Page 46 - Journal of Structural Heart Disease Volume 2, Issue 6

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Meeting Abstracts
Introduction : Since 10 years the MelodyTM valved stent is used for percutaneous pulmonary valve replacement (PPVR) with over 10.000 implants worldwide. It has been proven to be a safe and e ective intervention. The main risk factors of the valve compared to surgical alternatives are stent fractures with subsequent valve dysfunction and endocarditis. Most biological valves have limited long term pre- served function requiring redo interventions.
Aim : evaluation of the valve function and its risks from a prospective ongoing registry
Patients and methods : all data are collected from the Belgian registry which started in 2006. Follow-up data are prospectively and ongoing collected. 97% are pre-stented in this cohort. The analyzed data : leaf- let function by means of echocardiography, re-interventions, mortal- ity, endocarditis (Duke’s criteria) and stent fractures by means of X-ray. Data presented is single center experience.
Results : 159 valves have been implanted 2006-2016. The indication was stenosis 44.0%, regurgitation 33.3% and mixed 22.6 %; male/ female ratio was 2:1, the mean age at implant was 19.6 y (3.5 – 81.6). Original conduit diameter was median 22 mm (10-26 mm).
1. Overall survival was 98 % at 10 years, there were no procedural or valve related deaths.
2. Endocarditis occurred in 9.4% (15/159) with a freedom from endo- carditis of 78% at 10 y. The maximal annual incidence of endocarditis was 3.3% in 2015. Mean time of occurrence of endocarditis was 2.4 y (0.7 – 8.9) after implant. Mean age at endocarditis was 18.2 y (8.1 – 45.6), male 87%.
3. Chest X-ray was performed in 87 % of the patients showing a stent fracture in 8 % median 2.9 y (0.4 – 6.9) after implant. None of the fractures led to hemodynamic problems and no re-intervention was necessary.
4. Re-intervention overall 11 % : explantation of valve in 4.4% (endo- carditis n= 6, residual subvalvular stenosis n=1); balloon dilation due to somatic growth in 5 % and 1.9 % received second PPVR (post endocarditis).
5. Valve function: a/ indication PS : mean PS 65 mmHg (SD 17) at implant drops to 23 mmHg (SD 11) post implant and is 37,5 mmHg (SD 17) 10 y later. B/ Indication PR : median 4/4 at implant drops to 0/4 post and is 2/4 at 10 y follow-up.
Discussion : Ten year follow-up of the MelodyTM valved stent shows good long term preservation of the valve function with current no replacement for intrinsic valve dysfunction. No hemodynamic import- ant stent fractures occur since the pre-stenting era. Acceptable risk of endocarditis remains in male young adult patients.
#0079
PERCUTANEOUS DOUBLE VALVE IMPLANTATION
IN A GROWN-UP CONGENITAL HEART WITH DEGENERATED HOMOGRAFT IN BOTH AORTIC AND PULMONIC POSITION.
Joelle Kefer, Sophie Pierard, Jean Renkin, Thierry Sluysmans Cliniques universitaires Saint-Luc, Brussels, Belgium
This is the case of a 43 yr-old male with a truncus arteriosus who underwent three previous cardiac surgeries : - 1972 : pulmonary banding; - 1979 : prosthetic valved tube between right ventricle and pulmonary artery + aortic valve prosthesis (Bjork)+VSD closure; - 1991: homograft EHB 22 mm in pulmonic position, homograft EHB 22 mm in aortic position replacing the Bjork prosthesis. He was admit- ted in April 2016 in the intensive care unit for a severe heart failure. Echocardiograpy showed a severe aortic regurgitation, a pulmonic valve stenosis, enlarged and poor function of right and left ventricles. Diagnostic cardiac catheterization showed a heavy calci ed and ste- notic (minimum diameter : 10 mm; RV-PA gradient : 44 mmHg) pul- monic homograft ; the aortic homograft was severely calci ed, had a free regurgitation(grade 4).Angio showed a pseudoaneurysm of the left ventricular out ow tract, an abnormal origin of the coronary arteries and an occlusion of the right femoral artery. Because of the hostile chest and the very high Euroscore, the heart team decided to attempt a percutaneous valvular treatment on this grown-up con- genital heart. The plan was to begin with the aortic valve which was the main problem of the patient and to do pulmonic replacement in a stage procedure.TAVI was challenging in this case because of the severe regurgitation of the degenerated homograft without any pre- cise annular plane, with heavy calci cations and a tortuous shape ; in addition, the pseudo-aneurysm of the LVOT was a risk factor for para- valvular leak at this level and the abnormal origin of coronary arteries was a potential danger for occlusion in case of suboptimal valve posi- tionning. Finally, the right femoral artery occlusion was also an issue. Despite all these limitations, an Evolut-R 26 mm was deployed by the left femoral artery without any residual leak, improving immediately the aortic regurgitation and the hemodynamics of the patient. This second generation device is a recapturable and repositionable device allowing an evaluation of the result before nal release, adjusting if needed to achieve a nal accurate positioning. After a short period of recovery, the pulmonic homograft will be replaced by a Melody valve in a few weeks. In conclusion,this case illustrates how struc- turalinterventional cardiology can o er an e ective treatment in grown-up congenital heart with contra-indication for repeated com- plex surgeries.
#0080
THE DETERMINATION OF HYPERTENSION PERSISTENCE IN CHILDREN WHOSE AORTIC COARCTATION WERE TREATED WITH CP STENT
Ali Baykan, Ayse Demiraldi, Nazmi Narin, Kazim Uzum, Özge Pamukcu
Erciyes University Medical Faculty Dept. of Pediatric Cardiology, Kayseri, Turkey
Objective: Recent studies reveal that hypertension and cardiovascular diseases are more prevalent in patients with Aortic coarctation (AC), even it is treated. Our aim is to address presence of hypertension and risk for cardiovascular diseases in patients with stent applied AC by using data from ambulatory blood pressure monitorization (ABPM)/ arteriography, echocardiography and radiological and biochemical evaluations.
Material and method: Twenty stented pediatric patient and 20 age- and sex-matched controls were enrolled. Physical examination ndings and ECG data were recorded. Echocardiography performed
Hijazi, Z
20th Annual PICS/AICS Meeting Abstracts