Page 58 - Journal of Structural Heart Disease - Volume 1 Issue 2

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Meeting Abstracts
scatheter closure. During follow-up period, normal PA pressure was shown in 12 patients who had remaining PAH after the procedure. No significant complications related to ASD occlusion and PAH were demonstrated.
Conclusions: Patients with Atrial septal defect with pulmonary hyper- tension have more complex clinical and pathophysiologic character- istics. Therefore, treatment strategy in congenital heart disease pa- tients with pulmonary hypertension should be tailored to individual details of disease as well as general measures targeting the pulmo- nary arterial hypertension.
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ACUTE AND MID-TERM OUTCOMES OF STENT IMPLANTATION FOR RECURRENT COARCTATION OF THE AORTA IN YOUNG SINGLE VENTRICLE PATIENTS FOLLOWING THE NORWOOD PROCEDURE: A MULTI- CENTER PICES INVESTIGATION
Osamah Aldoss1, Bryan H. Goldstein2, Saar Danon3, Derek A. Williams4, Wendy Whiteside2, Shyam Sathanandam5, Robert G. Gray6, Jeffrey D. Zampi7
1University of Iowa, Iowa city, USA
2Cincinnati Children's Hospital, Cincinnati, USA
3St. Louis University, St. Louis, USA
4Wake Forest Baptist Medical center, Winston-Salem, USA 5LeBonheur Children's Hospital, Memphis, USA
6University of Utah, Salt Lake city, USA
7University of Michigan, Ann Arbor, USA
Objective: To evaluate acute and mid-term outcomes of stent implan- tation (SI) for recurrent coarctation of the aorta (RC) in single ventricle (SV) patients following the Norwood operation.
Background: RC is common following the Norwood operation and is a risk factor for morbidity and mortality. Balloon angioplasty (BA) is usually the first line treatment but occasionally results in unsatisfac- tory outcomes that may warrant SI. There are limited data on acute and mid-term outcomes following SI for treatment of RC in the young SV population.
Methods: Multi-center retrospective study, including 7 participating US centers from 2007 to 2015. SV patients who underwent SI for RC between Norwood operation and Fontan completion were included. Acute and mid-term outcomes were examined, including serious adverse events (SAE). A core laboratory was used for angiography assessment. Coarctation index (CI), defined as the ratio of narrow- est arch dimension to the diameter of descending aorta at the dia- phragm was calculated. Paired t-test and Wilcoxon signed-rank test were used to compare pre- and post-SI variables.
Results: Twenty-four SV patients were included with a median age of 4.6 (IQR 3.5, 10.0) months and weight of 5.6 (4.9, 8.0) kg. Nine (37.5%) patients underwent SI prior to stage II palliation and 15 (62.5%) un- derwent SI between stage II and Fontan completion. BA was per- formed prior to SI in 21 (88%) patients. The approach to SI was pro- grade in 17 (71%), “hybrid” in 5 (21%), retrograde in 1 (4%) and via carotid artery cut-down in 1 (4%). The median CI before and after SI was 0.52 (0.39, 0.62) and 0.96 (0.89,1.06) respectively (p<0.0001). The peak systolic gradient across the RC site improved from 20 (15, 23.5)
to 0 (0,0) mmHg following SI (p<0.0001). There were no procedural deaths but SAEs occurred in 9 (37.5%) patients, including significant hypotension/bradycardia requiring treatment (29%), stent emboliza- tion (4%) and blood loss requiring transfusion (4%). During a median follow-up duration of 28.3 (12, 57.3) months, freedom from death or heart transplant was 79%, and freedom from re-intervention was 50% with median time to re-intervention of 15.9 (5.7, 24.7) months.
Conclusions: SI for treatment of RC in SV patients after the Norwood operation provides excellent acute relief of obstruction. Intra-proce- dural hemodynamic instability is common and re-intervention is fre- quent at mid-term follow-up.
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SAFETY, FEASIBILITY, RESULTS, AND ECONOMIC IMPACT OF COMMON INTERVENTIONAL PROCEDURES IN A LOW VOLUME REGION OF THE UNITED STATES Aaron Clem1, Sami Awadallah1, Zahid Amin2
1Avera McKennan Hospital and University Health Center, Sioux Falls, SD, USA
2Children’s Hospital of Georgia; Georgia Regents University, Augusta, GA, USA
Background: Rural areas of the U.S. may not have a full-time pediatric interventional cardiologist (IC); this requires patients to travel out of state even for minor interventions. Travel may put increased financial burden on both the patient's family and their state's Medicaid pro- gram. Since 2005, we have adopted a policy of performing cardiac catheterizations and common interventional procedures with a vis- iting IC. The purpose of this study is to evaluate the safety, feasibility, and economic benefit of this arrangement.
Methods: We reviewed data of all patients who underwent cardiac catheterizations from May 2005 through September 2014 at our cen- ter. Variables analyzed were type of procedure, results, and follow-up six months after procedure.
Results: A total of 180 catheterizations were performed, of which 98 were for atrial septal defects (ASD), 46 for patent ductus arteriosus (PDA), 16 for diagnostic procedures, 12 for balloon pulmonary val- vuloplasty, 4 for balloon aortic valvuloplasty, 2 for Fontan fenestra- tion dilations, 1 for aortic pseudoaneurysm occlusion, and 1 for right ventricular outflow tract stenting. Amongst 98 ASD cases, 95 devices were placed successfully, 2 defects were not able to be closed due to concomitant pathology and 1 patient was referred for surgical clo- sure because of high risk anatomy. 1 patient developed 1st degree AV block and 1 patient developed intra- and post-procedural SVT. Fol- low-up data was available for 78 of the 95 patients who had a device placed. All but 2 patients had no cardiac symptoms at 6 months. No device embolization, erosion, or residual shunt was seen. PDA clo- sure was successfully performed in 43 of 46 procedures. A device was not implanted in 3 cases due to hemodynamically insignificant PDA (n=2) and unavailability of appropriate device (n=1). Residual shunt was present in 1 patient who had coil embolization; this patient re- quired a repeat procedure. Follow-up data was available for 33 of the 43 patients and showed that all patients were asymptomatic with complete closure.
Conclusion: With a technical success rate of 100% and results com- parable to those of high volume centers, cardiac catheterization and
19th Annual PICS/AICS Meeting Abstracts