Page 44 - Journal of Structural Heart Disease Volume 2, Issue 6

271
Meeting Abstracts
National Institute of Cardiology ¨Ignacio Chavez¨, Mexico City, Mexico
Background: Interventricular septum rupture following acute myo- cardial infarction (MI) is a rare (≈0.2%) but serious and potentially life threatening complication. Current AHA/ACC guidelines recom- mend urgent surgical repair even in the absence of hemodynamic compromise. However, surgical mortality rate remains high (reported between 20 to 80%) particularly in patients with cardiogenic shock. Percutaneous closure is an attractive, less invasive alternative yet this approach remains to be performed only in few selected centers around the world.
Methods: Single centre, retrospective study of 17 consecutive patients diagnosed with postmyocardial infarction ventricular septal defect (pMIVSD) that underwent percutaneous device closure between July 2003 (index procedure) and July 2016. Patients were further divided into those with (n=8) (Group A) and without cardiogenic shock (n=9) (Group B) at the time of intervention. The latter was de ned as those requiring inotropic support or intra-aortic balloon counterpulsation to sustain cardiac output.
Results: Nine (47%) patients were female. Median age was 65 years (range 51-75 y). Median time in days between MI and pMIVSD clo- sure was 8 days (range 1-25) for group A and 11 days (range 3-91) for Group B. Systolic pulmonary artery pressure/systemic pressure ratio was 0.57 (range 0.38-0.7) and Qp:Qs 1.83:1 (1.72-3.6) for patients in Group A and 0.6(range 0.33-0.89) and Qp:Qs 3:1 (1.58-4.39) for patients in group B (NS). A variety of devices were used to occlude the defect: muscular VSD Amplatzer n=6(35%), postinfarct VSD Amplatzer n=5(30%), ASO n=4(24%), other (AVP II and PFO) n=2(11%). Device embolization occurred in only one patient (device was snared and retrieved) and a second occluder used. In group A, signi cant residual shunt was found in two cases; hence they were brought back to the lab to deploy a second occluder. No reintervention was required for patients in group B, mild to moderate residual shunt was present in 6 out of 9 (66%) patients. Early (<30 day) mortality was 0% in Group B and 62% (5 out of 8 patients) in Group A.
Conclusion: Transcatheter device closure of pMIVSD can be consid- ered a reasonably safe and e ective procedure in selected patients. Our series is consistent with previous experience reported in other series regarding high mortality in patients with cardiogenic shock despite intervention.
#0075
THE IMPACT OF TRANSCATHETER PULMONARY VALVE IMPLANTATION ON THE MANAGEMENT OF POSTOPERATIVE RIGHT VENTRICULAR OUTFLOW TRACT DYSFUNCTION
Catherine Tomasulo, Jeremy Asnes, Robert Elder, John Fahey, Gary Kopf, William Hellenbrand
Yale School of Medicine, New Haven, CT, USA
Pulmonary valve implantation (PVI) for pts with CHD has undergone revolutionary changes in recent years with the advent of transcath- eter therapies. Surgical and transcatheter procedure characteristics
and valve function were investigated in 172 consecutive pts referred for PVI (median weight 56.7kg [12.3-161.3]; median age 18.6 years [4.7-65.5]) from 2007 to 2016. Diagnoses included tetralogy of Fallot (126), PA/PS (IVS) (21), and other (25). Indication for PVI was PI in 107, PS in 31 and PS/PI in 34. The number of PVI procedures increased from 9 to 27 per year with the availability of transcatheter pulmo- nary valve implantation (TcPVI). Prior to the availability of TcPVI, 34 pts were referred for surgery. Of the next 138 pts, 101 were referred for TcPVI and 37 went directly to surgery. TcPVI was attempted and successful in 85/101. The remaining 16 were referred for surgical pul- monary valve implantation (sPVI) without any attempt to implant a percutaneous valve due to RVOT size (11), coronary or aortic com- pression (4) and conduit tear pre-PARCS (1). 8/11 pts referred for surgery due to RVOT size would have been candidates for the 29mm Sapien valve if it had been available. TcPVI was successful in 27/27 pts with a bioprosthetic pulmonary valve (BPV), 24/27 with homografts and 34/47 with transannular patch repair (TAP). A Melody valve was implanted in all pts with a BPV or homograft and in 22/34 TAP pts. The other 12 pts received a Sapien valve. In total, 53 pts were referred for surgery in the TcPVI era. The RVOT was too large for TcPVI (44), too small (4), coronary or aortic compression (4) and conduit tear (1); 2 declined surgery. Comparing TcPVI to sPVI in the same time frame, freedom from > mild PI is 84/85 (TcPVI) and 36/51(sPVI) p<.001; 4/51 sPVI underwent subsequent Melody valve implantation for PI. Obstruction developed in 1 pt in each group p=ns. A second Melody valve was implanted in the 1 TcPVI pt with obstruction. SBE occurred in 1/85 (TcPVI) vs 2/51 (sPVI).
Since the introduction of TcPVI, referrals for PVI have tripled and 63% have had a percutaneous approach. Pts treated with TcPVI have had better long-term valve function in comparison to sPVI over the same time period. Given the superiority of TcPVI and the ability to avoid repeat open heart surgery, earlier intervention to reduce the incidence of RV dysfunction and development of symptoms may be warranted.
#0076
THROMBOPROPHYLAXIS STRATEGIES FOR CHILDREN WITH SINGLE VENTRICLE CIRCULATIONS (SUPERIOR OR TOTAL CAVO-PULMONARY CONNECTIONS) AFTER STENT IMPLANTATION
Yinn Khurn Ooi, Michael Kelleman, Holly Bauser-Heaton, Dennis Kim, Robert Vincent, Christopher Petit
Emory University, Atlanta, GA, USA
Background: The most e ective thromboprophylaxis strategy after stent implantation in the superior or total cavopulmonary connec- tion (SCPC or TCPC) is unclear.
Methods: We reviewed our cardiac database over a 13-year period ending in 2015. Patients were divided into those who received aspi- rin (ASA) alone versus advanced anti-coagulation (AA), including warfarin, enoxaparin, heparin, or clopidogrel. Primary endpoint was presence of thrombus on advanced imaging, such as cardiac cathe- terization, CT-angiogram or MRI. Other endpoints included presence of thrombus on echocardiogram and bleeding complications.
Hijazi, Z
20th Annual PICS/AICS Meeting Abstracts