Page 103 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
Background: Surgical ligation was previously the tradi- tional method of patent ductus arteriosus (PDA) closure in small infants, but recent studies have demonstrated suc- cessful transcatheter PDA closure to be equivalent in safety and efficacy, without the morbidities of surgical ligation. Early and midterm complications of transcatheter closure in this patient population have been reported, including left pulmonary artery (LPA) stenosis and coarctation of the aorta. The longer-term outcomes of PDA closure in this population, including whether LPA stenosis and aortic coarctation caused by the device persist or improve with time/growth have not been evaluated.
Methods: This is a single-center retrospective cohort study including all patients who underwent transcathe- ter PDA closure at weight ≤4 kg between February 2007 and September 2018. Patients with significant co-exist- ing congenital heart disease were excluded. Patient and procedural characteristics were collected, as well as the long-term outcomes and complications, with a focus on post-procedural LPA and aortic obstruction.
Results: Forty-four patients were included. Median birth- weight, gestational age, and procedural weight and age were 0.89kg (0.49-3.25), 27.1 weeks (23–40), 2.8kg (1.2– 4.0), and 2.9 months (0.5-6.6), respectively. Thirty patients underwent transcatheter PDA closure with an AVP2, ten with an ADOII-AS, three with an ADO1 and one with an AVP filled with three coils. All devices were placed using an antegrade approach. Arterial access was obtained in 26/44 patients, though in only 3/17 patients since 2017. Complete PDA closure occurred in all thirty-nine patients assessed with post-procedural echocardiograms at median fol- low-up 0.7 years (2 days-7 years). Thirty-eight patients had post-procedural echocardiograms assessing flow accelera- tion in the LPA and descending aorta. Seventeen (45%) had flow acceleration in the LPA, which resolved in seven by last follow-up, five had decreased flow acceleration, with only mild flow acceleration at last follow-up (1.51-2.0m/s), two had unchanged mild flow acceleration (1.8m/s) with only short-term follow-up and three had flow acceleration (1.54, 2.08, 2.5m/s) assessed only on one echocardiogram. Three patients developed mild flow acceleration in the descend- ing aorta (1.75-1.8 m/s), which resolved by last follow-up. Four patients developed mild coarctation (2.3-3.0m/s), which improved in two (1.7, 2.3m/s), and the remaining two had only short-term follow-up. Seven patients devel- oped femoral vascular thromboses and 6/7 resolved with medical therapy. One patient had respiratory decompen- sation prior to intervention; there were no other proce- dural complications. There was no procedural mortality or need for PDA related reintervention. 41/44 patients were
admitted to the ICU; seven remain inpatient, nine trans- ferred to another NICU, four died prior to discharge and the other twenty-one had a median discharge time of fifty-one days (5-128) post-procedure. 38/44 patients returned to pre-procedure respiratory support at a median of nine hours (0-339.5). Thirty-one patients are known to be alive at the end of the study, four are followed by an outside cardiologist, three were lost to follow-up, and six had late mortality unrelated to the PDA.
Conclusion: Transcatheter PDA closure in small infants is effective, without significant long-term complications or need for reintervention. LPA and aortic obstruction caused by the device can improve with time/growth.
135. IMPLANTATION OF THE EDWARDS SAPIEN-XT AND S3 VALVE FOR PULMONARY POSITION IN NATIVE LARGE RIGHT VENTRICULAR OUTFLOW TRACT
Alper Guzeltas, Ibrahim Cansaran Tanidir, Murat Sahin Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey
Introduction: Transcatheter Pulmonary Valve Replacement (tPVR) into the right ventricular to pulmonary artery con- duits is being increasingly performed. But there are few options for patients with native and dilated right ventricu- lar outflow tracts (RVOT). An option for these patients is off label use of Edwards Sapien® valve. We aimed to review the outcomes for the SAPIEN-XT and S3 valves for pulmonary position in patients with dilated and native RVOT.
Method: Between Janurary 2015 and November 2018, totally 80-90 edwards ve melodiler var tPVR procedures were performed. Among them 48 (%) had native RVOT. Retrospective analysis was performed for all patients to have undergone PPVI using the SAPIEN-XT or S3 valves with native RVOT.
Results: The procedural success was 46/48 (96%). Median age and weight of the remaining patients were 19 (8-46 years) and 56 (22-102) kg, respectively. Primary underly- ing diagnosis was tetralogy of Fallot (n=40/46). Stenting was performed simultaneously with tPVR in 17/46(37% and 5 of them hybrid) cases whereas pre-stenting was performed 4 to 14 weeks earlier in 29/46 patients. Before tPVR median antero-posterior and lateral sizes of the stents were 27.5(23-32) mm and 28(21-32) mm, respectively. Valve sizes were XT-26 mm (n=6), XT-29 mm (n=33) and S3-29mm (n= 7). In 27 patients additional 1-5 ml (median 3ml) volume was added to the valves’ balloon for stabili- zation. Five of the patients underwent hybrid procedure. In all hybrid procedures stent and valve implanted in the
Hijazi, Z
22nd Annual PICS/AICS Meeting