Page 63 - Journal of Structural Heart Disease Volume 2, Issue 6

Meeting Abstracts
290
Methods: Retrospective descriptive review of early use of the CardioMEMS® monitoring system in pts with complex CHD. Clinical and procedural data were reviewed from 2 IRB approved studies.
Results: From 5/2015-8/2016, 8 pts (4 male) underwent catheteriza- tion with the intent to implant a CardioMEMS® device. Median age: 36.7 yr (20.8-43.8); median wt: 68.1 kg (52.4-79). Diagnoses: sin- gle ventricle s/p Fontan - 5, D-TGA s/p Mustard – 3. NYHA class: III - 7, IV – 1. Recent CHD-related admission in 7; 2 awaiting transplant. Procedural details: Standard right heart catheterization; 5 with gen- eral anesthesia, 3 with deep sedation. Vessel access for device deliv- ery: RFV – 7, RIJV – 1; delivery sheath 11-12 Fr; device implant site: LPA – 7, RPA – 1. Concomitant procedures: LPA stent – 2, collateral vessel occlusion – 1. Successful sensor calibration and transmission of PAP in all prior to procedure completion. No procedural complica- tions. All Fontan pts were discharged on warfarin; others were placed on clopidogrel and aspirin. In follow-up, all have successfully trans- mitted diagnostic quality PAP tracings. Interference with a previously implanted loop recorder was encountered in 1 pt with subsequent loop recorder explantation. There has been no evidence of thrombus formation. There have been 2 deaths in the group, unrelated to the procedure/device.
Conclusions: Implantation of the CardioMEMS® sensor is safe and feasible in adult pts with HF secondary to complex CHD. Sensor cali- bration is feasible and accurate in a non-pulsatile Fontan circulation and ambulatory transmitted recordings are comparable to those obtained at implant catheterization. Continued follow-up is needed to determine the impact on clinical management. This technology has the potential to provide previously unknown insight into single ventricle ambulatory physiology.
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THE ROLE OF TEVAR IN THE MANAGEMENT OF ADULTS WITH COARCTATION OF THE AORTA Jonathan Ginns, Melissa Argenio, Francesca Prandi, Alejandro Torres
Columbia University Medical Center, New York, USA
Objectives: The purpose of this study was to review the utility of thoracic endovascular aortic repair (TEVAR) in adults with coarctation of the aorta.
Background: Adults with coarctation of the aorta or recoarctation may have complex anatomical substrates with recurrent obstruction or other complications including aneurysm or pseudoaneurysm for- mation, making traditional stenting procedures less than ideal.
Methods: Retrospective chart review was performed of all coarcta- tion patients who had undergone TEVAR between 5/12 and 2/15 at our institution.
Results: Five patients with coarctation of the aorta underwent TEVAR. Mean age was 53 ± 13 years. Two patients had bicuspid aortic valve (one with asymptomatic severe aortic stenosis) and one had previous multives- sel PCI. Two patients had native coarctations and 3 were previous subcla- vian ap repairs of coarctation. Indications for stenting included complex native coarctation with adjacent aneurysms in 2 patients, recurrent coarc- tation with repair related aneurysm in 2 and pseudoaneurysm formation
soon after subclavian ap repair in 1. All procedures were performed in the catheterization laboratory. Two patients underwent TEVAR alone and 3 underwent hybrid procedure combining TEVAR with vascular bypass sur- gery (carotid to left subclavian in 2, aorta to left common carotid in 1). Three types of endovascular stent grafts were utilized: the Gore TAG Thoracic Endoprosthesis was implanted in 2 patients, Cook Zenith TX2 in 2 and Medtronic Valiant in 1. Successful deployment was achieved in all patients. Balloon dilation of the stent graft after implantation was performed in 3 patients. Minimum aortic diameter increased from 1 ± 0.4 cm preopera- tively to 1.8 ± 0.3 cm (p=<0.05). Mean blood pressure gradient between upper and lower extremities was reduced from 37 ± 18 to 7 ± 11 mmHg (p=<0.05). The number of antihypertensive medications in all patients decreased or was eliminated, mean 2.8 (range 1-6) pre to 1.4 (range 0-3) post. No major bleeding, femoral artery injury or other early procedural complications were encountered. However, 2/3 vascular bypasses had late thrombosis with transient arm ischemia in 1 and neurologic ischemia in 1.
Conclusions: Complex native or recurrent coarctation of the aorta with large anureurysm/pseudoaneurysm can be safely and e ec- tively managed by TEVAR in selected patients. These procedures are a viable alternative to cardiac surgery.
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THE USE OF BIORESORBABLE VASCULAR SCAFFOLD (ABSORB) IN RESCUE TREATMENT OF VASCULAR INJURY OF EXTERNAL ILIAC ARTERY IN TWO CHILDREN UNDERGOING INTERVENTIONAL CARDIAC CATHETERIZATION
Iyad Al-Ammouri, Tareq Goussous, Omar Obedat
The University of Jordan, Amman, Jordan
Bioresorbable vascular sca old (ABSORB, Abbott Vascular, Santa Clara, California) has been recently approved as a treatment alterna- tive for coronary artery disease. Use of bioresorbable technology has long been thought to have a theoretical advantage in children, where stented vessel may retain their growth potential. We report the use of bioresorbable stents as rescue procedure in two children with arterial vascular injury during cardiac catheterization.
Two girls, age 9 and 13 year old, who underwent interventional cardiac catheterization for a large PDA, and severe aortic stenosis, respectively, had dissection with near total occlusion of the right external iliac artery. In the rst child, dissection occurred after retrieval of an embolized PDA occluder device, and the second child with withdrawal of a large balloon that failed to be withdrawn into the arterial sheath. Both children were treated with a 4 mm Absorb stent with excellent immediate results. In one child, follow up angiography done at the time of a subsequent car- diac catheterization for 2 months after the stent showed patent vessel with mild narrowing at the site of stent, no reintervention was done due to absence of clinical symptoms. Further clinical follow up 6 months after the stenting showed no symptoms with normal distal pulses. In the other child there were no symptoms of vascular occlusion, and distal pulses were normal at the time of discharge, with planned follow up.
Conclusion: We report the use of Bioresorbable stents as a rescue treatment in two children with arterial injury with good immediate results. The theoretical bene t of retaining the potential for growth in stented vessels need to be validated.
Journal of Structural Heart Disease, December 2016
Volume 2, Issue 6:241-306