Page 26 - Journal of Structural Heart Disease Volume 2, Issue 6

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Meeting Abstracts
#0031
PERCUTANEOUS PULMONARY VALVE IMPLANTATION WITH SAPIEN VALVES IN NATIVE AND LARGE RVOT; EARLY AND MID-TERM RESULTS
Ahmet Celebi, Ilker Kemal Yucel, Mustafa Orhan Bulut,
Sevket Balli, Mehmet Kucuk
Dr. Siyami Ersek Hospital for Cardiology and Cardiovascular Surgery, Istanbul, Turkey
Introduction: Percutaneous pulmonary valve implantation (PPVI) has been used mainly for conduit dysfunction in right ventricular out ow tract (RVOT). Until recently, native RVOT without stenosis used to be considered a relative contraindication to transcatheter valvulation. We present early and midterm results of PPVI with Edwards–Sapien XT (ES-XT) in repaired tetralogy of Fallot (TOF) patients with native- large RVOTs.
Method: 53 s/p repaired TOF patients who had native RVOT with with severe/free pulmonary regurgitation, signi cant dilatation of the RV and without signi cant RVOT stenosis (peak pressure gradi- ent between RV and main pulmonary artery (MPA) < 25 mmHg on TTE), and with a minimum RVOT / (MPA) diameter of ≤ 26 mm on TTE included into the study. Balloon sizing was performed with compliant (34 mm Amplatzer sizing) and semi-compliant balloons for interro- gation (BI). The size of the Z-Med /BIB balloons that the Andra Stents XXL would be mounted on was decided up to the indentation diam- eter occurred during BI; as at least 1 mm larger than the indentation diameter.
Results: Mean age and weight of the patients were 17 ± 7.7 (7-50) years and 49 ± 16 (22-84) kg, respectively. Before presenting pressure gradient between RV and MPA was 4.8 ± 3.4 (0-14) mmHg. Indentation diameter with BI was 26.2 ±2.7 (22-32) mm. Balloon size used for prestenting was 28.1±2 (24-30) mm. Successful PPVI was achieved in 45 patients; 29 mm in 38 and 26 mm in seven. PPVI was performed in same session in ve and 3-12 weeks after prestenting in 40. 8 patients are waiting for valvulation after presenting. One patient has severe tricuspid insu ciency and underwent to surgery after valvulation. Valve function was good in all immediate after and at the last fol- low-up; a median of 10 months (2-25 months). RV volumes decreased and mild paravalvar leakage was observed only in ve. Stent fracture has not been observed and no reintervention required yet.
Conclusion: PPVI with ES-XT valve, which has larger sizes as 26 and 29 mm, is feasible and safe in adolescents and adult’s patients with native RVOT without stenosis. Newer delivery systems, which is used through the smaller sheaths, gives us also an opportunity of early transcatheter valvulation in smaller patients. Prestenting for provid- ing a secure landing zone is the most important part of the proce- dure. Only Andra XXL stents which has an expansion capacity up to 32 mm can be used for this purpose, currently.
#0032
TRANSCATHETER INTERVENTIONS AFTER GLENN ANASTOMOSIS AND FONTAN OPERATION IN PATIENTS WITH UNIVENTRICULAR HEART
Ahmet Celebi, Ilker Kemal Yucel, Mustafa Orhan Bulut, Sevket Balli, Mehmet Kucuk
Dr. Siyami Ersek Hospital for Cardiology and Cardiovascular Surgery, Department of Pediatric Cardiology, Istanbul, Turkey
Introduction: In this paper, we aimed to present transcatheter treat- ment of patients with a single ventricle physiology, experiencing low cardiac output (LCOS) or severe systemic desaturation (SSD) after a Glenn or a Fontan operation
Method: We retrospectively evaluated 30 patients between 2007 and 2016.
Results: The mean age was 7.6 years (6 months-21 years) and the weight was 25.2 kg (6-54). 31 attempts were made in 30 patients. The procedures were performed after a Kawashima, Glenn and Fontan surgery in 3, 12 and 15 patients, respectively. SSD was encountered in 15 patients. Amongst these patients, closure of a Fontan fenestration was performed in 7. We occluded a decompressing vein in 5 and a pulmonary arteriovenous stula closure in one. Closure of a residual right SVC-atrium connection was performed in one and stent implan- tation to reroute the hepatic blood ow to the right lung in one, after a Kawashima operation. The mean oxygen saturation of 79.3±8.1 % increased to 92.2±5.6 and the mean PA pressure increased from 11.9±2.2 mmHg (8-16) to 13.5±2.1 mmHg (10-17). LCOS and / or increased PA pressure was detected in the remaining 15. One patient was on an ECMO support. Amongst these 15 patients, an antegrade pulmonary ow was occluded using a number of devices in 7, ante- grade ow was closed with the use of a covered stent, resolving an associated left PA stenosis at the same time in one. Among 4 patients su ering from branch PA stenosis, 3 received stent implantation while the remaining was treated via cutting balloon angioplasty. Two sepa- rate stents were needed to treat branch PA and extracardiac conduit stenosis in one. In the patient on ECMO support, Fontan fenestration was dilated with a balloon to ensure cardiac output at the expense of systemic desaturation. And fenestration was created in one. In patients with LCOS, the preprocedural PA pressure decreased from 20.6 mmHg (15-27) to 14.9±1.8 mmHg (11-18). There was no proce- dural mortality. Circulatory failure regressed in all cases except one.
Discussion and conclusion: To avoid reopening of the antegrade ow, surgeons should not only ligate but divide the PAs from the ventricle. In the presence of LCOS or SSD, urgent catheterization should be con- sidered. Signi cant PA stenosis should be treated even if there exists no pressure gradient throughout the circulation.
#0033
PDA CLOSURE WITH CERAFLEX OCCLUDER: IS THERE ANY ADDITIONAL BENEFIT?
Ahmet Celebi, Ilker Kemal Yucel, Mustafa Orhan Bulut, Sevket Balli, Mehmet Kucuk
Dr. Siyami Ersek Hospital for Cardiology and Cardiovascular Surgery, Department of Pediatric Cardiology, Istanbul, Turkey
Introduction: Although transcatheter closure of PDA is an established standard method, most frightening complication is protrusion of the aor- tic disc to the DAO which may cause iatrogenic COA, especially in small children with small aorta. Cera ex duct occluder (CDO) is a new device with similar properties with Amplatzer duct occluder (ADO). Device comes preassembled with the delivery cable by a loop connection through the holes and ready to load via the loader on the delivery cable. The loop made of surgical thread that provides the device to become exible in 3600 direction and t to the ductal shape before releasing.
Hijazi, Z
20th Annual PICS/AICS Meeting Abstracts