Page 32 - Journal of Structural Heart Disease Volume 2, Issue 6

259
Meeting Abstracts
regular ventricular septal occluder. However, it is not useful in VSDs measuring more than 6 mm and in those with insu cient aortic rim.
Conclusion: ADO II is an excellent device in ventricular septal defects. The procedure time and the cost are signi cantly lesser than regular devices. The success rate is very high and complication rate is very low.
#0046
TRANSCATHETER DUCTUS ARTERIOSUS STENTING WITH EXPECTED REDILATION AS A SURGICAL ALTERNATIVE
Jesse Lee, Howaida El-Said, Kanishka Ratnayaka, John Moore University of California San Diego/Rady Children’s Hopistal, San Diego, CA, USA
Background: Transcatheter ductus arteriosus stenting (DAS) has been used to provide a reliable temporary source for pulmonary blood ow in cyanotic congenital heart patients. However, even in the context of surgical mortality rates approaching 10%, most modern congenital cardiovascular centers continue to rely almost exclusively on surgical shunts. Data on DAS from centers with sophisticated surgical services is limited. We report DAS experience from a modern comprehensive congenital heart center in North America.
Methods: This is a single-center retrospective review of all patients who were taken to the cardiac catheterization lab with the intent of DAS from January 2006 to August 2016.
Results: Successful DAS was performed in 30/32 patients (97%), median age 7 days (range 1-176), median weight 3.43kg (1.5-6.8). Diagnoses included 14 PA/IVS, 5 critical PS, 4 TOF, 2 PA/VSD, 3 TGA, 1 DORV/TGA, 1 tricuspid atresia, 1 Ebstein’s & 1 Heterotaxy/AVC/PS. 2/32 required urgent surgical shunt placement, due to ductal spasm prior to stenting in one and stent thrombosis in the other. Bare metal coronary artery stents were used, median stent diameter 3.5 mm (2.5- 4). Median saturation at discharge was 91% (80-99). At a median fol- low up of 3.9yrs (2 mos-9.4yrs), 17 (55%) had reinterventions for low saturations (balloon dilation alone n=5 and restent n=12). Median time between implant and re-intervention was 74 days (33-186). Stent thrombosis at the time of re-intervention occurred in 1/17; patient was referred for an early Glenn. Complications involving fem- oral vessel compromise occurred in 7 (22%), 3 resolved with anticoag- ulation, 4 formed su cient collaterals. 16/30 progressed to surgical repair or next stage palliation; 14 did not require further surgical intervention with adequate prograde pulmonary blood ow [balloon pulmonary valvuloplasty (n=13), bilateral DA stenting as destination palliation (n=1)]. There were no deaths associated with the DAS. One patient died after a Glenn procedure while awaiting heart transplant 3 months post DAS.
Conclusions: DAS appears to be a safe and e ective procedure for establishing a reliable temporary source of pulmonary blood ow in selected cyanotic congenital heart patients. Reintervention for stent redilation is common and should be a planned component of this management strategy. It is likely that more experience from centers with sophisticated surgical services will be necessary before commu- nity practice evolves toward greater reliance upon DAS.
#0047
RE-STENTING IMPROVES VESSEL PATENCY, LUMEN AREA AND ENDOTHELIALIZATION: A FEASIBILITY STUDY IN PIGLETS DEMONSTRATING RE-STENTING WITH SIMULTANEOUS INTENTIONAL FRACTURE OF PREVIOUSLY PLACED STENTS
András Bratincsák3, William Van Alstine2, Lindsay Koren2, Kimberly Stoughton2, José Negrón-Garcia2, John Moore1, Howaida El-Said1
1University of California Sand Diego, Rady Children’s Hospital, San Diego, California, USA
2Cook Medical, Bloomington, Indiana, USA
3Kapi’olani Medical Center for Women and Children, Honolulu, Hawaii, USA
Background: Intentional stent fracture in-vivo has shown medial dis- section/vessel injury. Spontaneous stent fracture in humans has been reported to cause stent collapse, hemodynamic compromise and embolization of stent fragments, many of which were treated with re-stenting.
Objective: To demonstrate feasibility and propose re-stenting prior to intentional stent fracture to avoid such complications. We sought to compare stent fracture with and without a stabilizing additional stent and study the e ects on the tissue.
Methods: Five months after fourteen low pro le stents where implanted in the aorta of four piglets, they were intentionally fractured using high-pressure balloons, one group with another stent placed inside (re-stent group) and one without (single stent group). Vessel/stent were studied at both short-term and long term intervals. Results: The re-stent group demonstrated signi cantly larger vessel segment (113±28mm2 versus 59±17mm2, p=0.0476), less long term luminal diameter loss 45.5% versus 73.7%, p=0.0065), lack of strut protrusion and higher degree of endotheliziation (95.7±2.1% versus 74.1±7%, p=0.0145). There was similar degree of vessel wall injury at the time of the frac- ture, however at long term evaluation the injury score in the re-stent group demonstrated statistically signi cant improvement (p=0.0426). No damage to the external part of the blood vessels or the surrounding soft tissue was noted in either group.
Conclusion: Re-stenting at the time of intentional stent fracture provides numerous advantages including larger vessel diameter, maintained vessel patency, more complete endothelizalization, lack of stent strut protrusion with decreased chance of injury and future complications. Human studies are needed to con rm our observations.
#0048
VSD CLOSURE USING CERA® DEVICES
Jesus Damsky Barbosa, Victorio Lucini, Adelia Marques, Judith Ackerman, Fernanda Biancolini, Julio Biancolini,
Ana de Dios
”Pedro de Elizalde”, Ciudad Autonoma de Buenos Aires, Argentina
Objective: the aim of this study is to describe the immediate to long follow up in 15 patients (p) with perimembranous (PMVSD)
Hijazi, Z
20th Annual PICS/AICS Meeting Abstracts