Page 62 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
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97% at 30-days follow-up. All other results are summarized in the table below.
Conclusions: The high rate of implant success and the low rate of device and procedure related serious adverse events observed in this subset of patients supports the safety and effectiveness of transcatheter PDA closure using the Amplatzer PiccoloTM Occluder in ELBW infants.
81. THE AMPLATZER DUCT OCCLUDER [ADOII] AND AMPLATZER DUCT OCCLUDER ADDITIONAL SIZE DEVICES[ADOIIAS]FORPATENTDUCTUSARTERIOSUS CLOSURE: A RETROSPECTIVE COMPARATIVE SINGLE CENTER STUDY
Kristoffer Steiner1,2, Elchanan Bruckheimer1, Michael Levinzon3, Alexander Lowenthal1, Tamir Dagan1, Gabriel Amir4, Einat Birk1
1Section of Pediatric Cardiology, Schneider Children’s Medical, Tel Aviv, Israel. 2Section of Pediatric Cardiology, Astrid Lindgren Children’s Hospital, Stockholm, Sweden. 3Section of Pediatric Anesthesiology, Schneider Children’s Medical, Tel Aviv, Israel. 4Section of Pediatric Cardiothoracic Surgery, Schneider Children’s Medical, Tel Aviv, Israel
Aim: To Evaluate ADOII and ADOIIAS for transcatheter PDA closure. ADOIIAS has smaller retention discs reducing flow disturbance but residual leak and embolization may increase.
Methods: Retrospective review of all patients undergoing PDA closure with an Amplatzer device between January 2008 and June 2018 in our institution. Data from procedure and after 6 months were collected.
Results: 548 patients, median age 2.8 years [0.3-46.8] years and median weight 13 kg [3.5-82], were referred for PDA closure. 547 had successful implantation [269 ADOII, 250 ADOIIAS, 28 AVPII]. ADOII vs. ADOIIAS demonstrated smaller patients with larger PDA diameters [11.5 [5.2-79.0] vs 17.0 [4.0-82.0], p<0.001, 2.3 mm vs 1.9 mm, p<0.001, respectively]. Mean device diameter was similar for both groups. Closure rate at follow-up was similar for all devices. Complications and Follow Up: All patients were discharged the following day with normal distal pulses palpated and with no venous or arterial complications. ADOIIAS: There were four implantation failures, two in a type A PDA and two in a type C. In three of these cases, the ADOIIAS was demonstrated to be unstable before release. The device was retrieved in all cases and the PDA was closed suc- cessfully with an AVPII 6mm device. There was one device embolization to the right pulmonary artery which was suc- cessfully retrieved and the PDA closed with an AVPII 6mm
with no further complications. On mean follow up 8.4±15.2 months, one patient had mild left pulmonary artery steno- sis on echocardiography with a maximal velocity of 2.5 m/ sec. There were no cases of aortic flow disturbance. ADOII: There were two cases of device embolization to the right pulmonary artery, one patient was treated with surgical PDA closure the same day. In the other patient the device was successfully retrieved and the PDA was closed using an ADOI 8-6 device. On mean follow up 11.9±20.4 months, there were five cases of LPA stenosis, four mild and one significant who underwent balloon dilation four years later with good result. There were no cases of aortic flow distur- bance. One patient suffered from endocarditis and a resid- ual shunt after PDA closure with an ADOII 5-4mm device. The shunt eventually disappeared on echocardiographic follow up 14 months after implantation.
AVPII: On mean follow up of 7.4±13.4 months there were no complications.
Conclusions: The lower profile ADOIIAS device was used in larger patients with smaller PDA diameters with an excellent closure rate and very few complications. The major concerns of embolization and residual leak due to its smaller retention disks were not supported when a device:PDA diameter of approximately 2:1 was maintained.
In our opinion, the ADOIIAS device is a safe and effective device for transcatheter PDA closure and is our preferred choice for transcatheter closure of small to moderate PDAs in all age groups. We prefer a retrograde approach through a 4Fr system with device waist-to- PDA diameter ratio of greater than 2:1 with a length that places the aortic disc inside the diverticulum.
82. PERCUTANEOUS TREATMENT OF CONGENITAL HEART DISEASES IN UNUSUAL SITUATIONS.
Edmundo Oliveira1,2, Marco Antonio Moura1,2, Jose Augusto Barbosa1,2
1Hospital Felicio Rocho, Belo Horizonte, Brazil. 2Hospital Vila da Serra, Belo Horizonte, Brazil
Introduction: The number of patients treated through interventional catheterization has been increasing accord- ing to the experience of the interventionists and according to the availability of new tools. Some rare special situations may require the off-label use of materials or the accom- plishment of the procedure through unusual vascular accesses.
Journal of Structural Heart Disease, August 2019
Volume 5, Issue 4:75-205