Page 35 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
Younes Boudjemline, Hesham Al-Saloos, Muhammad Dilawar, Reema Kamal, Ziyad M. Hijazi
Sidra Medecine, Doha, Qatar
Background: Radiation exposure during transcatheter ASD/PFO closure has been recently studied. Variations in level of dose had been advocate to be related to multi- ple factors including patient, x-ray equipment(brand,set- tings), and interventionist(experience and skills, technical aspects...) factors. Our center has the particularity of hav- ing multiple interventionists using a single dedicated car- diac catheterization laboratory. This peculiarity provides a unique opportunity to analyze the effect of intervention- ist’s experience and variation of practice on level of radia- tion exposure.
Methods: ASD/PFO cases performed between January 2013 and 2019 were respectively reviewed and analyzed. Fluoroscopic time(FT), dose area product(DAP, cGy.cm2), DAP/kg(cGy.cm2/kg), and total air kerma(mGy) were col- lected .
Results: 237 consecutive patients had attempted of ASD/ PFO closure. 15 patients were excluded because level of exposure was not recorded leaving a total of 222 patients for analysis(194 ASD, 28 PFO). 32 patients experienced 39 complications including 19 device missizing(15 success- fully closed after changing the device), 9 failures, 8 tran- sient arrhythmias, 2 device embolizations(retrieved by catheterization, 1 ASD successfully closed), one pericardial
effusion (device removed surgically). 10 patients(9 failure, 1 pericardial effusion/erosion) were referred to surgery.
Procedural time (PT), FT, DAP/kg and complications rate were higher in the ASD group(PFO and ASD respectively: 41.3 vs 76.3-min, 6.5 vs 12.5-min, 21.9 vs 62.6-cGy.cm2/kg, and 0 vs 16.6%). There was a great variation in collected parameters amongst interventionists (see table). More experienced interventionists had lower PT, FT, DAP/kg and complication rates. Among two interventionists with the higher experience, the one having focus on keeping level of radiation low had the lowest PT, FT and DAP/kg for both groups (ASD group: mean PT, FT, DAP/kg respectively: 22.3 vs 64.6-min, 1.7 vs 11.5-min, and 0.31 vs 47.46-cGy.cm2/ kg). Reasons for lower radiation exposure were: use of low frame rate (4fps), avoidance of cineangiogram, no use of lateral view, no systematic right heart catheterization, lim- ited use of balloon sizing, and use of echo to guide the procedure. Such approach did not negatively impact the success and complication rates.
Conclusions: Interventionist’s experience and vari- ation of practice have a major impact on level of radiation exposure. More experienced interven- tionists have lower PT, FT, DAP/kg and complica- tion rates. At similar experience, interventionists considering radiation as key performance indicator beside success and complication rates had lower level of radiation.
37. Table 1.
Interventionist 113,8 21,9 1 -ASD
Interventionist 82,5 12,7 2 - ASD
Interventionist 64,6 11,5 3 - ASD
Interventionist 22,3 1,7 4 - ASD
Interventionist 56,5 11,4 1 - PFO
Interventionist 42,1 4,4 2 - PFO
Interventionist 40,8 6,3 3 - PFO
Interventionist 15,8 1,9 4 - PFO
434,6 402,7 332,1 2,5 328,2 235,1 84,6 4,0
6752,0 92,7 4249,8 72,1 2990,3 47,5 11,1 0,3 3294,3 41,0 2446,7 31,7 650,4 8,8 7,3 0,1
90,6% 31,3% 9,4% 96,3% 9,8% 3,7% 95,3% 23,3% 4,7% 100,0% 4,0% 0,0% 100% 0% 0% 100% 0% 0% 100% 0% 0% 100% 0% 0%
Procedural time(min)
Fluoro time(min)
Air kerma (mG)
DAP cGycm2
DAP/KG cGycm2/kg
Success
Complication
Failure
Hijazi, Z
22nd Annual PICS/AICS Meeting