Page 116 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
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≤50% was kept only on medical treatment(TRAS-).Mean follow-up time was 7,6(4-11)years. Primary endpoints com- bined were death and graft failure and secondary end- points were clinical and laboratory parameters consisted of:serum creatinine level(Scr),systolic(SBP) and diastolic blood pressure (DBP), all patients underwent to reassess- ment at one month and one year after arteriography.
Results: Comparing both groups results was observed respectively TRAS+ and TRAS-:the median age 14,75±3,29 vs.15,5±1, 96years p=0,23,male predominance 11(55%)vs.15(93,75%)p=0,010,mean body mass index 19,17vs.19,11p=0,95,mean pre-transplantation dialysis time of 14,85±6,25vs.9,93±5,53 months p=0,01,prevalent disease that caused the renal transplant was unknow cause 7(35%)vs. 4(25%)p=0,936,with an average transplant time by the time 11,3vs.14,9p=0,67 months, decease donor was 20(100%)vs.13(81,25%)p=0,043,organ preservation time 166vs.41,6min p=0,68,cold ischemia time 24,92vs.21,89 hours p=0,11. These population(TRAS+20vs.TRAS- 16),the therapeutic immunosuppression (ISS) scheme was used by 34 patients(94,44%) and it was respective- ly:TRAS+19(55,88%)vs.TRAS-15(44,11%).One patient from each group didn´t use ISS 1(5%)vs.1(6,25%).The most used ISS scheme was used by 23 patients(67,64%) consisted of tacrolimus, azathioprine and prednisone 14(60,86%)vs.9(39,13%).Twenty four patients had hyper- tension (66,67%), each group presented TRAS+(N=20) vs.TRAS-(N=16): 12(60%) vs.12(75%).All patients were on antihypertensive therapy and the commonly antihyperten- sive agent used was calcium channel blocker 15(62,5%),it was respectively: 7(46,67%) vs.8(53,33%). At the follow up TRAS+ and TRAS- respectively found 1 vs. 0 deaths p=0,495 and 4 vs.2 grafts failure p=0,495,there wasn´t statistically significant difference neither for primary out- comes of death nor graft failure. The Scr pre procedure was 1,68vs.1,87 mg/dl p=0,9601 and the SBP and DBP was respectively 134vs.129 mmHg p=0,5822 and 87vs.79 mmHg p=0,1406 and the secondary outcomes were after 1month of TRAS+vs.TRAS- was Scr 1,64vs.1,65mg/dl p=0,5516, SBP 126vs.130 mmHg p=0,8024, DPB 79vs.75 mmHg p=0,3347 and after 1year:Scr 1,45vs.1,46mg/dl p=0,1549,SBP 128vs.118mmHg(p=0,1671)and DPB 80 vs.76mmHg p=0,4689.
Conclusion: Both groups had similar outcomes either in death and graft failure’s. TRAS+ was effective as well as TRAS- in improving Scr and BP levels at 1 month and 1 year. We can speculate that without a PI the TRAS+ patients could have a worse outcome. There is limitations on our study, for being a specific sample, thus new studies are needed.
152. ROUTINE RECOVERY OF INTERSTAGE SINGLE VENTRICLE PATIENTS IN THE CARDIAC INTENSIVE CARE UNIT AFTER CATHETERIZATION: PUTTING ONE CENTER’S STANDARD OF CARE TO THE TEST
Steven Healan, Joe Stidham, Thomas Doyle, George Nicholson, Dana Janssen
Vanderbilt Children's Hospital, Nashville, USA
Background: Single ventricle patients carry high mortal- ity (~12%) between stage I and stage II surgical palliation (interstage period). Due to their relative fragility, interstage patients at our institution who have undergone planned catheterization are routinely admitted to the intensive care unit (ICU) for observation. Prior to 2010, they were usually admitted to the general floor. In this study, we examined whether routine ICU admission improved outcomes, or changed overall length of stay (LOS) or exposure to inter- ventions during admission.
Methods: We conducted a retrospective chart review of 191 interstage patients at our institution who underwent planned catheterization to determine suitability for stage II surgical palliation between 2006-2018. Subjects already admitted to the ICU, those who experienced a catheteriza- tion complication, and patients not extubated after cathe- terization were excluded. Differences between the groups admitted to the ICU and the general floor were analyzed using the Mann-Whitney U and Fisher’s exact tests.
Results: Out of 191 patients identified, 134 met inclusion criteria. 101 were admitted to the ICU after catheteriza- tion, and 33 to the floor. There was a longer median LOS for patients admitted to the ICU compared with the floor (2 days [1.15-3.0] versus 1 [1.0-1.67], p=0.04). Two of 33 patients admitted to the floor required ICU transfer (6.1%), one for sedation to obtain venous access; one for poor perfusion and cyanosis. No patients admitted to the floor required cardiopulmonary resuscitation (CPR) and there were no deaths prior to stage II palliation. A higher per- centage of ICU patients received supplemental oxygen (48.8% versus 21.9%, p=0.01), and there was a trend toward a higher percentage who had their feeds held (25.7% versus 12.1%, p=0.08). There was no difference in age at catheterization (109 days [104-120.9] versus 105 [96.7- 123], p=0.68), history of necrotizing enterocolitis (p=0.36), ECMO requirement after stage I (p=0.16), or prior hospi- tal LOS after stage I (43 days [15-171] versus 41 [14-133], p=0.37). There was no difference in serum lactic acid at the time of catheterization (0.9 [0.51 – 1.39] versus 0.85 [0.60 – 1.41], p=0.44). Patients in the current era (after 2010) were more likely to have received an intervention as part of their catheterization (46% versus 17% prior to 2010, p=0.016).
Journal of Structural Heart Disease, August 2019
Volume 5, Issue 4:75-205