Page 39 - Journal of Structural Heart Disease - Volume 1 Issue 2

Meeting Abstracts
68
Objective: To described a simple reliable technique to aid in creating diabolo configuration using a gooseneck snare without increasing the size of the delivery sheath.
Methods: The diabolo configuration was created using a standard 5-mm Amplatz GooseNeck true 90° coaxial snare loop centered on an intentionally oversized angioplasty catheter. The stent chosen for deployment was then mounted on the balloon and snare. The lowest profile of the snare loop was maintained with the snare catheter as the stent is crimped onto the angioplasty catheter. Fluoroscopy was used to confirm a proper snare position at the middle of the stent prior to deployment. An introducer size 2 Fr larger than that recom- mended for the angioplasty catheter was chosen. Once the stent is centered across the desired location the distal portion of the stent to the snare is unsheathed and deployed. The entire system is then withdrawn against the wall and the proximal stent is unsheathed and deployed. The diabolo configuration is created with an accurate 5 mm waist and the stent stability is assured. The snare and balloon are then removed and if necessary the waist can be enlarged to the desired diameter. Data expressed as median and IQR.
Results: A total of 6 diablo stents were successfully implanted in 4 pa- tients; 5 to create a transcatheter fenestration and 1 across restrictive atrial septum. Their weight was 24.8 kg (19.6-46.95) and age was 9.2 years (6.28-13.23). The sheath size was 9 (9.5-10.75) Fr and the bal- loon size was 12 (10.5-13.5) mm. There were no complications and a consistent diabolo configuration with a central waist of 5 mm was created. In two patients the waist was easily dilated to a desired size.
Conclusion: The snare serves as a readily available tool, available in adequate length, sterile, has sufficient tensile strength, preconfig- ured with a true 90° coaxial loop, radiopaque to aid in positioning, and does not increase the size of the delivery sheath yet creates a consistent and reproducible diabolo configuration. Further there is no suture that limits potential for future dilation. This technique is a simple, reproducible, easy to learn, and addresses limitations of other techniques.
#0087
CARDIAC CATHETERIZATION IN THE IMMEDIATE POSTOPERATIVE PERIOD: DO RESULTS FROM HIGH VOLUME CENTERS APPLY TO THE REAL WORLD Benjamin Dexter, Osamah Aldoss, Abhay Divekar
University of Iowa Childrens Hospital, Iowa City, IA, USA
Background: Cardiac catheterization performed in the immediate postoperative period (< 6 weeks) is a high risk procedure. The pub- lished data is limited and exclusively from high volume centers.
Objective: The goal of this study was to compare the real world out- comes for early postoperative catheterization with published data from larger centers.
Methods: In this retrospective study previously published definitions, outcome measures, inclusion and exclusion criteria were chosen. All patients undergoing unplanned postoperative cardiac catheteriza- tion excluding central line placement, pericardiocentesis, post-trans- plant surveillance biopsies, and fluoroscopy only procedures between November 2007 and May 2015 were analyzed. The primary outcome measured was whether there was a change in management; tran- scatheter intervention, unplanned reoperation, or change in medical
treatment. The secondary outcomes measured were death, cerebro- vascular accident, major adverse event, need for emergent surgical bailout or mechanical support, worsening or new onset acute kidney injury. All decisions were made after multidisciplinary discussion. The data is expressed as median with IQR.
Results: Eighty-eight patients, median age 117 days (36 to 209.5 days), weight 4.5 kg (3.52 to 6.63 kg), underwent 134 catheterizations on median postoperative day 21.5 (8 to 41 days). Sixty (45%) proce- dures were performed in patients with single ventricle physiology. In 107 (80%) procedures there was a change in clinical management. Fifty-two (39%) procedures were interventional and 82 (61%) were di- agnostic. Fourteen (10%) procedures were performed on ECMO. Suc- cess rates by procedure were: angioplasty 55 %, stent implantation 100 %, and occlusion 100 %. SAE during cardiac catheterization in- cluded thrombosis in the Fontan circuit (one procedure), and access site bleeding (one procedure). Twenty-three interventions involved stent implantation and 22 interventions were balloon angioplasty. In- tervention (balloon angioplasty or stent implantation) across a fresh suture line (<42 days) was performed during 27 (52%) procedures. Suture disruption or trans-mural vascular tears were not observed. There was no procedural mortality. Twelve patients (14%) died within 30 days post catheterization and 22 (25%) patients died before hos- pital discharge.
Conclusions: Similar to data published from high volume centers our data shows that postoperative diagnostic and interventional cath- eterizations can be safely performed and yield critically important information. The outcomes reported by high volume centers can be reproduced in the real world setting.
#0088
TRANSCATHETER
VENTRICULAR SEPTAL DEFECTS
Julio Cesar Biancolini, Maria Fernanda Biancolini, Jesus Damsky Barbosa, Victorio Luccini, Adelia Marques, Judith Ackerman, Eugenia Bazan, Ana Maria Susana de Dios Childrens Hospital Pedro Elizalde, CABA, Argentina
Purpose: Report the experience of 34 cases of transcatheter closure of congenital ventricular septal defects (VSD).
Material and Methods: Transcatheter device implantation was at- tempted in 34patients (p) with congenital VSD until November 2014. The median age was 9.7±7 years.
Anatomic VSD types: 21 perimembranous (2 case post surgery both with light prolapse), 1 multiple (needed 3 devices). 13 muscular (7 middle ventricular- 2 after surgery-, 4 muscular-membranous, 2 mul- tiple),
Devices used: 21 Amplatzer (14 muscular, 7 membranous devic- es and 1p PDA device) type device VSD; 2:9/6 ductus, 10/6, 2:12/6, 2:12/8, 14/8, 2:16/8, y VSD 18, 12,10 y Amplatzer ductus occluder2; 1 AGA ADO II
2 devices N06: 2 Type II, T III, TI; N0 7 Type II, N08 Type II, N010 Type II, N012 Type III.
8 Nit Occlud VSD device. (12/6, 2p 12/8, 5p 10/6, 2p 14/8)
CLOSURE
OF
CONGENITAL
Journal of Structural Heart Disease, August 2015
Volume 1, Issue 2: 36-111