Page 39 - Journal of Structural Heart Disease Volume 3, Issue 3

Meeting Abstracts
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CLINICAL PROFILE, PROCEDURAL OUTCOME AND SHORT TERM FOLLOW UP OF PATIENTS UNDERGOING ENDOVASCULAR STENTING FOR COARCTATION OF AORTA
Sreeja Pavithran, Lakshmi Sadasivan, Kumar Sivakumar
Madras Medical Mission ,Chennai, India
Background: Endovascular stenting is considered the preferred option in managing coarctation of aorta in older children and adults. Covered stents are used in selected or high risk catergory of patients.
Aims: To study the clinical pro le, procedural outcome and short term follow up of patients undergoing endovascular stenting of coarcta- tion of aorta.
Methods: Between May 2013 and November 2016, 26 patients who underwent stenting of coarctation of aorta were retrospectively analyzed.
Results: 26 patients (eight females) aged 1-54 years (median 29), weighing 7.8 -86.4 kg (median 55.1), underwent stenting of COA. All except one had post-subclavian coarctation. 70% of patients had hypertension and were on treatment. Mean gradient at catheter- ization was 69.2 ± 29.4 mmHg and mean gradient post-procedure was 3.5 ± 4 mmHg. A total of 27 stents were deployed, Covered CP (17), Cook Formula (1), Advanta V12 Atrium (2), Intrastent Mega (3), Palmaz (2),Andrastent (1), Bare CP (1). Covered stents were used in 59.1%. The mean stent length and balloon diameter were 34.73 ± 11.56 mm and 16.3 ± 2.42 mm respectively. Pre-dilatation was done in two patients including one with near interruption. Post dilatation was needed in 35% of patients. Procedural complications included dissection in one patient needing a second covered stent and right femoral artery occlusion in another. Retroperitoneal hemorrhage in one resulted in mortality. Follow-up ranged from 1 month to 3.5 years. 36.4% required continuation of antihypertensive therapy even after stenting. Re-dilatation was required in 1 patient with pre-sub- clavian coarctation.
Conclusion: Stent implantation is a safe and e ective alternative to surgical repair in COA. It provides immediate and near complete relief of pressure gradient which is sustained on short-term follow up. Systematic long-term follow up is required to look for restenosis, aneurysm formation and persistent systemic hypertension.
INITIAL PALLIATION OF TETRALOGY OF FALLOT: COMPARISON BETWEEN BT SHUNT AND RVOT STENT G. Penford, D. Quandt, B. Ramchandani, J. Stickley, C. Mehta, V. Bhole, O. Stumper
Birmingham Children’s Hospital, UK
Background: Neonatal repair of symptomatic infants with Fallot-type (ToF) lesions remains the excep-tion in the UK. Initial palliation can be achieved by creation of a BT shunt, or RVOT stenting.
Aims: To compare the outcome of BTS and RVOT stent in the pallia- tion of TOF.
Methods: 10 year retrospective review of the outcome of 101 ToF patients who required initial pal-liation (RVOT stent n=60 ; BTS n=41) prior to complete repair. Detailed assessment of PA growth in patients with comparable underlying anatomy.
Results: In the RVOT stent group vs the BT shunt group, there was a lower PICU admission rate (22% vs 100%) [p<0.001], a lower early mortality (1.7% vs 4.9%] [ns], a shorter initial hospital stay (7 vs 14 days) [p<0.004], and a shorter time to surgical repair (232 vs 428 days) [p<0.001]. In terms of PA growth after palliation, the bene t of RVOT stenting ver-sus mBTS was +0.599 z-score for the LPA and +0.749 z-score for the RPA. Rise in oxy-gen saturations was greater with RVOT stenting (p=0.012). There were 3 non-cardiac deaths in the RVOT stent group and none in the BTS group. There were no deaths after correction, and comparable bypass times and rate of transannu- lar patching / conduit use. Overall mortality was comparable (8.4% vs 4.9%) [p = 0.69].
Conclusions: RVOT stenting is a safe and e ective palliation in the initial treatment of infants with symptomatic Fallot-type lesions and provides superior growth of the pulmonary arteries.
FACTORS ASSOCIATED WITH COMPLICATIONS DURING TRANSCATHETER CLOSURE OF PATENT DUCTUS ARTERIOSUS IN HASAN SADIKIN GENERAL HOSPITAL, BANDUNG, INDONESIA
RiesmaViovica Sari, Gadih Ranti Endamatriza, Chaerul Achmad, Rahmat Budi Kuswiyanto, Muhammad Rizki Akbar, Augustine Purnomowati, Toni Mustahsani Aprami Universitas Padjadjaran / Hasan Sadikin General Hospital, Bandung, Indonesia
Background: Patent ductus arteriosus (PDA) forms about 5-10% of congenital heart diseases (CHD). PDA was the rst example of CHD to be treated by transcatheter closure, which becomes an established form of treatment for the majority of patients with PDA and as a safe alternative to surgery.
Objective: This study is designed to determine factors that can pre- dict the likelihood of incidence of all complications of transcatheter closure of PDA.
Methods: This was a retrospective cohort study. Pediatric patients with PDA who had a successful transcatheter closure were studied. Transcatheter closure report found at Diagnostic Invasive Division, Hasan Sadikin General Hospital from January 2014 to May 2016 were collected (n=114). Reports with incomplete data were excluded from the study. Multivariable logistic regression was used to identify pre- dictors of complications of trancatheter closure of PDA.
Results: A total of 98 patients were enrolled in this study. There were 18 patients (18.4%) experienced complications of trancatheter pro- cedure. Complications were seen more in those with type C defect (30.8%). The multivariate analysis shows that the size of ampulla and male gender were associated with incidence of complications of tran- catheter closure of PDA (OR= 1.26; 95% CI: 1.01-1.56 and OR= 4.38; 95% CI: 1.32-14.45).
Conclusions: In our center, the size of ampulla and gender are inde- pendent risk factors for the incidence of complications of trancathe- ter closure of PDA.
Journal of Structural Heart Disease, June 2017
Volume 3, Issue 3:73-95