Page 120 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
182
156. IMPACT OF PERCUTANEOUS CLOSURE OF ATRIAL SEPTAL DEFECTS ON QUALITY OF LIFE IN ADULTS IN THE UNITED STATES
Mary Heitschmidt
Rush University Medical Center, Chicago, USA
Background: In 2010, 2.4 million people, of which 1.4 million were adults >18 years, were estimated as living with a CDH in the US. The US prevalence of atrial septal defect (ASD), the most common defect in adults, is greater than 100,000. An ASD is a hole between the atria of the heart that allows blood to shunt from the left to the right atrium. Increased pressure in the right side of the heart, increased pressure in the lungs, paradoxical embolisms, arrhythmias, and symptoms of fatigue, dyspnea, palpi- tations, and recurrent respiratory infections may occur if ASD is left untreated at the second decade of life or later. Percutaneous interventional repair of ASD is increasingly prevalent, as a substitute for surgery, and continues to be a safe and effective procedure since approved by the US Food and Drug Administration in 2001. To determine the effect of cardiac device implantation on a patient’s overall life experiences the assessment of quality of life is neces- sary to help address health care needs and guide care of these patients, however minimal information describing QOL in these patients is available.
Objective: The purpose is to prospectively evaluate changes in health related QOL (HRQOL) and health status in newly diagnosed adult patients with an ASD before and post percutaneous closure of the ASD.
Methods: A longitudinal design was used to measure subjects HRQOL and health status pre-ASD device closure and at 1 and 6 months post closure procedure. A demo- graphic form, Ferrans and Powers QOL Index (QLI) Cardiac IV Version, SF-36v2 Health Survey, and a linear analog scale (LAS) QOL measure were completed.
Results: Sixteen subjects ranged in age from 22-65 years (mean 43.13), 81.3% were white, 75% female, 56% mar- ried, and college was the highest education level for 62.5%. Fourteen subjects received the AmplatzerTM Septal Occluder device. SF36v2 determined the following at 6 months: moderate effect size (.36) in Physical Health Summary score; increase in all mean sub-scale scores; and a moderate effect size in Physical Function (.51), Bodily Pain (.40), and Role-Physical (.39) subscales but were not sig- nificant. LAS scores increased from 72.0 mean + 20.1 pre closure to 78.2 mean + 20.0 at 6 months with a moderate effect size (.31) but were not statistically significant. Overall mean health QLI scores increased at 6 months to 22.05
+ 6.22 from 20.89 + 5.66 pre closure and all sub-scores increased at 6 months except the psych/spiritual social subscale, with a moderate effect size seen in the QLI Health function (.29) and the Family subscale (.26). All mean QLI scores decreased from 1 to 6 months.
Conclusion: Six months post ASD closure improved HRQOL and health status was found using a general, car- diac specific, and self-rating QOL measures but were not significant due to the small sample. Providers should con- sideration objective assessment of HRQOL to promote optimal care for this population. The need for further research with larger sample sizes is warranted to further determine HRQOL changes in patients who receive inter- ventional ASD closure.
157. VIABAHN VBX STENT IN THE TREATMENT OF VASCULAR STENOSIS IN CHILDREN
John Lozier, Martin Bocks
Rainbow Babies and Children's Hospital, Cleveland, OH, USA
Background: Covered, pre-mounted stents provide an attractive option for the treatment of certain vascular stenoses in children with congenital and acquired heart disease. The ideal stent has yet to be identified, however desirable characteristics of these stents include struc- tural integrity over a wide range of diameters, the ability to ‘unzip’ safely to allow dilation at higher diameters, low profile for delivery through a small sheath, and PTFE cover- ing to improve safety during high-risk dilations. The Gore® Viabahn® VBX Balloon Expandable Stent (VBX) is approved for adult peripheral vascular disease. We present a series of five children treated with this stent.
Methods: Retrospective chart review was performed in all cases in which VBX stents were used to treat vascular stenoses in our institution. Data collected included patient demographics, indications for using the VBX stents, pro- cedural characteristics, procedural outcomes and limited follow-up. Successful interventions were defined as resolu- tion of a high-risk vascular obstruction, or relief of vascular obstruction with concomitant elimination of an adjacent unwanted vascular communication.
Results: Five children, ages 1.6 to 10.3 years (median 4.2 years) were treated with VBX stents. Four were treated with a single stent and one patient was treated with three stents. Two VBX stents were delivered in stenotic left pulmonary arteries, one in a long-segment aortic coarctation, one in a nearly occluded iliac vein, and three were delivered into a chronically occluded superior vena cava through which
Journal of Structural Heart Disease, August 2019
Volume 5, Issue 4:75-205