Page 39 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
mean weight 6.9 ± 2.0 kg. Eleven (21%) had single ventricle anatomy. Eight patients had left sided lesions and required venous access for pacing only. Forty-three patients had 3DRA for right sided lesions; 2 venous sheaths were placed in 11 (26%) while the rest (32, 74%) had one venous sheath. The mean contrast volume for 3DRA was 1.6 ± 0.5 mL/kg, while total procedural contrast volume was 4.9 ± 1.9 mL/ kg. The mean DAP to acquire a 3DRA was 64.1 ± 40.2 uGy. m2. Total mean DAP per case was 1041.8 ± 796.1 uGy. m2. Thirty-six (71%) cases were interventional: LPA stent/ angioplasty in 13 (36%), RPA stent/angioplasty in 8 (22%), conduit stent in 5 (14%), coarctation angioplasty in 5 (14%), 1 (3%) pulmonary valvuloplasty and 4 (11%) underwent multiple interventions (combined conduit and branch PA angioplasty, SVC and RPA angioplasty and combined LPA and BT-shunt stents). There were no complications related to 3DRA acquisition and no evidence of peripheral access complications. There were 5 (10%) complications related to intervention which were all managed conservatively (3 pulmonary hemorrhages, 1 RPA aneurysm and 1 intra- stent thrombus).
Conclusion: To our knowledge, this is the first report describing the safety and feasibility of 3DRA in small chil- dren less than 10kg. 3DRA for right sided lesions can be performed using a single venous long sheath for both simultaneous angiography and RV pacing to minimize the risk of peripheral venous thrombosis.
44. THREE-YEAR OUTCOMES FROM THE HARMONY NATIVE OUTFLOW TRACT EARLY FEASIBILITY STUDY Lee Benson1, Lisa Bergersen2, Matthew Gillespie3, Brian McHenry4, John Cheatham5
1Hospital for Sick Children, Toronto, Canada. 2Boston Children's Hospital, Boston, MA, USA. 3Children's Hospital of Philadelphia, Philadelphia, PA, USA. 4Medtronic, Mounds View, MN, USA. 5Nationwide Children's Hospital, Columbus, OH, USA
Background: The Harmony transcatheter pulmonary valve (TPV) was designed to treat pulmonary valve regurgi- tation (PR) occurring during follow-up after surgical repair of right ventricular outflow tracts (RVOT).
Methods: The Native TPV Early Feasibility Study (EFS) is a prospective, multicenter, non-randomized feasibility study designed to evaluate the Harmony TPV device in 20 patients. Here we report 3-year follow-up clinical, echocar- diographic, and CT outcomes.
Results: Of 20 implanted patients, 17 completed 3-year follow-up (max: 4.1 y). There were no deaths but 2 early explants (previously reported). One patient did not
complete a 3-year visit. In remaining patients with avail- able 3-year echo data, paravalvular leak (PVL) was mild in 1 patient and no/trace in the remainder; PR was mild in 1 patient and no/trace in the remainder. The 3-year mean RVOT gradient was 15.7±5.5 mm Hg. No significant frame fractures were identified via radiography. Two patients required catheter reintervention due to development of significant outflow tract obstruction; subsequently, a follow-up CT scan was obtained (n=16) 3.2±1.5 months after the index procedure. The degree of luminal loss (intraluminal in-growth) was compared to the immediate post-implant scan at 3 predesignated frame locations and averaged (median [Q1,Q3] of 20% [11,34] inflow, 9% [-1, 14] valve housing, and 19% [12, 31] outflow), excluding the 2 patients with catheter reintervention.
Conclusions: The 3-year results from the Native TPV EFS demonstrate consistent valve function without mod- erate/severe PVL, PR or valve stenosis, and a stable Harmony TPV frame without significant frame fractures.
(as presented at SCAI.2019)
45. PERCUTANEOUS TREATMENT OF ASCENDING AORTA OBSTRUCTION AFTER ORTHOTOPIC HEART TRANSPLANTATION USING A PRE-MOUNTED STENT Konstantin Averin, Paula Holinski, Darren Freed, Jennifer Conway, Simon Urschel, Angela Bates, Cameron Seaman Stollery Children's Hospital, Edmonton, Canada
Background: Treatment of typical juxtaductal coarctation and/or aortic arch hypoplasia is often undertaken via a percutaneous approach. Lesions involving the ascending aorta (AAo) have traditionally required surgical repair.
Objective: To describe a novel percutaneous approach to AAo obstruction via stent angioplasty.
Methods: 14 month old male with Shone's complex status post multiple surgical palliations who underwent orthot- opic heart transplantation 4 weeks prior for persistent left heart obstruction and secondary pulmonary arterial hypertension. Post-transplant he had a persistent inotropic requirement and needed high-dose diuretics to maintain euvolemia. An echocardiogram raised suspicion for AAo obstruction. He underwent cardiac catheterization and was found to have severe AAo obstruction with a peak systolic ejection gradient (PSEG) of 45mmHg and angiographic narrowing to 6mm (normal aortic dimensions 8-9mm). He was deemed to be a poor surgical candidate given the previous 5 sternotomies so a percutaneous approach was undertaken. A 0.018” Steelcore guidewire was positioned in the LV apex. Balloon stability was extremely challenging
Hijazi, Z
22nd Annual PICS/AICS Meeting