Page 21 - Journal of Structural Heart Disease - Volume 1 Issue 2

Meeting Abstracts
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Background: Previous attempts at percutaneous closure of Pm VSDs were abandoned because of incidence of heart block likely as a result of device rigidity and/or over sizing.
Methods: Retrospective review of patients who underwent closure of Pm VSDs using AVPII or ADOII was performed.
Results: 19 patients were identified. AVPII was used in 9, ADOII in 10. Median weight was 13.2 Kg + 19 (range 6.5 to 76); age 24 + 79 months (range 11 to 352). Post procedure, 4 were noted to have new aortic insufficiency (AI); trivial in 3 & mild in 1 (unrelated to the device). Mild tricuspid regurgitation possibly device or procedure related was seen in 4. Residual flow through the device was common post procedure and disappeared in all but 2, graded as trivial in 1. 1 patient had small residual flow above the device. Average follow-up period was 7.3 months + 7.6 (1 day – 25 months). There was no incidence of heart block, bacterial endocarditis, hemolysis, device embolization or frac- ture. The AI was trivial in 2, mild in 1 and resolved in 1.
Conclusions: Percutaneous closure of Pm VSDs using the softer new generation devices as the AVP II and the ADO II is feasible and safe. Longer follow up and larger series are needed.
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SELECTIVE PROPENSITY OF BOVINE JUGULAR VEIN MATERIAL TO BACTERIAL ADHESIONS AND THE IMPACT OF PERCUTANEOUS PULMONARY VALVE IMPLANTATION PROCEDURAL STEPS IN THE GENESIS OF INFECTIVE ENDOCARDITIS: AN IN-VITRO STUDY Zakaria Jalal1, Louise Galmiche1, David Lebeaux2, Olivier Villemain1, Georgia Brugada1, Jean-Marc Ghigo2, Christophe Beloin2, Younes Boudjemline1
1M3C Necker Hospital, Paris, France
2Pasteur Institute, Paris, France
Objective: Percutaneous pulmonary valve implantation (PPVI) using bovine jugular vein made Melody valve is safe and effective. Howev- er, infective endocarditis has been reported for unclear reasons. We sought to assess the impact of PPVI procedural steps on valvular his- tology, selective bacterial adhesion and leaflet mechanical behaviour.
Methods: Three valved stents (Melody valve, homemade stents with bovine and porcine pericardium) were tested in-vitro in 4 conditions: I) control group, II) crimping, III) crimping + inflation of low-pressure balloon and IV) condition III + post dilatation (high-pressure balloon). For each condition, valvular leaflets (and venous wall sample for Mel- ody stents) were taken for histological analysis, bacterial adhesion using S. aureus and S. sanguinis strains and mechanical uniaxial tests of valve leaflets.
Results: Among Melody valves, incidence of transverse fractures was significantly higher in traumatized samples compared with control group (p<0.05) whereas, incidence and depth of transverse fractures were not statistically different between the 4 conditions for bovine and porcine pericardial leaflets. Bacterial adhesion was higher on bo- vine jugular venous wall for S. aureus and on Melody valvular leaflets for S. sanguinis in control groups and significantly increased in trau- matized Melody valvular leaflets with both bacteria (I vs IV: p=0.05). Bacterial adhesion was lower on bovine pericardial leaflets.
Conclusion: Valved stent implantation procedural steps induce his- tological lesions on Melody valve leaflets. Selective adhesion of S. aureus and S. sanguinis pathogenic strains to Melody valve tissue was noted on healthy tissue and increased after implantation procedural steps.
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PERCUTANEOUS LEFT ATRIAL APPENDAGE CLOSURE FOLLOWED BY SINGLE ANTIPLATELET THERAPY: SHORT AND MID-TERM OUTCOMES
Zakaria Jalal1, Marie-Lou Dinet1, Xavier Iriart1, Nicolas Combes2, Pauline Renoux1, Igor Sibon1, Jean-Benoit Thambo1 1University Hospital of Bordeaux, Bordeaux, France
2Pasteur Clinic, Toulouse, France
Introduction: Left atrial appendage closure (LAAC) is non inferior to warfarin in patients with nonvalvular atrial fibrillation (NVAF). Howev- er, postprocedural antithrombotic therapy is not clearly established. We aimed to assess the safety and efficacy of LAAC followed by single antiplatelet therapy for patients with NVAF and contraindication for anticoagulation (OAC)
Methods: Consecutive patients with a previous ischemic or hemor- rhagic stroke, NVAF and contraindication for OAC underwent LAAC between July 2010 and December 2014 in 2 French centers (Univer- sity Hospital of Bordeaux and Pasteur Clinic, Toulouse, France). Fol- low-up included clinical evaluation at 1, 3 and 6 months, and a cardi- ac computed tomography (CT) at 3 months to assess device position, device-related thrombus and residual leak. In case of abnormal CT, TEE was performed to confirm the suspected diagnosis. Single-an- tiplatelet therapy was prescribed after the procedure for at least 6 months.
Results: 81 patients (age 73 ± 8 years) were included. The mean CHA2DS2-VASc and HAS-BLED scores were 4 ± 1.3 and 3 ± 0.9, respec- tively. Main LAAC indication was anticoagulation contraindication (71 patients, 87,6%). The procedure was successful in 100%. Peripro- cedural complications were serious pericardial effusion (n=1, 1.2%) and major bleeding (n=2, 2.4%). After a mean follow-up of 9,7 (3-22) months, one death occurred (following device embolization needing surgical retrieval 2 months after procedure). Four patients presented stroke/TIA/systemic embolism after a mean duration of 15 months (annualized incidence=3.2 % patient/year) that were not related with device thrombus on CT/TEE. Thrombus-related device was observed in 5 patients (4%) but without clinical related event. No bleeding was observed during follow-up.
The observed annual rates of thromboembolic and bleeding events were lower than expected by CHA DS VASC and HAS-BLED scores (p<0.05). 2 2
Conclusions: LAAC followed by a single antiplatelet therapy could be a reasonable alternative for stroke prevention. This strategy provides a significant reduction in the rate of events such as stroke or bleeding versus the score-predicted rate.
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EXTENDING
APPENDAGE CLOSURE INDICATIONS: THE THROMBUS
PERCUTANEOUS
LEFT ATRIAL
Journal of Structural Heart Disease, August 2015
Volume 1, Issue 2: 36-111