Page 43 - Journal of Structural Heart Disease - Volume 1 Issue 2

Meeting Abstracts
72
Figure 1. Conduit rupture post Melody implantation (A & B) and after coil embolization (C).
#0096
TRANSCATHETER AORTIC VALVE REPLACEMENT IN YOUNG PATIENTS WITH CONGENITAL HEART DISEASE Arvind K. Hoskoppal1, Brian Whisenant2, John Doty2, Anwar Tandar1, Amit N. Patel1, Mary Hunt Martin1, Robert G. Gray1 1University of Utah School of Medicine, Salt Lake City, UT, USA 2Intermountain Medical Center, Salt Lake City, UT, USA
Background: Patients with congenital heart disease (CHD) often re- quire multiple operations early in life, increasing their risk with each additional surgery. TAVR can be an attractive alternative to surgical
aortic valve replacement.
Methods: Retrospective review of patients with CHD who underwent TAVR at our institutions.
Results: A total of 6 pts underwent TAVR between 5/2013–5/2015 (Ta- ble 1). Each had a different form of CHD. Indications included AS in 1, AI in 2, and mixed AS/AI in 3. All were high risk for surgery: poor LV function (3/6 pts) ± multiple previous sternotomies (mean 3.5, range 1-5). Mean sheath time was 125 mins (63-234), mean fluoro use was 23 mins (11-51). Percutaneous approach was utilized in all (femoral in 5 and jugular vein in 1). AS gradients fell from 44mmHg to 6mmHg (p<0.05). Average length of stay was 2 days (1-4). Mean follow-up was 6 months (1-23). All had ≤ mild AI, 5/6 had ≤ mild AS, and all had sustained resolution of prior symptoms. Complications included a femoral arterial dissection requiring surgery in 1.
Pt
Diagnosis
Age
Wt (kg)
Indica- tion
Valve Type
1 HLHS s/p Fontan, neo-AI
2 DORV, d-TGA s/p ASO, AVR
3 Shone’s, s/p arch repair, MVR, AoV balloon
4 AVSD s/p repair, sub-AS repair, AoV/MV plasty
5 d-TGA s/p ASO
6 Bicuspid AoV
8.7 23.5 11.5 38.9 14 36.3 17.8 69.1 25.7 59 25.2 70
AI
AS, LV dysfxn
AS/AI, LV dysfxn
AS/AI
AI, LV dysfxn
AS/AI
22mm Melody
23mm Sapien 3
22mm Sapien XT
23mm Core valve
29mm Core valve
29mm Sapien XT
Conclusion: To our knowledge this is the largest series to date re- porting the use of TAVR in young patients with CHD. AS and AI were successfully treated in all patients regardless of underlying diagno- sis. TAVR can be performed safely in carefully selected patients with CHD and may reduce the need for repeat surgical valve replacements. Collaboration with surgeons and interventionalists with TAVR experi- ence is key. Longitudinal follow-up studies are needed to determine long-term outcomes.
#0097
TRANSCATHETER FONTAN FENESTRATION CLOSURE WITH THE GORE HELEX SEPTAL OCCLUDER IN 21 PATIENTS
Karen Iacono, Mathew Schwartz, David Nykanen
Arnold Palmer Hospital For Children, Orlando, FL, USA
Background: Persistent fenestrations in the Fontan pathway can re- sult in hypoxemia and/or paradoxical embolization. The Gore Helex Septal Occluder can be used for transcatheter fenestration closure, but its use has not been extensively reported.
Methods: We retrospectively reviewed all patients who underwent attempted transcatheter Fontan fenestration closure using the Gore Helex Septal Occluder at our center from 2007 to 2011.
Journal of Structural Heart Disease, August 2015
Volume 1, Issue 2: 36-111