Page 25 - Journal of Structural Heart Disease Volume 2, Issue 6

Meeting Abstracts
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requiring anesthetic medication boluses) and lack of failed sedation (need to convert from CS to GA). Multivariate logistic regression mod- els were utilized to compare results.
Results: Of 104 infants who underwent a pre-stage II catheterization, 82 (79%) had safe sedation and 56 (54%) had e ective sedation. CS was utilized in 91 (88%) patients and 8 (10%) required conversion to GA (failed sedation). There were no di erences between CS and GA patients in baseline demographics, shunt type, procedural dura- tion, intra-procedural lowest pH/highest PCO2, or rates of safe and e ective anesthetic management. However, ICU admission was more common in GA patients (23% vs 2%, p=0.013) and patients with higher intra-procedural PCO2 (OR 1.17, p=0.013). Higher PCO2 was also associated with greater odds of a failed sedation (OR 1.18, p=0.004). Higher baseline oxygen saturation was independently associated with a safe catheterization (AOR 1.12, p=0.014) and higher weight was independently associated with both safe (AOR 2.86, p=0.004) and e ective (AOR 1.74, p=0.013) anesthetic management.
Conclusions: CS can provide safe anesthetic management for SV infants undergoing a pre-stage II diagnostic catheterization and few patients require conversion to GA. However, hemodynamic steady state can be di cult to achieve regardless of the anesthetic manage- ment strategy.
#0029
FIRST HUMAN CASES OF SELF-EXPANDABLE PERCUTANEOUS PULMONARY VALVE IMPLANTATION USING KNITTED NITINOL-WIRE STENT MOUNTED WITH A TRI-LEAFLET PORCINE PERICARDIAL VALVE Gi Beom Kim, Mi Kyung Song, Eun Jung Bae, Chung Il Noh Seoul National University Children’s Hospital, Seoul,
Republic of Korea
Background: Severe pulmonary regurgitation (PR) and associated right ventricular (RV) dilatation in native right ventricular out ow tract (RVOT) is challenging and still on clinical trial. We report rst human cases of self-expandable percutaneous pulmonary valve implantation (PPVI) using newly made knitted nitinol-wire stent mounted with a tri-lea et porcine pericardial valve developed in South Korea.
Methods: We reviewed 8 cases of self-expandable PPVI at the Seoul National University Children’s Hospital. This self-expandable valved-stent was newly developed by our research team with the cooperation of the TaeWoong medical company in South Korea. This valved-stent was made by knitted nitinol-wire backbone with tissue valve using porcine pericardium with multiple steps for tissue preservation including decellularization and alpha-galactosidase treatment.
Results: Eight patients underwent total correction of Tetralogy of Fallot previously and showed severe PR (mean PR fraction: 43.7%, range: 35.4-56) and enlarged RV volume (mean indexed RV end- diastolic volume; 188.6 mL/m2, range: 167.5–209.8). Their median age at PPVI was 21 years old (range: 13-26). At the targeted RVOT area, 4 patients were implanted with 28 mm diameter valved-stent and 4 patients were implanted with 26 mm diameter valved-stent loaded in the 18 French delivery cable. There were no signi cant peri- procedural complications in all patients. After procedure, there was
no signi cant pulmonary stenosis or PR from cine-angiography and echocardiography in all patients. Chest X-ray showed good valved- stent position at targeted RVOT area. All patients discharged 4 days after PPVI without any problem. One patient completed 6 months follow-up after PPVI and showed decreased indexed RV end-diastolic volume from 181.7 to 126.7 mL/m2 from cardiac MRI.
Conclusion: First human implantation of self-expandable percuta- neous pulmonary valve using knitted nitinol wire mounted with a tri-lea et porcine pericardial valve developed in South Korea was feasible and e ective at short-term follow-up. A clinical trial for fea- sibility to evaluate the safety and short-term e ectiveness of this self-expandable valved-stent for 10 patients is ongoing for the con- genital heart disease with pulmonary valve disease in South Korea.
#0030
SAFETY OF OUTPATIENT CARDIAC CATHETERIZATION IN INFANTS WITH SINGLE VENTRICLE CONGENITAL HEART DISEASE.
Jamie Colombo, Michael Spaeder, Michael Hainstock University of Virginia, Charlottesville, VA, USA
Background: The bene ts of outpatient cardiac catheterization (cath) were rst assessed in the 1980s; it reduces anxiety to patients and families and decreases cost. Cardiac cath is routinely performed in patients with single ventricle congenital heart disease (SVCHD) to aid in hemodynamic assessment, intervention and surgical plan- ning. There is signi cant morbidity and mortality associated with interstage SVCHD in shunt-dependent patients and substantial intra- procedural variation exists between centers. Post-procedural best practices following cardiac cath of infants with SVCHD are unknown. Our institutional strategy has been to discharge patients following a 4-6 hour post-procedure observation period. The objective of this study was to investigate the incidence and causes of readmission of infants with SVCHD following outpatient cardiac cath. Methods: We performed a retrospective review of all patients less than one year of age with SVCHD who underwent cardiac cath between 2007 and 2015 at our institution querying the Society of Thoracic Surgeons Database. Unplanned readmissions were de ned as an admission to the hospital <48 hours following discharge after cardiac cath. Results: 92 patients were included in the analysis. Median age was 134 days (105-179 days) with median weight of 5.6kg (5-6.4kg). 62 patients were discharged following a 4-6 hour observation period. Of those, 5 underwent a cath intervention. Two of the 62 patients initially discharged were readmitted within 48 hours of discharge due to fever and hypoxemia. Of the remaining 30 patients, 18 stayed for 23-hour observation; 9 of those had an intervention. The other 12 patients were admitted to the hospital for >23 hours; 4 under- went intervention. There were no di erences in age, weight, sex, shunt-dependence, arterial access or use of general anesthesia between those patients discharged and those admitted follow- ing cath. Patients who underwent intervention were more likely to be admitted (p<0.001), though nearly one third were discharged home without readmission. Readmission was rare (3%). No intra- or peri-procedural deaths occurred. Conclusion: Outpatient cardiac cath of infants with SVCHD can be performed with low readmission rate. Further investigation will compare cost-e ectiveness of uni- versal 23-hour overnight observation vs. outpatient discharge with potential readmission.
Journal of Structural Heart Disease, December 2016
Volume 2, Issue 6:241-306