Page 74 - Journal of Structural Heart Disease Volume 2, Issue 6

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Meeting Abstracts
Background: Classically, transcatheter closure of membranous and muscular out ow ventricular septal defects (VSD’s) has involved device deployment from the venous side following creation of an arteriovenous (AV) loop. This may be time-consuming and lead to hemodynamic instability particularly in small infants. We report our recent experience with transcatheter VSD device delivery via a direct retrograde left ventricular approach.
Methods: Peri-procedural and follow-up analysis of patients under- going retrograde VSD closure between November 2014 and October 2016 from two tertiary referral centres was carried out.
Results: 22 patients (16 paediatric, 9 female) with a median age 7.5 years (range 6 months to 59 years), median weight 24.3kg (range 6kg to 80kg) underwent retrograde transcatheter VSD closure. Nineteen VSDs were perimembranous, two were muscular and one case involved an LV to RA shunt. The median VSD diameter was 6mm (range 3.5mm to 11mm). Indications for closure included left ventric- ular volume overload (n=13), failure to thrive (n=2), previous bacte- rial endocarditis infection (n=2), haemodynamically signi cant (n=2), symptomatic (n=2) and left ventricular dysfunction (n=1). A variety of closure devices were used including Lifetech Symmetric Membranous (n=12), Amplatzer Ductal Occluder II (n=5), Lifetech Asymmetric Membranous (n=3), Amplatzer muscular (n=1), Lifetech Muscular (n=1) and Lifetech Eccentric Membranous (n=1). Mean uoroscopy time was 15.6mins (range 5.6 to 33.2 minutes). Device delivery was successful in all cases. In one patient, the device prolapsed through the VSD during an antegrade AV loop approach. The retrograde approach was then successfully used to close the defect with a larger occluder. Immediate complete closure was seen in 15 cases with trivial to mild leak seen in the remaining 7 patients. There was no increase in the pre-procedural grading of aortic incompetence. One patient developed intermittent junctional rhythm within 24 hours however this resolved sponta- neously. At median follow-up of 2.1 months (range 1.25 to 7 months), all patients were well. There were no rhythm abnormalities seen at fol- low-up. Trivial to mild residual leaks remained in four patients.
Conclusions: Retrograde transcatheter VSD closure is safe and e ec- tive and may avoid some of the technical challenges associated with creation of an arteriovenous loop.
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CLASSIFICATION SCHEME FOR DUCTAL MORPHOLOGY IN CYANOTIC PATIENTS WITH DUCTAL DEPENDENT PULMONARY BLOOD FLOW AND INFLUENCE ON OUTCOMES OF PATENT DUCTUS ARTERIOSUS STENTING
Athar M. Qureshi1, Bryan H. Goldstein2, Andrew C. Glatz3, Hitesh Agrawal1, Varun Aggarwal1, R Allen Ligon4, Courtney McCracken4, Alicia McDonnell3, Timothy M. Buckey3,
Wendy Whiteside2, Christina M. Metcalf2, Christopher J. Petit4 1The Lillie Frank Abercrombie Section of Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA 2The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
3The Cardiac Center at the Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA 4Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
Introduction: Stenting of the patent ductus arteriosus (PDA) in cya- notic patients (pts) with ductal dependent pulmonary blood ow (PBF) can be technically challenging. The purpose of this study was to devise a classi cation scheme for ductal morphology in this pop- ulation and to evaluate its association with outcomes of PDA stent implantation.
Methods: Between 2008-15 all pts < 1 yr of age who underwent PDA stenting for PBF at the 4 centers comprising the Congenital Catheterization Research Collaborative (CCRC) were included. A clas- si cation scheme for PDA morphology was devised based on tortuos- ity index (TI) (1-mild: relatively straight, II-moderate: 1 turn, III- severe: >1 turn); and curvature index (CI) based on the entire length of the PDA including all curves (L1) and the direct distance between aortic and pulmonary artery (PA) insertion of the PDA (L2), with CI= (L1– L2)/L1. Primary outcome was reintervention to treat cyanosis (RI) and secondary outcomes included procedure time, branch PA jailing, and subsequent surgical PA plasty.
Results: 107 pts underwent PDA stenting in whom the TI was type I (n= 61, 57%), type II (n=23, 21%) and type III (n=23, 21%). Pts with a higher CI had greater discrepancy between the pre-intervention PDA length and ultimate stented PDA length (r = 0.3; 95% CI 0.11-0.47). 46
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(41%) pts required RI, which was less common in pts with TI of I versus
II/III (34% vs. 50%, p=0.1). Procedure times did not di er based on TI or CI. Partial (n=18) and complete (n=4) PA jailing occurred in 22 pts. Higher TI and CI were associated with PA jailing (p < 0.01 for both). PA plasty was performed in 65 pts (61%) at time of subsequent surgi- cal repair, with no di erence in risk based upon presence or absence of a jailed PA (p=0.17).There were 14 (13.1%) complications and no mortality.
Conclusions: We devised a classi cation scheme based on qualitative and quantitative measures of PDA morphology that may be helpful in anticipating outcomes in cyanotic pts undergoing PDA stenting. PDA stenting is achievable even in highly tortuous PDAs, although those with higher TI had greater RI rates and those with higher TI and CI were associated with higher risk of branch PA jailing, and greater discrep- ancy between measured PDA length and ultimate stented PDA length. Despite this, PA plasty was not more common in pts with PA jailing.
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USE OF THE SAPIEN S3 VALVE FOR TRANSCATHETER VALVE REPLACEMENT IN CONGENITAL HEART DISEASE: A MULTI-INSTITUTIONAL EXPERIENCE Sanjay Sinha1, Morris Salem4, Jamil Aboulhosn1, Evan Zahn2, Bryan Goldstein3, Daniel Levi1
1UCLA, Los Angeles, CA, USA
2Cedar Sinai, Los Angeles, CA, USA
3Cincinnati Children’s Hospital, Cincinnati, OH, USA
4Kaiser Permanente, Losa Angeles, CA, USA
Objectives: To describe a multi-center experience and techniques used for percutaneous transcatheter pulmonary valve replacement (TCPVR) using the Edwards SapienTM S3 Valve.
Background: O -label use of the Sapien S3 valve can allow for large diameter transcatheter valve replacement in patients with congenital
Hijazi, Z
20th Annual PICS/AICS Meeting Abstracts