Page 74 - Journal of Structural Heart Disease - Volume 1 Issue 2

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Meeting Abstracts
Neslihan Kiplapinar, Ilker Kemal Yucel, Orhan Bulut, Evic Zeynep Basar, Emine Hekim Yilmaz, Ahmet Celebi
Dr Siyami Ersek Hospital for Cardiology and Cardiovascular Surgery; Pediatric Cardiology, Istanbul, Turkey, Istanbul, Turkey
Introduction: The aim of this study is to investigate the efficacy and safety of Cocoon septal occluder (CoSO) in ASD closure, which has similar characteristics with Amplatzer septal occluders (ASO) but low cost than it.
Methods: From January 2004 to December 2014, 724 patients under- went transcatheter ASD closure with various devices. Initially we used ASO in 144 patients. The other devices used were 434 Cardiofix septal occluders, 29 Ceraflex, 13 Cardia, 9 Figulla Occlutech, 7 Gore Helex, 2 Hyperion, 2 PFM septal occluders later. Nowadays, we have been using predominantly CoSO in ASD closure. We evaluated the efficacy and safety of CoSO in ASD closure in patients whose ages <18 years and compared with the patients’ that ASO was used in regarding to procedural success, complications, procedure and fluoroscopy times, complete occlusion rate in one month. Only transthoracic echocardi- ography (TTE) was performed before the procedure in all, but TTE or transesophageal echocardiographic guidance was preferred accord- ing to complexity of the defect or echogenicity of the patient during the procedure.
Results: We have used CoSO in 76 and ASO in 87 children. Age and weight of the patient in CoSO and ASO groups were comparable as 8.5±3.9 vs 8.2±3.3 years, 29.8±15.5 vs 27.1±11.2 kg, respectively. Mean size of defects and devices were not statistically different be- tween the groups; 15.1±5 vs 15.2±3.8, p: 0.85 and 19±5.5 vs 20±4.8, p: 0.95; respectively. The number of TTE guidance was 35 in CoSO and 45 in ASO. The complex defect rate and deployment technique was similar in both groups. Procedural success rate was %100 in both groups. Procedure and fluoroscopy time were significantly lower in CoSO group (48.6±21.6 vs 66±28.1; p: 0.008 and 8.8±5.7 vs 16.6±11.6; p<0.001, respectively). Complications were minimal and 2 in CoSO and 2 in ASO. Complete occlusion rate was similar as %97 in CoSO and %99 in ASO in one month. No complication has occurred during the intermediate term follow-up in both.
Conclusions: Our early and intermediate term results showed that CoSO is efficient and safe alternative in transcatheter ASD closure. It can be preferred because of low-cost.
#0171
TRANSCATHETER INTERVENTIONS IN NEONATES WITH CRITICAL PULMONARY STENOSIS IN THE ERA OF DUCT STENTING
Ahmet Celebi, Ilker Kemal Yucel, Orhan Bulut, Sevket Balli, Neslihan Kiplapinar, Evic Zeynep Basar, Mehmet Kucuk
Dr Siyami Ersek Hospital for Cardiology and Cardiovascular Surgery; Pediatric Cardiology, Istanbul, Turkey
Introduction: Critical pulmonary stenosis (CPS) is defined as severe PS in a newborn with cyanosis or signs of low cardiac output at presen- tation. Pulmonary blood flow is mostly duct dependent. We present our experience with CPS between 2005 and 2014.
Method: 56 patients aged between 2-28 days (median 7 days) under- went pulmonary balloon valvuloplasty (PBV). Duct stenting was per-
formed immediate after in patients that hypoxemia persists (<75%) and had smaller RV and RVOT. In good RV morphology or non-con- stricted PDA, we waited for one week on prostaglandin (PGE) infu- sion. If hypoxemia persists longer, stent was implanted.
Results: In 56 patients, 46 of them were duct dependent, 10 of them have significant hypoxemia but duct had been occluded. The pro- cedure was successful in 55 of 56 (98%). In one patient we couldn’t crossed the valve and underwent to surgery. Predilation with cor- onary balloons in 10 and snare assisted technique was needed in two for crossing the valve with the final balloon. 20 newborn need- ed duct stenting; 14 in the same and 6 in subsequent session. Duct spontaneously occluded in two when waiting on PGE, recanalyzed and stented in one and surgical shunt was performed in another. Stent implantations were done antegrade fashion in 16, retrograde in four. There was no procedure-related mortality. The mean Z scores and valve diameters in duct stent group were significantly lower for both tricuspid and pulmonary valve than the others’. In one patient in whom pericardial effusion was developed, effusion was drained and the procedure was completed. During the follow up (median 58 months), transcatheter reintervention was performed in 10; PBV due to recurrent PS in 6, stent redilation in 3, transcatheter shunt occlusion in one. Surgical interventions were needed in 4; RVOT reconstruction in two, Glenn anastomosis in two. Severe pulmonary regurgitation was seen in two but no need valve replacement yet.
Conclusion: Although additional interventions are not uncommon in early and intermediate time after the procedure, PBV should be the first choice in newborn with CPS.
#0172
PERCUTANEOUS PULMONARY VALVE IMPLANTATION WITH EDWARDS–SAPIEN XT IN PATIENTS WITH NATIVE AND LARGE RIGHT VENTRICULAR OUTFLOW TRACT; EARLY PRELIMINARY RESULTS
Ahmet Celebi, Ilker Kemal Yucel, Orhan Bulut, Sevket Balli1, Mehmet Kucuk
Dr Siyami Ersek Hospital for Cardiology and Cardiovascular Surgery; Pediatric Cardiology, Istanbul, Turkey, Istanbul, Turkey
Introduction: Percutaneous pulmonary valve implantation (PPVI) has been used mainly for conduit dysfunction in right ventricular outflow tract (RVOT. Until recently, native RVOT without stenosis used to be considered a relative contraindication to transcatheter valvulation. We present early results of PPVI with Edwards–Sapien XT (ES-XT) in repaired tetralogy of Fallot (TOF) patients with native-large RVOTs.
Method: 12 s/p repaired TOF patients who had native RVOT with free pulmonary regurgitation and right ventricular dilatation without sig- nificant stenosis. Balloon sizing was performed in all patients with semi-compliant (±compliant) balloons for secure pre-stenting. The size of the Z-Med balloons and BIB catheters that the Andra Stents XXL would be mounted on was decided up to the indentation diam- eter occurred on the balloon during interrogation; as at least 2 mm larger than the indentation diameter.
Results: Median age and weight of the patients were 16 (8-50) years and 46 (27-84) kg, respectively. Indentation diameters with balloon interrogation were between 21.3 and 27.5; a median of 24.2 mm, and balloon sizes used for pre-stenting were 24 to 30 mm; a median of 27
19th Annual PICS/AICS Meeting Abstracts