Page 55 - Journal of Structural Heart Disease Volume 2, Issue 6

Meeting Abstracts
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Material and Methods: This was an observational study in a cohort of infants with HLHS or variants. Data collection was retrospective. The bands were con gured from 3 mm EPTFE tubes at the initial procedure. Indication for balloon dilation included persistent hypox- emia (Sats < 70%) and increased gradients on echocardiography (> 60 mmHg). Balloon dilation was performed using 2.5 to 3.5 mm angio- plasty balloons. Measures of outcomes included increase in the min- imal diameter of the band, increase in sats, gradient reduction across the band on echo and appropriate timing of the Norwood Glenn operation.
Results: Between March 2012 and January 2016, out of 68 neonates who underwent the Hybrid procedure, 7 were diagnosed with tight PA bands and underwent dilation at 12 band sites. The median age and weight were 60 days and 2.9 Kg, respectively. Five had HLHS (2 had variants). Three patients needed additional interventions: atrial septostomy, new ductal stenting, stenting the vertical vein and arch stenting. Arrhythmias were observed in 3 patients and minor air emboli occurred in one patient with no deleterious e ects. There was no mortality. There was an increase in the minimal diameter from 0.8 ± 0.5 to 1.7±0.5 mm (p<0.001) and in the systemic saturation from 67±9 to 84±4% (p<0.001) One patient underwent a new dilation one month afterwards. In all patients the Norwood Glenn operation could be performed at an appropriate time at a median age of 6 months with no mortality. At surgery, there was a band fracture in just a single vessel. There were no lesions to adjacent vessels in any of the patients.
Conclusions: Balloon dilation of the PA bands after the Hybrid proce- dure was feasible, safe and e ective, resulting in clinical stabilization allowing performing the Norwood Glenn operation at an appropriate time. The mechanism of dilation is probably stretching of the eptfe, which may occasionally result in fracture. No signi cant trauma to the adjacent vessel was observed at surgery.
#0100
TECHNICAL FACTORS ARE ASSOCIATED WITH OUTCOMES FOLLOWING RIGHT VENTRICLE DECOMPRESSION FOR NEONATES WITH PULMONARY ATRESIA AND INTACT VENTRICULAR SEPTUM: RESULTS FROM A MULTICENTER COLLABORATIVE Christopher Petit1, Athar Qureshi4, Andrew Glatz2,
Michael Kelleman1, Courtney McCracken1, Allen Ligon1, Namrita Mozumdar2, Wendy Whiteside3, Asra Khan4, Bryan Goldstein3,
1Emory University School of Medicine, Atlanta, GA, USA 2Children’s Hospital of Philadelphia, Philadelphia, PA, USA 3Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA 4Texas Children’s Hospital, Houston, TX, USA
Background: Transcatheter right ventricle (RV) decompression in neo- nates with pulmonary atresia and intact ventricular septum (PA-IVS) is technically challenging, with risk of cardiac perforation and death. Further, despite successful RV decompression, repeat intervention (ReINT) on the pulmonary valve (PV) is common. The association between technical factors during RV decompression and the risk of complications and ReINT are not well described.
Methods: Multicenter retrospective study at the 4 member centers of the Congenital Catheterization Research Collaborative (CCRC).
Between 2005-15 all neonates with PA-IVS undergoing transcath- eter RV decompression were included. Technical factors evaluated included: use and characteristics of radiofrequency (RF) application, maximal balloon:PV annulus ratio (BAR), infundibular diameter, and RV systolic pressure pre- and post-valvuloplasty (BPV). Primary endpoint was cardiac perforation or death; the secondary endpoint was ReINT.
Results: 93 neonates underwent RV decompression at median 3d (IQR 2-5) of age, including 61 pts via RF perforation of the PV and 32 via wire perforation. There were 12 (13%) complications with 7 occurring in the rst 2 years of the 10 year study period. Complications included 8 (8.6%) cardiac perforations, of which, there were two deaths. Cardiac perforation was associated with the use of RF (p=0.047), RF duration (3.5 vs 2.0 seconds, p=0.02) and maximum RF energy (7.5 vs 5.0 Joules, p<0.01) but not with patient weight (p=0.09), PV diameter (p=0.23) or infundibular diameter (p=0.57). ReINT was performed in 36 patients including repeat BPV (n=25) or surgery (n=11). ReINT was associated with higher RV pressure (median 60 vs 50mmHg, p=0.041) and with residual valve gradient (p=0.046) post initial BPV, but not with BAR, atmospheric pressure used during BPV or the presence of a residual balloon waist during BPV. ReINT was not associated with any RV ana- tomic measurements, including PV annulus.
Conclusion: Technical factors surrounding transcatheter RV decom- pression in PA/IVS in uence the risk of procedural complications but not the future need for ReINT. Cardiac perforation is associ- ated with use of RF energy as well as RF application characteristics. Reintervention after RV decompression for PA-IVS is common, and appears related to nal gradient and RV pressure after initial BPV.
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ENDOCARDITIS ASSOCIATED WITH TRANSCATHETER PULMONARY VALVE IMPLANTATION: AN INSTITUTIONAL EXPERIENCE
Ashish Ankola, Julie Vincent, Matthew Crystal,
Mariel Turner, Alejandro Torres1
Columbia University Medical Center, New York, NY, USA
Objective: Transcatheter pulmonary valve (TPV) implantation has become a viable therapy for right ventricular out ow tract (RVOT) dysfunction. While rare, infective endocarditis (IE) following TPV has been reported. In this study, we describe our center’s experience with IE after Melody TPV (Medtronic, Minneapolis, MN).
Methods: Single-center retrospective review of pts who underwent TPV implantation with Melody valve from 2007-2014. IE was de ned using the modi ed Duke’s criteria.
Results: A total of 85 pts underwent TPV implantation during the study period, of which 12 (14%) developed IE. Median time to the develop- ment of IE was 32 months (range 2-100). 2 pts had a history of IE and 2 of IV drug abuse. One pt was diagnosed with severe gingivitis prior to IE. Seven pts were on ASA at the time of IE. Compliance with SBE prophylaxis was documented in only 2 pts at the time of IE. Baseline RVOT anatomy in IE pts included homografts in 8 pts, prosthetic PV in 2 and direct RV-PA anastomosis in 2. Stenting prior to TPV implantation was performed in 8 (67%) pts. There was no signi cant di erence in demographics, type of RVOT reconstruction, pre-stenting, and residual RVOT gradient after TPV implantation between IE and non-IE pts. Eleven pts were febrile at presen- tation. Eight pts (67%) presented with RVOT obstruction, 5 of which had a
Journal of Structural Heart Disease, December 2016
Volume 2, Issue 6:241-306