Page 67 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
septum primum was redundant and mobile with several poorly localized areas of additional shunting. On 3D TEE, a central defect in the aneurysmal septum was identified having a “fish mouth” appearance, along with multiple peripheral small fenestrations. The entire area of shunt- ing in the septum was measured at 22x22 mm. Under 3D TEE, the central “fish mouth” defect was crossed and an SL1 sheath was placed. A 30 mm Cardioform Septal Occluder was placed through this sheath. The device completely occluded all defects successfully. Transthoracic echocar- diogram at 3 month follow-up did not demonstrate resid- ual shunting.
Real-time 3D TEE is an essential imaging modality in the anatomic evaluation of complex multi-fenestrated ASDs. Comprehensive understanding of anatomy is key to guid- ing catheter course and ensuring optimal device place- ment. As care teams become more comfortable with real-time image generation and interpretation, 3D TEE has the potential to improve the approach to complex anat- omy and shorten procedure times.
88. ACUTE AND MID-TERM OUTCOMES OF TRANSCATHETERPULMONARYVALVEIMPLANTATION IN PATIENTS OLDER THAN 40 YEARS
Osamah Aldoss1, Kaitlin Carr1, Shabana Shahanavaz2, David Balzer2, Daniel Levi3, Jamil Aboulhosn3
1University of Iowa, Iowa City, USA. 2Washington University in St. Louis, St Louis, USA. 3UCLA Adult Congenital Heart Disease Center, Los Angeles, USA
Objective: Evaluate short and mid-term outcomes of Transcatheter pulmonary valve implantation (TPV) in patients older than 40 years of age at time of implant.
Background: TPV is a widely used option for patients with dysfunctional right ventricular outflow tracks (RVOT). Although there are numerous studies detailing acute and intermediate term outcomes of TPV in adolescent and young adult patients, there is a paucity of data on the outcomes of TPV in older patients with more comorbid- ities. This study seeks to describe the outcome of TPV in patients older than 40 years at three adult congenital inter- ventional programs.
Methods: Retrospective multicenter study of patients older than 40 years at the time of TPV from January 2010 to February 2018. Demographics, procedure details, pro- cedure related complications and follow up data were collected.
Results: A total 75 subjects presented for TPVR with median age of 49.8 (IQ 45-60). Half of the patients 39 (52%) had evidence of NYHA class III or IV heart failure symptoms at time of presentation. The types of substrate included native RVOT in 32 (43%), conduit in 20 (27%) and biopros- thetic valve (BPV) in 23 (30%). Indications for TPV included pulmonary insufficiency (PI) in 37 (49%), stenosis (PS) in 16 (21%) and combined PS/PI in 22 (30%).A total of 65 (87%) had successful TPV. The remaining 10 patients were not able to receive the valve due to non-suitable RVOT in 7 and coronary compression upon balloon testing in 3. The Transcatheter valve types used were the Medtronic Melody in 42 (65%), Edwards Sapien S3 in 21 (32%) and Edwards Sapien XT in 2(3%). The Melody valve was the most com- mon used valve in conduits (78%) and BPV (86%) and the Sapien valve in native RVOT (62%). Patients with severe PI had immediate resolution of PI (no patients with more than mild central PI and only one patient with moder- ate para-valvar leak). Patients presented with PS and PS/ PI had significant improvement in peak-to-peak gradient from median of 25.5 to 5.5 mmHg (p<0.0001). There were no procedure related deaths. Adverse procedural events occurred in 4 (5%) as 2 procedure related arrhythmias and 2 peripheral vascular injuries.The median follow up was 2 years (IQ 0.74-3.13). Functional capacity has significantly improved after PVR in the majority of patients (Class III and IV were in 33 (51%) dropped to 10 (15%), p<0.001). There was 4 (6%) total later non-procedure related mortality, 2 (3%) TVR replacement (1 post endocarditis and 1 for re-ste- nosis of distal conduit beyond the valve), and 1 (2%) listed for heart transplant. Five patients (8%) experienced an epi- sode of infective endocarditis (4 Melody valve (2 conduits, 1 BPV, 1 native) and 1 Sapien S3 valve (native)).
Conclusion: TPV implantation is safe and provides an effective treatment of dysfunctional RVOT is patient older than 40 years of age. Mid-term follow up demonstrates improvement in functional capacity with stable valvular function, however, infective endocarditis occurred in 8% of patients.
89. HYBRID APPROACH TO ESTABLISH RIGHT VENTRI- CLE TO MAIN PULMONARY ARTERY CONTINUITY IN A NEONATE WITH MUSCULAR PULMONARY ATRESIA, INTACT VENTRICULAR SEPTUM, AND SEVERE TRICUS- PID REGURGITATION
Bassel Mohammad Nijres1, Yasser Al-Khatib1,2, E. Oliver Aregullin1,2, Giedrius Baliulis1,2, Neal Hillman1,2, Yashesh Savani3,2, Jessica Guiles1, Paul Nelson1, Dalton Jacobs1, Bennett Samuel1, Joseph Vettukattil1,2
1Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, USA. 2Michigan State University College of Human
Hijazi, Z
22nd Annual PICS/AICS Meeting