e10 Abstracts all valve sizes. It also leads to a significant early reduction in RV size. Peak gradient (mmHg) Mean gradient (mmHg) Pre op RVD (cms) Post op RVD (cms) Significance 21mm 18 8 +/- 1.14 23mm 25.78 +/- 8.34 14.71 +/- 5.25 4.12 +/- 0.71 3.32 +/- 0.59 P<0.0001 25mm 30.2 +/- 13.19 15.65 +/- 6.26 4.35 +/-1.04 3.44 +/-0.71 P=0.001 3.77 +/-0.65 3.12 +/-0.62 P<0.0001 27mm 24.04 +/- 11.47 12.62 +/- 6.29 29mm 25.33 +/- 0.58 13.33 +/- 1.528 http://dx.doi.org/10.1016/j.hlc.2014.12.024 ensuring the correct patients receive this treatment, whilst fitter patients receive the gold standard of surgical drainage and decortication. Our protocol is also presented. Management of empyema with intrapleural dnase-b/tpa compared to surgical decortication in high risk and non surgical candidates http://dx.doi.org/10.1016/j.hlc.2014.12.025 Charles Jenkinson *, Ashleigh Punch, Ian Gilfillan, Deepak Mehrotra, Sanjay Sharma Outcomes following repair of left partial anomalous pulmonary venous connection in children Fremantle Hospital, Fremantle, Western Australia * Corresponding author. Phillip S. Naimo *, Tyson A. Fricke, Yves d’Udekem, Christian P. Brizard, Igor E. Konstantinov Introduction: Pleural infection (empyema) is associated with significant morbidity and mortality. As conservative management often fails, the mainstay of treatment has become surgical decortication. The recent MIST2 trial demonstrated better patient outcomes with intrapleural DNase-B (Pulmozyme) and tPA (Alteplase) compared to placebo or drainage alone. At our institution, we manage empyema with early drainage and decortication of the visceral pleura (via posterolateral minithoracotomy or VATS) in fit patients who fail conservative management. In poor surgical candidates, we have recently used intrapleural DNase-B/ tPA via intercostal catheter, according to a policy based on the MIST2 protocol. Last year we presented our early experience with intrapleural DNase-B and tPA in high risk surgical candidates, demonstrating overall comparable outcomes, despite greater age, more comorbidities, and poorer preoperative function. We add to this body of work. Methods: We conducted a retrospective clinical audit of patients treated at Fremantle Hospital from 1 January 2011 to 30 August 2014. Patients were identified from our Operating Suite Database (TMS v2.17 HIN WA) and Hospital Pharmacy dispensing records. Patients then were grouped into Surgical and Intrapleural Fibrinolytic groups, and data obtained by file review on multiple parameters, including age, empyema risk category, aetiology, comorbidities and biochemical parameters. Outcomes including length of stay, complications and all-cause mortality were compared. Results: With greater numbers of patients, our results from last year’s audit of 42 patients now becomes more statistically robust, with subgroup analysis of comorbidities including malignancy and higher RAPID scores becoming statistically significant. Despite a highly selected group receiving intrapleural fibrinolytics, complication rates remain low. Discussion: Our sample size remains small, however we are able to demonstrate that intrapleural fibrinolytics according to our protocol is a safe and effective alternative in high risk surgical patients. Since last year we have instituted a hospital policy for the use of intrapleural DNase-B/ tPA via intercostal catheter, Royal Children’s Hospital, Melbourne, Australia * Corresponding author. Introduction: Left partial anomalous pulmonary venous connection (L-PAPVC) is a rare congenital defect in which part or all of the left pulmonary veins (PV) drain into the right atrium via the superior vena cava or coronary sinus (Figure 1A). It is repaired by anastomosing the PV to the left atrial (LA) appendage (Figure 1B). There is limited data on the long-term patency of this anastomosis. We sought to determine outcomes of L-PAPVC repair at the Royal Children’s Hospital. Methods: We conducted a retrospective review of children (n=15) who underwent repair of L-PAPVC between 1980 and 2014. Results: Median age at surgery was 3.6 years (range 5 days to 17.2 years). Concomitant anomalies were present in 87% (13/15). Thirteen patients (13/15, 87%) underwent repair of their L-PAPVC with the use of cardiopulmonary bypass. There were no early deaths. There was 1 late death occurring 63 days following surgical repair due to pneumococcal septicaemia in a patient with prior ASD closure and EhlersDanlos syndrome. Overall survival was 92% at 10 years. Figure 1 Left partial anomalous pulmonary venous connection before (A) and after (B) repair. e11 Abstracts Freedom from any reoperation was 70% at 10 years. A single patient (1/15, 7%) required reoperation 1 year after L-PAPVC repair for PV stenosis due to several thrombi located throughout the PV. Freedom from PV reoperation was 90% at 10 years. Follow-up was 87% complete with median follow-up time of 10 years (range 52 days to 20 years). Discussion: To our knowledge, this is the youngest cohort of patients who have undergone surgical repair of L-PAPVC. Repair of L-PAPVC in children can be achieved via anastomosis of the anomalous vessel to the LA with excellent outcomes. The rate of anastomotic stenosis at the site of implantation on the LA is low. http://dx.doi.org/10.1016/j.hlc.2014.12.026 that can be pulled to either side of the dissection field. The concerned hilar lymph nodes were easily identified. With the pulmonary veins pulled aside dissection of the lymph nodes was performed without undue traction preventing damage of the nodal capsule and tumour cell spill. http://dx.doi.org/10.1016/j.hlc.2014.12.027 Outcomes of surgery for anomalous origin of left coronary artery from the pulmonary artery Tyson A. Fricke 1*, Phillip S. Naimo 1, Andrew D. Cochrane 2, Christian P. Brizard 1, Igor E. Konstantinov 1 1 Royal Children’s Hospital, Melbourne, Australia Monash Medical Centre, Melbourne, Australia * Corresponding author. 2 Videoscopic hilar lymph node dissection: a new application of vat surgery used in two cases of malignant melanoma metastases to pulmonary hilar lymph nodes Lucas H.A. Sanders 1,2,3,4*, Brooke Murphy 1, Louis Okiwelu 1, Mitchell Gooch 1 1 Sir Charles Gairdner Hospital, Nedlands, Australia Hollywood Private Hospital, The Lung Health Clinic, Nedlands, Australia 3 University of Western Australia, Crawley, Perth, Australia 4 Lung Institute of Western Australia, Nedlands, Australia * Corresponding author. 2 Introduction: With the paucity of alternative treatment options surgery is still the method of choice to address pulmonary metastases from melanoma. A lateral thoracotomy is the conventional approach. We describe a new application of VAT surgery that allows easier resection of solitary hilar lymph node melanoma metastases. Material/Patients: Two patients presented to our unit with a solitary left and right hilar nodal melanoma metastasis situated close to the pulmonary vein. Using a thoracoscopic approach the pulmonary vein and its branches were mobilised as much as possible to allow removal of several normal appearing anthracotic and the pathologically appearing lymph nodes. On removal the lymph node capsule appeared intact macroscopically. Formal histology demonstrated an intact capsule and no extranodal spread. Discussion: Distant metastatic melanoma Stage IV has a poor 5% 5-year survival rate. Pulmonary resection is an independent predictor of survival in pulmonary metastatic melanoma. Despite recent promising results in systemic therapy, surgery still remains the recommended approach for limited metastatic melanoma if complete resection is possible. Review of the literature revealed no description of thoracic hilar lymph node dissection or a patient presentation with isolated hilar metastases. A lateral thoracotomy approach necessitates dissection through the fissure associated with bleeding and air leak from the opened lung parenchyma. Access to hilar lymph nodes can be difficult between surrounding lung tissue and pulmonary artery. An anterior VAT approach was the ideal avenue in our patients. Extensive mobilisation of the pulmonary veins was easily performed. Retraction of the veins was possible with slings Introduction: Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart defect with limited data on long-term outcomes after surgery. We sought to determine outcomes of patients operated for ALCAPA at the Royal Children’s Hospital. Methods: All patients who underwent repair of ALCAPA were identified from the hospital database and retrospectively reviewed. Results: From November 1972 to March 2014, forty-four patients were operated for ALCAPA at the Royal Children’s Hospital. Median age at operation was 141 days (range 49 days to 26 years) and median weight at operation was 5.8 kilograms (range 2.3 kilograms to 64 kilograms). Four (4/44, 9%) patients had associated anomalies. Twenty-nine (29/44, 66%) patients underwent reimplantation technique, 13 (13/44, 30%) had intrapulmonary baffle repair (Takeuchi repair) and 2 patients (2/44, 4%) had ligation of the anomalous artery. Eight (8/44, 18%) patients had associated mitral valve (MV) repair and 1 patient (1/44, 3%) had a MV replacement at time of initial surgery. Fifteen (15/44, 34%) patients required left ventricular assist device (LVAD) support at the completion of surgery. LVAD was removed at a mean 4 days (range 2 days to 8 days) after surgery. Early mortality was 2.3% (1/44). Follow-up was 100% complete for local patients. Mean follow-up was 12.3 years (range 4 months to 31 years). There were no late deaths. Survival was 97% at 20 years. Ten patients underwent 13 reoperations at a mean 7 years (range 2 months to 25 years) after surgery. Freedom from reoperation was 81%, 77% and 66% at 5, 10 and 20 years after surgery, respectively. Seven patients underwent late MV repair or replacement at a mean 8 years (range 2 months to 25 years) after surgery. Freedom from late MV repair or replacement was 83%, 83% and 77% at 5, 10 and 20 years after surgery, respectively. Eleven (11/44, 25%) patients had severe mitral regurgitation (MR) preoperatively. Of those 11 patients, 5 (5/11, 45%) had MV repair or replacement at time of initial repair, 3 (3/11, 27%) had late MV repair or replacement and the remaining 3 (3/11, 27%) patients had mild MR at last follow-up. All patients had normal left ventricular function at last follow-up. Discussion: ALCAPA can be operated with good outcomes. The possibility of late mitral valve repair or replacement warrants close follow-up. http://dx.doi.org/10.1016/j.hlc.2014.12.028