have investigated the cost-effectiveness of POEM. Conflicting findings were reported on whether POEM is cheaper or more expensive than LHM. POEM is a technically challenging procedure with a substantial learning curve. Patients who undergo POEM may require postoperative surveillance and testing to evaluate procedural success and to identify potential complications. Current literature showed limited analysis and systematic elucidation of an optimal patient group that may best benefit from POEM.Conclusions:The POEM procedure should be carried out at an experimental or trial level only, with strict auditing of results. POEM procedures should ideally be performed at institutions where an adequate level of surgical and critical care backup is available to provide expert care should complications arise. Monitoring of patient outcomes, including symptom improvement, is recommended for clinical assessment and reporting to determine future adoption in the South Australian public health sector.

Cardiac Invasive Electrophysiology Studies with Radiofrequency Ablation Without Onsite Cardiothoracic Surgical Back-Up in a New Cardiac Electrophysiology Laboratory: Single-Centre Experience

Introduction: Previous studies of invasive cardiac electrophysiology (EP) and radiofrequency catheter ablation (RFA) concluded that procedures can be safely performed successfully in selected groups of patients, by experienced staff, without on-site cardiothoracic surgery back-up. We aim to report a single centre experience.

Structural Heart Interventions in Far North Queensland: Feasibility and Safety in a Regional Centre

Background: With advancements in device technology and procedural techniques, structural heart intervention is becoming increasingly common. However, this has been largely limited to metropolitan centres, usually with on-site surgical backup. This study sought to assess the safety and outcomes of structural heart interventions at Cairns Hospital.