Page 35 - Journal of Structural Heart Disease - Volume 1 Issue 2

Meeting Abstracts
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structed using the Ensemble sheath and a 30 mm Nucleus balloon. This system was bench tested prior to its clinical use.
Results: Ten patients had successful implantation of Sapien valves into native right ventricular outflow tracts (n=7) or tricuspid valves (n=3). There was no stenosis or regurgitation after Sapien valve im- plantation. Several of the pulmonary valve replacement cases were extremely challenging due to the limited flexibility of the Novaflex system (fig 2). The Sapien valve was crimped onto a 30mm Nucleus balloon preloaded through an Ensemble sheath. This system was able to consistently deliver the Sapien valve safely in a bench model as well as in native right ventricular outflow tracts in two patients (Fig 3).
Conclusion: The 29 mm Sapien XT valve allows for large diameter transcatheter valve replacement in both the pulmonary and tricuspid positions. Initial results of new techniques to utilize a more flexible delivery platform are described that could obviate the need for the Novaflex system.
Figure 1.
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FULLY PERCUTANEOUS TRANSTHORACIC LEFT ATRIAL ENTRY AND CLOSURE TO DELIVER LARGE CALIBER TRANSCATHETER MITRAL VALVE IMPLANTS Toby Rogers, William Schenke, Jonathan Mazal, Merdim Sonmez, Ozgur Kocaturk, Kanishka Ratnayaka, Michael Hansen, Anthony Faranesh, Robert Lederman
National Heart, Lung, and Blood Institute; National Institutes of Health, Bethesda, MD, USA
Background: To overcome limitations of transapical and transsep- tal access to deliver large caliber transcatheter implants to the mi- tral valve, we hypothesized that the left atrium could be accessed through the posterior chest wall by displacing the lung with CO2 under imaging guidance.
Methods: We tested fully percutaneous transthoracic left atrial access in 12 animals (10 pigs and 2 sheep) and 3 human cadavers under re- altime magnetic resonance imaging (n=10) or x-ray fluoroscopy plus C-arm computed tomographic (n=2) guidance. We also simulated transthoracic trajectories to the left atrium on human contrast-en- hanced cardiac computed tomographic angiograms.
Results: Animals were survived for median 7.5 days (Q1-Q3, 7–8.5
days). The pleural space was insufflated with CO2 to displace the lung, an 18-26F sheath was delivered to the left atrium, and the left atrial port was closed using an off-the-shelf nitinol cardiac occluder (Am- platz Atrial Septal Occluder) successfully in 12/12 animals. There was no procedural mortality and no important change in hemodynamics (heart rate, mean arterial pressure and expired CO2). Median bleed- ing into the pericardium and pleura were 55mL (40–73mL) and 10mL (10–75mL) respectively, which were immediately auto-transfused.1 hemodynamically insignificant pericardial effusion was observed at follow-up. We also successfully accessed and closed the left atrium in 3 human cadavers under realtime magnetic resonance (n=1) or X-ray fluoroscopic guidance (n=2). A theoretical trajectory to the left atri- um, assuming the right lung was displaced, was present in all of 10 human cardiac computed tomographic angiograms analyzed.
Conclusions: Percutaneous transthoracic left atrial access is feasible in large mammals and in human cadavers under realtime magnetic resonance or x-ray fluoroscopic guidance. The presence of potential transthoracic trajectories to the left atrium on human cardiac com- puted tomographic analysis suggests clinical translation is realistic. This technique could provide fully percutaneous access to deliver large caliber transcatheter mitral valve implants.
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CHALLENGES AND OUTCOME OF BALLOON AORTIC VALVULOPLASTY IN CHILDREN AT VARIOUS AGE GROUPS
Amjad Mehmood, Maad Ulla, Nadeem Sadiq, Hajira Akbar, Khurram akhtar, Mehboob Sultan
AFIC, Rawalpindi, Pakistan
Objectives: This study was aimed to determine the success, compli- cations, trouble shooting, and survival of patients after balloon aortic valvuloplasty (BAV).
Background: The introduction of transcatheter aortic valve balloon- ing in infants and children with severe aortic stenosis has greatly improved symptomatology and quality of life. Even certain neonates with critical aortic stenosis and poor left ventricular function have benefitted tremendously following aortic valve ballooning.
Methods: A cohort of 81 patients with severe aortic valve stenosis un- derwent aortic valve ballooning from august 2010 to April 2015 . All patients had single procedure . Clinical, hemodynamic, and follow-up morbidity and mortality data were collected.
Results: The cohort mean age was 90.5 ± 9.8 months. male to female ratio was 3:1.BAV was performed for symptomatic relief and to gain time for surgical aortic valve replacement. The mean pressure gradi- ent decreased from 80 ± 6 mm of Hg to 25 ± 7 mm of Hg. The mean aortic valve annulus increased from 12 ± 2 mm to 15 ± 3 mm. Serious adverse events occurred in 5 patients (6.17%), Death in one child(1.2 %)during procedure ,ventricular premature contractions in 3 (3.7 %), bradycardia in 1 (1.2 %), mortality rate 1 (1.2%)
Conclusions: Balloon aortic valvotomy is quite rewarding in paedi- atric age group with good results.This procedure relieves symptoms as well as preserves left ventricular function for future aortic valve replacement.
Journal of Structural Heart Disease, August 2015
Volume 1, Issue 2: 36-111