Page 64 - Journal of Structural Heart Disease - Volume 1 Issue 2

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Meeting Abstracts
#0145
LEAVE NOTHING BEHIND: INITIAL EXPERIENCE WITH THE ARSTASIS AXERA ARTERIAL CLOSURE DEVICE IN PEDIATRICS
Gregory Jutzy1, David Juma2, Michael Kuhn1, Aijaz Hashmi1, Brent Gordon1
1Loma Linda University Children's Hospital, Loma Linda, CA, USA 2Loma Linda University, Loma Linda, CA, USA
Background: Arterial closure devices in children may be undesirable due to foreign material (collagen, suture) left behind in a vessel ex- pected to undergo future somatic growth. The Arstasis AXERA arte- rial closure device (AXERA) creates an ultra-low angle arteriotomy to deliver tissue-on-tissue overlap for secure vascular closure without patient implant. We report on the first pediatric use of this device.
Methods: A retrospective, random, single-center study was per- formed pulling pediatric patient encounters (ages 5-18 yrs) undergo- ing heart catheterization with arterial sheath placement from April 2010 to November 2014. Demographics, periprocedural details, and time to hemostasis/discharge were compared among patients who received AXERA (N=34) and those who did not (N=44). The decision to use AXERA was at the discretion of the primary operator. Two sam- ple t-test analysis was used to compare the two groups, with signifi- cance set at p < 0.05.
Results: Demographic characteristics, type of procedure, and heparin dosing were similar between groups. Median sheath size was signifi- cantly larger in the AXERA group (6 Fr vs 4 Fr, p < 0.001). AXERA was successfully deployed 33/34 times (97%) with no reported hemato- mas or loss of pulse post procedure. Angled wires were utilized in >95% of cases. Time to arterial hemostasis was significantly shorter in the AXERA group 8.4 ± 5.3 min compared to the manual compres- sion group 13.4 ± 3.1 min (p < 0.001) and remained significant after adjustment for heparin and protamine dosing, ACT levels, and sys- temic blood pressure. Time to discharge after procedure also trended towards shorter times in those patients being discharged same day.
Conclusions: AXERA appears to be safe and effective in larger pedi- atric patients. Time to arterial hemostasis was significantly reduced compared to manual pressure. Time to discharge can also be poten- tially decreased, potentially representing cost savings. Long term fol- low-up and larger studies are necessary to completely evaluate safety and economic implications.
#0146
ECHOCARDIOGRAPHY
METHOD TO MEASURE AORTIC VALVE ANNULUS DIAMETER WHEN PERFORMING BALLOON AORTIC VALVULOPLASTY
Kevin Gao1, Ritu Sachdeva1, Bryan Goldstein2, Sean Lang2, Scott Gillespie1, Sung Kim1, Christopher Petit1
1Emory University School of Medicine, Atlanta, GA, USA 2University of Cincinnati College of Medicine Department of Pediatrics, Cincinnati, OH, USA
Background: During balloon aortic valvuloplasty (BAV) for congenital aortic stenosis, operators minimize the balloon-to-aortic annulus ra- tio (BAR), as BAR>1.1 is associated with increase in AI. Yet, the method
of measurement of the aortic valve annulus has not been standard- ized or evaluated as an important factor in outcomes of BAV.
Methods: BAV patients at two large pediatric centers between 2007- 2014 with complete echocardiogram (echo) and catheterization (cath) data were included. The aortic valve annulus diameter was de- termined by echo as the distance between the valve hinge points in the long axis view. Largest balloon diameter used, and reported valve annulus as measured by angiography was reported for each patient. The BAR based upon the cath measurement (BARc) was compared with the BAR based upon the echo (BARe). BAV outcomes were com- pared. Primary endpoint was increased aortic insufficiency (AI) by at least 1 degree (none, mild, moderate, severe) by echo.
Results: 98 patients undergoing BAV had available echocardiogram and catheterization data. The median age at valvuloplasty was 2.1 months IQR(0.2- 105.5), BSA 0.3 m2 IQR(0.2-1.0), pre-balloon gradient 58.0 mmHg IQR(48.0-70.0), and median reduction in gradient 35.5 mmHg IQR(26.0-43.0).The median cath-derived aortic valve annu- lus diameter was 8.2 mm IQR(6.8 – 16.0), larger than the echo-based annulus of 7.5 mm IQR(6.1-14.8) (p<0.001). This corresponded to a significantly lower median BARc of 0.9 IQR(0.9-1.0), compared to the median BARe of 1.1 IQR(1.0-1.1) (p<0.001). The amount of discrep- ancy in measured diameter increases with smaller valve diameters (p=0.041) and neonate status (p=0.044). Using catheterization, only 3 (3.1%) patients had an “excessive” BARc of >1.2, while 12 (12.2%) had an excessive BARe (p=0.029). Of the patients with increased AI, only 3(5.5%) had BARc >1.1, while 21 (38%) had BARe>1.1 (p<0.001). There was no trend towards improved gradient reduction using either BARe or BARc.
Conclusions: Angiography has been traditionally used for measure- ment of aortic annulus for cases of BAV. Angiographic calibration methods are problematic. Angiographic measurement is associated in a higher BAR, and increased AI. Operators should use caution when relying on cath measurements of the aortic valve when performing BAV.
IS THE MORE
PRUDENT
#0147
CATHETERIZATION
PERIOD FOLLOWING PEDIATRIC CARDIAC SURGERY: SECURITY AND EFFICACY
Fernando Ballesteros, Nuria Gil, Alejandro Rodriguez, Teresa Alvarez, Jose Luis Zunzunegui
Gregorio Marañón Hospital, Madrid, Spain
Introduction: Cardiac catheterization in postoperative critical care unit period after cardiac surgery is generally perceived as high risk and often debated; to date there is little published data regarding this setting.
The aim of this study is to examine the indications, safety and efficacy of catheterization performed early after congenital heart surgery.
Methods: All catheterizations performed within six weeks after sur- gery between January 2011 and December 2014 were retrospective- ly reviewed. Morphological, surgical and catheterization data, includ- ing mortality and reintervention were analyzed.
Results: 75 patients, median age 5 months (0-169), median weight 6 kg (1,5-65) underwent 83 catheterizations on median postoperative
IN EARLY
POSTOPERATIVE
19th Annual PICS/AICS Meeting Abstracts