Page 54 - Journal of Structural Heart Disease Volume 2, Issue 6

281
Meeting Abstracts
recognized precursor to mortality in patients with cyanotic congen- ital heart disease and SP shunt dependence. Surgical clamp injury with resultant vascular stenosis of a supplying artery proximal to the SP shunt may mimic restrictive shunt physiology without evidence of SP shunt pathology.
Methods: Single-center case series from 1/2012 to 7/2016. All cases with SP shunt dependent physiology involving balloon angioplasty of a systemic artery were evaluated for inclusion. Cases without angiographic stenosis of a supplying artery were excluded.
Results: Eight cases were performed in 6 patients (50% female) with median age of 94 days (IQR 71, 144) and weight of 5.0 kg (3.75, 6.2). The predominant cardiac diagnosis was hypoplastic left heart syndrome (67%). The primary interventional indication was desaturation (75%) with a median pre-cath arterial SaO2 of 71% (66, 72). The vascular obstructions presenting as restrictive shunt physiology were proximal to the shunt origin and located at the innominate artery (67%), the right subclavian artery (17%) and the right common carotid artery (17%). In 50% of cases, a second vas- cular stenosis was present immediately distal to the origin of the SP shunt. In all cases, balloon arterioplasty of the proximal lesion was performed with an increase in median minimal luminal diam- eter from 2.4 (1.5, 2.9) to 3.5 mm (3.2, 4.0), or a median increase of 52% (30, 92) over the baseline diameter. No stents were placed. No patients had SP shunt stenosis or underwent transcatheter inter- vention on the SP shunt or branch pulmonary arteries. Following intervention, arterial SaO2 increased to a median of 76% (76, 80). There were no procedural complications. 2 patients (33%) underwent repeat arterioplasty due to recurrent desaturation. All patients survived to stage II surgical palliation, but there were 3 mortalities (50%) by 18 months of age.
Conclusions: Surgically associated vascular injury to the arterial supply of an SP shunt can mimic restrictive shunt physiology without pathology of the SP shunt itself. Balloon arterioplasty is safe and effective in improving SP shunt and pulmonary blood flow. This cohort may be at increased risk for mortality in the medium term.
#0098
REFRAMING THE STS STAR RATING SYSTEM:
A HEART CENTER PERSPECTIVE
Raghav Murthy, Kanishka Ratnayaka, Howaida El-Said, John Moore, John Lamberti
Rady Children’s Hospital, San Diego, CA, USA
Background: STS-CHSD is the largest clinical database in the world for congenital and pediatric cardiac surgery. The STS Star Rating system is based on STAT complexity categorization and mortality (increasing number = increasing complexity). Institutional car- diac catheterization volume, complexity, and outcomes are not incorporated.
Methods: We reviewed our institutional data from the 23rd harvest of STS-CHSD and included institutional cardiac catheterization data to evaluate scoring from the perspective of a comprehensive Heart Center.
Results: Inclusion of institutional cardiac catheterization data improved STAT 1 [device closure (ASD, VSD, PDA), percutane- ous pulmonary valve implantation], STAT 2 [Coarctation balloon and/or stent angioplasty] and STAT 4 [RVOT stents, PDA stents, PV ballooning, adjustable PA band] reporting in this single center report.
Conclusions: Inclusion of cardiac catheterization data with traditional institutional cardiovascular surgical data may o er a more compre- hensive STS Star rating system.
#0099
FEASIBILITY, SAFETY AND EFFICACY OF BALLOON DILATION OF PULMONARY ARTERY BANDS AFTER THE HYBRID PROCEDURE FOR HYPOPLASTIC LEFT HEART SYNDROME AND VARIANTS
Natália Jatene, Simone Pedra, Marcelo Jatene, Fabiana Succi, Patrícia Oliveira, Rodrigo Costa, Marcelo Ribeiro,
Carlos Pedra
Hospital do Coração, São Paulo, SP, Brazil
Background: The Hybrid approach has been applied as an initial pal- liative procedure for neonates with hypoplastic left heart syndrome (HLHS) and variants. Precise adjustment of the pulmonary artery bands is crucial. Excessive constriction may result in severe hypoxemia in the post-operative period. Management of such patients is still unclear. We sought to determine the feasibility, safety and e cacy of balloon dila- tion of the pulmonary artery bands after this Hybrid procedure.
Overall 27/1659 1.6%
Table 1 (#0098).
BASELINE
#/Eligible
Observed
Distribution
+CATH
#/Eligible
New observed
Distribution
Overall STAT 1 STAT 2 STAT 3 STAT 4 STAT 5
27/1159 2.3% 1/288 0.3% 4/356 1.1% 1/148 0.7%
19/327 5.8% 2/40 5%
24.8% 30.7% 12.7% 28.2% 3.4%
STAT 1 1/546 STAT 2 4/399 STAT 3 1/148
STAT 4 19/526
STAT 5 2/40
0.2% 32.9% 1% 24.1%
0.7% 8.9% 3.6% 31.7% 5% 2.4%
Hijazi, Z
20th Annual PICS/AICS Meeting Abstracts