Page 69 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
remodeling seen in the aorta immediately proximal to the left carotid artery, left subclavian artery, and the aorta distal to the stent (p<0.05). There was also significant vol- umetric reduction in the ascending aorta, the aortic arch, and the aortic segment most proximal to the top of the stent (p<0.05).
Conclusion: There has been no prior literature in regards to aortic remodeling in coarctation patients with a focus on serial imaging. We have reported negative remodeling in multiple areas of the aorta with regards to the aortic cross-sectional area and volumetric measurements, and have additionally reported the long-term outcomes of this population.
91. SINGLE CENTER EXPERIENCE OF 100 CONSECUTIVE PERCUTANEOUS CARDIAC INTERVENTIONS IN INFANTS ≤ 1000 GRAMS
Neil Tailor, Shyam Sathanandam, Leah Apalodimas, Hitesh Agrawal, Benjamin Waller
Le Bonheur Children's Hospital, Memphis, USA
Background: For a long time, percutaneous cardiac inter- ventions (PCI) in infants born premature, age < 30 days and weight < 2.5 kg were considered to be associated with an increased incidence of serious adverse events. Recent advancements of imaging and device technologies has allowed for an extended application of PCI to very small infants. We describe a large single-center experience of performing PCI in infants weighing ≤ 1000 grams at the time of the procedure.
Methods: A retrospective review of 100 consecutive PCI performed on infants weighing ≤ 1000 grams at the time of the procedure between June 2015 to May 2019 was performed. Procedure success rate was determined by the proportion of patients in whom the intended interven- tion was performed irrespective of the outcome. A major adverse event (AE) was defined as hemodynamic compro- mise resulting from the PCI requiring an additional proce- dure. A minor AE was defined as any AE that did not require additional treatment.
Results: The average age and weight at the time of the procedure was 25 days (range 1-70 days) and 863 grams (range 490-1000 grams) respectively. The median gesta- tional age was 24 weeks (range 22-28 weeks). The inter- ventions consisted of 81 transcatheter device closures of patent ductus arteriosus (PDA), pulmonary valvuloplasties (n=7), foreign body retrievals (n=6), pericardiocentesis (n-4), stent implantation for coarctation of aorta (n=1), and pulmonary artery angioplasty (n=1). The procedure
success rate was 99%. The one procedural failure was a PDA occlusion in which the device had to be snared and retrieved secondary to left pulmonary artery stenosis. However, the PDA spontaneously closed immediately after retrieval. The major AE rate was 6% including one proce- dure related mortality secondary to vascular injury. The minor AE rate was 4%. Re-interventions have been neces- sary only for the patients with pulmonary valve stenosis with a rate of 100%, but not for other procedures. At the time of latest follow-up (median 15 months), the survival rate was 95%.
Conclusions: It is feasible to perform PCIs in infants weigh- ing ≤ 1000 grams using currently available technologies. There is a learning curve with these interventions with most AE happening earlier in the experience. Extreme care must be taken while performing interventions in such small human beings. Further miniaturization of equipment would facilitate better outcomes.
92. LATERAL THORACOTOMY WITH PULMONARY ARTERY MODIFICATION PROVIDES A LESS INVA- SIVE HYBRID APPROACH FOR PULMONARY VALVE PLACEMENT
Kaitlin Carr PA-C1, Yuki Nakamura MD2, Marco Ricci MD2, Manish Bansal MD1, Osamah Aldoss MD1
Objective: To review our experience of a hybrid approach to pulmonary valve replacement (PVR)
Background: To date there are no FDA approved devices that can be placed in a large right ventricular outflow tract (RVOT) nor is there a small enough delivery system to accommodate transcatheter PVR in smaller patients. Hybrid approach for PVR can provide a less invasive way to replace the valve by avoiding cardiopulmonary bypass (CPB) and, in some cases, a full sternotomy.
Methods: Retrospective review of our experience in hybrid approach PVR starting in 2014.
Results: Total of 10 patients underwent attempted hybrid PVR. The mean age and weight were 22.2 years (+/- 20.3) and 49.1 kg (+/- 29.8) respectively, of which 5 were less than 18 years of age. The average fluoroscopy time was 34.7 min (+/- 29.9), average contrast volume of 220.7 ml (+/- 148.9) and average hospital stay was 4.4 days (+/- 2.6), and for the ones receiving a successful valve through tho- racotomy 3.3 days (+/- 1.1).
Seven of the ten patients with known RVOT dilation underwent surgical pulmonary artery modification before
Hijazi, Z
22nd Annual PICS/AICS Meeting