Page 53 - Journal of Structural Heart Disease Volume 5, Issue 4

115
Meeting Abstracts
be useful as indicator of radiation exposure in pediatric catheterization.
67. THE COMPENSATORY RESERVE INDEX INCREASES AFTER TRANSCATHETER PULMONARY VALVE REPLACEMENT IN PATIENTS WITH CONGENITAL HEART DISEASE
Daniel Ehrmann, David Leopold, Ryan Phillips, Niti Shahi, Steven Moulton, Kristen Campbell, Michael Ross, Jenny Zablah, John Kim, Gareth Morgan
University of Colorado/Children's Hospital Colorado, Aurora, USA
Background: Early physiological changes in circulatory volume after successful surgical or transcatheter valve replacement (TcPVR) have not been characterized using non-invasive measures of compensation. Moreover, in contrast to patients undergoing surgical pulmonary valve replacement who must first recover from the effects of cardiopulmonary bypass, those undergoing TcPVR may experience immediate improvements in cardiac efficiency, left ventricular preload, and ultimately stroke volume. The Compensatory Reserve Index (CRI) is an FDA-cleared moni- toring technology that trends real-time changes in circula- tory volume by analyzing compensatory changes in pulse oximetry waveforms. The CRI ranges from 1 (normovole- mia) to 0 (life-threating decompensation, systolic blood pressure < 80mmHg). Since patients undergoing success- ful TcPVR may experience immediate improvements to their haemodynamics, we hypothesized that CRI would immediately increase after successful TcPVR.
Methods: A prospective cohort of subjects undergoing TcPVR was studied. CRI was continuously measured using a
67. Figure 1. Mean CRI by Procedural Phase Hijazi, Z
CipherOx® CRI M1 device. Data were analyzed during four procedural phases: pre-anesthesia baseline, after anes- thesia induction but before right ventricular outflow tract (RVOT) manipulation, immediately after TcPVR placement while still under anesthesia (“early post-valve period”), and during anesthesia recovery (“late post-valve period”). Clinical, catheterization, and imaging data were also col- lected. Data are presented as medians with interquartile ranges (IQR), means and 95% confidence intervals (CI), or counts and proportions as appropriate. Descriptive data only are presented in this interim analysis halfway through target enrollment.
Results: Thirteen subjects have been enrolled to date. The median age was 13 years (IQR: 12 – 26) and 6 (46%) were status post Tetralogy of Fallot repair. The primary indication for TcPVR was pulmonary stenosis (n = 5, 38%), pulmonary insufficiency (n = 3, 23%), or combination of both (n = 5, 38%). Nine patients had pre-operative MRIs with a median RV:LV ratio of 1.68 (IQR: 1.59 – 2.16). Mean CRI values over the four procedural phases were (figure 1): pre-anesthesia baseline 0.58 (95% CI: 0.51 – 0.65), before RVOT manipula- tion 0.62 (95% CI: 0.52 – 0.72), early post-valve period 0.75 (95% CI: 0.65 – 0.84), and late post-valve period 0.82 (95% CI: 0.74 – 0.90). The correlation coefficient between change in CRI (late post-valve period – baseline) and MRI RV:LV ratio was - 0.77 (figure 2).
Conclusions: In this pilot study of patients with CHD, CRI increased early after successful TcPVR. Improvement in CRI may correspond to improvements in cardiac efficiency and haemodynamics after successful TcPVR. Pre-operative RV:LV ratios by MRI were inversely related to post-TcPVR
67. Figure 2. Correlation between CRI change and RV:LV Ratio by MRI
22nd Annual PICS/AICS Meeting