Page 44 - Journal of Structural Heart Disease - Volume 1 Issue 2

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Meeting Abstracts
Results: 21 patients underwent attempted Fontan fenestration clo- sure with the Gore Helex Septal Occluder with a median age of 5.5 yrs (3.7-33.1) and weight of 17.2 kg (14.3-79). 17 (81%) patients had undergone extracardiac Fontan operation, while 4 (91%) had a later- al tunnel Fontan. 19 (90%) patients underwent fenestration closure for hypoxemia and 2 (10%) for cerebral paradoxical embolic event. A 15mm device was successfully placed in all 21 patients. A femoral venous approach was used 20 (95%) patients and an internal jugular approach in 1 patient. 7 (33%) had additional transcatheter interven- tions performed during the procedure. The median fluoroscopy time was 31.1 min (9.4-70.5). After closure, the median aortic saturation in- creased from 86% (76-91) to 96% (89-99), median Fontan pressure in- creased from 11 mmHg (8-16) to 13 mmHg (9-17), and median mixed venous saturation was unchanged (pre=67% (52-74), post=67% (56-80). No major complications occurred and obstruction of Fontan pathway was not observed in any patient. Complete occlusion of the fenestration was noted in all patients either at time of catheterization or by follow-up echocardiogram or clinical saturation.
Conclusions: Transcatheter Fontan fenestration closure with the Gore Helex Septal Occluder is safe and effective. The 15mm device is very low-profile and unlikely to lead to Fontan pathway obstruction.
#0098
COOPERATIVE APPROACH TO ASD CLOSURE AT A SINGLE INSTITUTION
Amee Bigelow, Michael Spector, Chandrakant Patel, John Lane, Wasim Khan, Phillip Smith, David Waight
Akron Children's Hospital, Akron, OH, USA
Background: Patients with a secundum atrial septal defect (ASD) and volume loading need closure of their defect. With current technolo- gy, patients and physicians have a choice between surgical closure or device closure.The exact criteria for determining which approach to take is still being defined. We present our experience utilizing a cooperative approach to optimize decision-making when planning closure of an ASD.
Methods: This is a 10-year single center retrospective review of all the secundum ASD closures from October 2003 through December 2014. The IRB of the participating center approved this study. Once it was decided that the patient required closure of the secundum ASD,the patient was evaluated by The Heart Center physicians (including pe- diatric and adult congenital cardiologists and congenital heart sur- geons) for device closure or surgical closure. Transthoracic echocar- diograms (TEE) were performed by the primary cardiologist before discussion. The group bias is for device occlusion if possible. If device occlusion was questionable by surface echocardiogram then evalu- ation in the cath lab with TEE was planned. Patients were scheduled for possible device closure with the surgical team on backup. The cat- egories which were evaluated to determine the closure method were ASD size and adequacy of the rim tissue, and ASD size relative to the atrial size. An ASD > 32-34mm was expected to have a balloon size too large to close with a device. If there were adequate margins on the superior, inferior and posterior sides then the patient was consid- ered be eligible for device closure.
Results: A total of 225 patients had secundum ASD closure with 141 patients in the device closure group, 65 patients in the surgical group and 19 patients who went to the cath lab for further ASD evaluation and were determined to be surgical candidates. Of the 19 patients
taken to the cath lab under the dual approach; there were 6 attempt- ed device occlusions. The mean age (SD) for the device group was 22.3years(20.8), 5.4years(5.6) for the surgical group and 8.9years(7.3) for the third cohort (p<0.001). The mean length of hospital stay was 0.98 days(0.15) for the device group, 3.56 days (6.3) for the sur- gical group, and 2.53(0.7) days for the third cohort (p<0.001). The mean size of the primary ASD was 11.7mm(5) for the device group, 15.81mm(7.4) for the surgical group and 16.11mm (5.5) for the third cohort (p<0.001). The procedural attempt success rate was 95.9% for the device group and 100% for the surgical group. The immediate and follow-up success rates were 96.4%, 98.5% respectively for the device group, 98.4%, 100% for the surgical groups and 94.7%, 100% for the third cohort (all p>0.05). Major complication rate was 1.4% for the device group and no major complications in the surgical group. The minor complication rate was 2.1% for the device group and 16.7% for the surgical group. There were no deaths with any of the groups.
Conclusions: Appropriate patient selection is an important factor for successful secundum ASD closure. We determined our cooperative approach has benefits to the patient including avoiding multiple anesthesia inductions as well as improved patient and family experi- ence as the patient will have their ASD closure during that single visit.
#0100
EXTENSIVE EXPERIENCE WITH TRANSHEPATIC CARDIAC CATHETERIZATIONS FOR CONGENITAL CARDIOVASCULAR DISEASES IN CHILDREN
C. Igor Mesia, Laura Murphy, Joohn D. Murphy
St. Christopher's Hospital for Children, Philadelphia, PA, USA
Objective: To describe our extensive experience with transhepatic cardiac catheterizations for congenital heart disease in a large cohort of patients.
Background: The feasibility, repeatability, and short term safety of transhepatic cardiac catheterizations have been previously de- scribed. To our knowledge there are no reports of results of transhep- atic cardiac catheterizations in a large cohort of patients.
Methods: Demographic, catheterization and clinical data and success and repeatability rate were obtained from a retrospective chart re- view of all patients who underwent transhepatic cardiac catheteriza- tions at St. Christopher’s Hospital for Children between June 1, 2005 and May 31, 2015.
Results: 1281diagnostic or therapeutic cardiac catheterizations were performed at our institution in that period. 52 (4%) procedures were performed via transhepatic approach. 34 (65%) procedures were performed in 23 patients with biventricular circulation and 18 (35%) procedures were performed in 10 patients with single ventricle. The median weight was 6.7 kg (3.2 to 34 kg). The indication for the tran- shepatic approach was no alternative venous access in 43 (83%) or preferred route despite presence of alternative venous access in 9 (17%). Multiple (2-5) transhepatic catheterizations were performed in 10 (30%) patients. Two (4%) patients had significant complications, which resolved without sequela. Two (4%) patients had transient AV block. Six (18%) patients died of unrelated causes. All other patients are clinically stable without sequela at the last follow up.
Conclusions: Transhepatic approach for cardiac catheterizations is re- liable and relatively safe alternative for patients without alternative
19th Annual PICS/AICS Meeting Abstracts