Page 40 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
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so right ventricular (RV) pacing was utilized during angio- plasty. Balloon angioplasty was performed with a 9mm x 3cm Sterling balloon. Angioplasty was technically success- ful but did not result in any improvement in the lesion. Stent implantation was undertaken. The Steelcore wire was exchanged for a 0.018” SV5 guidewire for additional support. The 4 Fr short sheath was exchanged for a 5 Fr x 45 cm Flexor sheath which was positioned in the trans- verse arch. A test inflation with an 8mm x 2cm Sterling balloon was performed to ensure system stability prior to stent deployment. An 8mm x 12mm Formula 418 stent was then deployed in good position. The stent was post-dilated with a 9mm Sterling balloon to match the normal aortic diameter.
Results: The residual PSEG was 14mmHg. Post-procedure the patient weaned off all support and was discharged home 4 weeks later. He is on aspirin for 6 months.
Conclusion: To our knowledge this is the first report of per- cutaneous treatment of AAo obstruction via stent implan- tation in pediatrics. Percutaneous relief of AAo obstruction may be feasible utilizing rapid RV pacing to optimize stent stability.
46. INTENTIONAL BIOPROSTHETIC TRICUSPID VALVE FRACTURE TO FACILITATE TRANSCATHETER VALVE IN VALVE DEPLOYMENT
Brian Karahalios1, John Breinholt2, Stephen Little3, Chun Lin3 1Houston Methodist, Houston, USA. 2Memorial Hermann Hospital, Houston, USA. 3Houston Methodist DeBakey Heart and Vascular Center, Houston, USA
While transcatheter valve-in-valve implantation may reduce the number of lifetime surgical reinterventions in some patients with congenital heart disease, in other patients the bioprosthetic valve ring can lead to patient-prosthe- sis mismatch due to reduction of internal diameter if a transcatheter valve is implanted. Intentional valve ring fracture during valve-in-valve implant has emerged as a solution for these patients, however, use of this technique in a bioprosthetic tricuspid valve has not been reported in adult patients. We report successful bioprosthetic tricus- pid valve fracture and valve-in-valve implant in a 49 year old woman who presented with stenosis of a #29 valve. At the time of intervention, initial predilation valvuloplasty demonstrated an internal diameter of 22mm, suggesting that a conventional valve-in-valve implant would induce patient-prosthesis mismatch. As a result, the valve ring was intentionally fractured with a 28mm non-compliant balloon at high pressure followed by implantation of a 29mm transcatheter valve. Final imaging demonstrated
successful expansion of the valve stent frame between 26.5-28mm in diameter and no AV block or compression of the coronaries. To our knowledge this is the first report of successful intentional tricuspid bioprosthetic valve frac- ture and valve-in-valve implant in an adult patient.
47. TORQUE DEVICE SUTURE TECHNIQUE TO ACHIEVE HEMOSTASIS IN LARGE-BORE VENOUS ACCESS
Brian Karahalios1, Stephanie Fuentes Rojas1, Rahul Singh1,
Miguel Chavez Cavazos1, Ponraj Chinnadurai2, Chun Lin3
1Houston Methodist Hospital, Houston, USA. 2Siemans Medical Solutions , Hoffman Estates, USA. 3Houston Methoidst DeBakey Heart and Vascular Center, Houston, USA
Objectives: To describe and compare a novel technique using a torque device to manage figure-of-eight suture tension for venous access hemostasis in patients who have undergone atrial septal defect (ASD) or patent foramen ovale (PFO) closure.
Background: Large bore venous access has become increasingly important in transcatheter procedures, but management of hemostasis can be time-consuming and/ or resource intensive. As such, various techniques have sought to provide cost effective and safe alternatives to manual compression. We describe a modification of the figure-of-eight suture technique wherein we apply a torque device to manage variable suture tension instead of tying a knot and compare it to the standard figure-of-eight suture technique.
Methods: We performed a retrospective study of 40 con- secutive patients who underwent ASD or PFO closure, 20 of whom underwent standard figure-of-eight tech- nique and 20 of whom underwent figure-of-eight with torque device modification. Bleeding Academic Research Consortium (BARC) definitions were used to categorize bleeding events.
Results: The groups were similar in age, gender, weight, aspirin use, platelet count, and INR. Standard figure-of- eight suture had seven patients with bleeding, with six classified as BARC II and one as BARC I. Figure-of-eight plus torque device had three patients with bleeding, with two classified BARC II and one as BARC I. There were no inci- dences of hematoma in either group.
Conclusion: The torque device suture technique is a safe and effective modification of the figure-of-eight suture technique. In addition, the modification allows secure and variable suture tension as well as easy removal by nursing staff
Journal of Structural Heart Disease, August 2019
Volume 5, Issue 4:75-205