Page 111 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
(MA) to TAVR with conscious sedation rather than general anesthesia has gained widespread popularity due to its impact on safety, resource utilization, and patient satisfac- tion. Up to this point, there has not been reported expe- rience with MA TPVR. We are reporting three TPVR cases performed with local anesthesia and conscious sedation.
Methods: This case series is a descriptive report of three consecutive TPVR cases performed at a single institution between September 2018 and May 2019. Cases were identified from a registry of TPVR cases. All MA cases were included. Demographic, comorbid, and procedural charac- teristics were recorded retrospectively.
Results: All cases were successful. The indications for TPVR were broad, including: prosthetic pulmonic stenosis (PS) in a patient with Tetralogy of Fallot, torrential pulmonic insufficiency and RV dysfunction in a patient with history of pulmonic valvulectomy, and severe PS in the setting of carcinoid heart disease. All TPVR were performed with a SAPIEN 3 transcatheter valve (Edwards Lifesciences, Irvine, CA). Conscious sedation was used in all cases with a median dose of 100mcg (IQR 175mcg) of fentanyl and 4mg (IQR 7mg) of midazolam. The interventional cardiologist controlled sedation in all cases. There were no respiratory emergencies or intubations. Median procedure time and hospital length of stay were 119 minutes (IQR 90 min) and 3 days, respectively. We observed a 100% 30-day survival rate.
Conclusions: Our initial experience with MA TPVR in lieu of general anesthesia includes three successful procedures without complication. Further investigation in a larger cohort is needed to ensure safety.
144. CARDIAC PERFORATION IN CATHETER PROCEDURES FOR CONGENITAL HEART DISEASE; A 10 YEAR RETROSPECTIVE OBSERVATIONAL STUDY. Steven Karayiannis1, Brian McCrossan1, Thomas Forbes2, David Nykanen3, Daisuke Kobayashi3, Damien Kenny4 1RBHSC, Belfast, United Kingdom. 2Detroit, Detroit, USA. 3Orlando, Orlando, USA. 4OLCHC, Dublin, Ireland
Objectives: The aim of this study is to determine the pre- dictors and outcomes of cardiac perforation during cath- eter procedures (interventional, electrophysiological and diagnostic) in congenital heart disease (CHD).
Background: The continued evolution of cardiac cath- eterisation has increased the complexity of patients and frequency of high-risk procedures. The Congenital Cardiovascular Interventional Study Consortium (CCISC)
database is a global network of interventionalists with pooled procedural data input from 2007. Data on cardiac perforation in CHD is limited to anecdotal reports and studies of generic catheter-related complications.
Methods: A retrospective, observational study of 45,175 catheterisation procedures was undertaken. Cases were taken from the CCISC registry between 2008 and 2018. Parameters reviewed included patient demographics, pro- cedure-specific data (including indication and type of pro- cedure), as well as management and outcomes of cardiac perforation.
Results: Cardiac perforation occurred in n=58/45,175 cases (0.13%). Death post-perforation occurred in 7/58 (12%). Patients aged less than 1 year, 35/58 (60%), and less than 5 kilograms, 28/58 (48.2%) were most prevalent. Of those patients who died post perforation, 6/7 (85%) weighed <5kg. Intervention at the atrial septum (20/58, 34%) was most common in those cases of perforation (transsep- tal puncture, balloon septostomy and device procedure). Interventions at the RVOT/PV were also high risk for per- foration (11/58, 19%). All those who died, (7/7) under- went procedures at the atrial septum or RVOT/PV. Gender, elective/emergency case-type, trainee-attendance and 'risk-scoring' did not seem to predict perforation. Medical or surgical choice of treatment and transfusion/no trans- fusion, did not seem to predict outcome post-perforation.
Conclusions: Cardiac perforation is rare. Predicting those patients most at risk can facilitate expedient manage- ment. High risk patients can be stratified by demograph- ics including age and weight. Procedures most associated with perforation and subsequent death include interven- tion at the atrial septum and RVOT/pulmonary valve.
145. CORONARY ARTERY COMPRESSION DURING PERCUTANEOUS PULMONARY VALVE IMPLANTATION: IS IT NECESSARY FOR ALL PATIENTS?
Ahmet Çelebi, İlker Kemal Yücel, Mustafa Orhan Bulut, Emine Hekim Yılmaz
Siyami Ersek Hospital for Cardiology and Cardiovascular Surgery, İstanbul, Turkey
Introduction: Coronary compression (CC) is of particular concern because it may be fatal after transcatheter stent implantation to right ventricular outflow tract (RVOT) and/ or pulmonary valve implantation (PPVI). We present our experience with CC during PPVI.
Method: Between 2012-2019, 194 patients underwent catheterization for RVOT stenting and PPVI. Among these
Hijazi, Z
22nd Annual PICS/AICS Meeting