Page 48 - Journal of Structural Heart Disease - Volume 1 Issue 2

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Meeting Abstracts
conferences (n = 39 months) have facilitated dialogue and education covering clinical case selection, planning, and review. Challenges im- peding more rapid progress include streamlined inventory procure- ment, timely domestic hardware support, and expert support staff (anesthesia, intensive care) shortage.
Conclusions: Through mentoring, Uganda Heart Institute is progress- ing toward the goal of 100 annual independent cases.
#0109
PERVENTRICULAR MELODY VALVE PLACEMENT: RESULTS AND RECOMMENDATIONS BASED UPON INITIAL EXPERIENCE
Aamisha Gupta1, Zahid Amin1, Damien Kenny2, Masimmo Caputo2, Anastasiosus Polimenakos1
1Georgia Regents University, Augusta, USA
2RUSH University Medical Center, Chocago, USA
Objective: Perventricular Melody valve placement has usually been used as a bail-out approach in patients (pts.) who had failed attempt- ed percutaneous placement. We used perventricular technique electively in a small group of patients who were not candidates for percutaneous approach. The objective of this study is to assess the feasibility, results and to offer recommendations for optimal out- comes.
Methods: The procedure was attempted in 5 patients. Pt. size preclud- ed percutaneous approach in 4 and one patient had limited venous access that would not allow placement of large sheath. Tetralogy of Fallot was present in 3 and truncus arteriosus in 2. Weight ranged from 4.7- 28.1 kg. All pts. had at least 2 median sternotomies. Four pts. had RVOT conduits and one pt. had trans-annular patch. Conduit size ranged from 14 to 21 mm. All pts. had severe conduit regurgitation and 4 had moderate to severe stenosis. All pts. met criteria to under- go surgical valve placement. Procedures were performed in the hy- brid cardiac suite. Transesophageal echocardiography (TEE) was used in 2 pts. in addition to fluoroscopy. The steps of the procedure were similar to the perventricular procedure for VSD closure except that this procedure was performed using sub-costal approach without sternotomy with the sheath introduced through the diaphragmatic surface of the right ventricle.
Results: Technical success was 100%. All pts. were pre-stented before Melody valve placement. In two pts. With absent pulmonary valve, the pre-stent migrated into the branch pulmonary artery during ad- vancement of the delivery sheath for Melody valve. These stents were anchored in the branch pulmonary artery without any sequelae. Tri- cuspid valve chordal injury occurred in 1 pt. which resulted in moder- ate tricuspid regurgitation. This is one of the three pts. where TEE was not utilized. No pt. required conversion to cardio-pulmonary bypass. Follow up was available in all and ranges from 1 month to 3 years. All pts. were doing well at the last follow up.
Conclusions: Our initial experience demonstrates that perventricular pulmonary valve can be placed safely in small sized pts. Care needs to be utilized in pre-stented pts. to prevent stent migration. TEE should be utilized to ensure that tricuspid valve chordae are not being com- promised. We conclude that the technique is feasible in small sized pts. and has steep learning curve.
#0110
WORLDWIDE EXPERIENCE WITH THE USE OF COCOON SEPTAL OCCLUDER FOR CATHETER CLOSURE OF ATRIAL SEPTAL DEFECTS. PROCEDURAL AND FOLLOW-UP RESULTS
Basil (Vasileios) Thanopoulos1, Petros Dardas2, Vlassis Ninios3, Dan Deleanou4, Silvia Lancovici5, Santosh Sateesh6, Ajith AnanthaKrishna Pillai7, Mahesh Kumar8, Kalyana Sundaram Muthusami9, Ajay Kumar Chuarasia10, 6 Hari Krishna Shivadasan11, Krishnamurthy Kavaserry12, Prabhat Kumar Dash13, Kannan Bhava Ramalingam14, Carlos Bernini15, Jorge Haddad15, Pedro Ambujamra15, Pornthep Lertsapcharoen15, Hung Quang Binh15, Maurizio Marasini15
1Agios Loukas Clinic, Thessaloniki, Greece
2Ares Medical Center, Bucharest, Romania
3Jirmer Hospital, Chennai, India
4GKNM Hospital, Chennai, India
5Nair Hospital, Mumbai, India
6Sree Chitra Thirunal Institute, Kerala, India
7Sri Sathya Sai Institute of Higher Medical Sciences, Karnataka, India
8Vadamalayan Medi Pharama, Chennai, India
9Nair Hospital, Mumbai, India
10Hospital Bosque de Saude, San Paulo, Brazil
11Hospital das Clinicas de Faculdade de Medicina da USP, Ribeirao Preto, Brazil
12Hospital Salvalus, San Paulo, Brazil
13Chulalonghorn Hospital, Bangkok, Thailand
14Bach Hai University, Hanoi, Viet Nam
15Instituto Giannina Caslini, Genova, Italy
Introduction: Transcatheter closure of atrial septal defects (ASDs) is an established treatment modality but no current device provides an ideal solution. The Cocoon septal occluder (CSO) is a new device with certain design features that make it potentially attractive for closure of ASDs.
Methods: In this non-randomized worldwide multicenter study we in- vestigated the safety and efficacy of the CSO for closure of atrial sep- tal defects (ASDs) in 3254 patients (1575 children and 1679 adults). Median age of the patients was 13.5 years (range 2-68 years) and me- dian weight was 28 kg (range 11-65 kg). The device is an improved new generation double disc design made of Nitinol wire mesh that is coated with platinum using NanoFusion technology. The discs are connected by a waist with diameter ranging from 6 mm to 40 mm with 2 mm increments. Mean echocardiographic ASD diameter was 21±7mm (range 14-35 mm), while the mean device diameter was 24±8 mm (range 17-40 mm).
Results: The CSO was permanently implanted in 3243 patients (99.6%). Two devices were implanted in 75 patients (2.3%). Complete echocardiographic closure of the defect immediately after the pro- cedure or at the 3 month follow-up, was observed in 3232 patients (99.4%). 11 patients had a trivial residual shunt. Device emboliza- tion occurred in 9 (0.27%) patients with insufficient septal rims. No device-related erosions or allergic reactions were observed during a follow-up period that ranged from 6 – 70 months.
Conclusions: The CSO is a safe and effective device that adds to our
19th Annual PICS/AICS Meeting Abstracts