Page 70 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
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attempting valve placement. Five of these patients under- went lateral thoracotomy with PA plication and three subsequently had successful transcatheter placement of a Sapien S3 valve via femoral access. One patient ended up with unstable valve position after transcatheter deploy- ment and underwent sternotomy, valve removal and suc- cessful surgical valve placement. The last patient had poor exposure via the lateral sternotomy so the hybrid approach was aborted and patient underwent a successful surgical PVR. The other two patients underwent sternotomy with main pulmonary artery banding with subsequent success- ful Sapien S3 valve placement via direct RV access.
The remaining 3 patients were small in size with multiple venous occlusions and underwent sub-xyphoid incision with RV access. Two had successful Melody valve place- ment and the last one had coronary artery compression upon balloon testing and the procedure was aborted.
PA plication provides a less invasive way for PVR by avoid- ing a full sternotomy. Nonetheless, it is less predictable in terms of reduction in PA and landing zone location when compared to direct PA banding and required repeated angiography and balloon sizing before being able to place the valve.
Conclusion: Hybrid approach PVR and PA plication through lateral thoracotomy in particular provides a good solution for patients who are deemed high risk for surgery and/or who are not a candidate for regular transcatheter approach. It is less invasive with the advantage of avoiding CPB and, in some cases, full sternotomy and often results in a shorter hospital stay.
93. TRENDS IN UTILIZATION OF THREE DIMENSIONAL GUIDANCE FOR CARDIAC CATHETERIZATIONS IN PATIENTS WITH CONGENITAL HEART DEFECTS Sebastian Góreczny1,2, Tomasz Moszura1, Jadwiga Moll3, Alexander Haak4,5, Hanne Håkonsen6,1, Edit Mathisen6,1, Paweł Dryżek3
1Polish Mother's Memorial Hospital, Research Institute, Lodz, Poland. 2Children's Hospital of Colorado, Aurora, Colorado, USA. 3Polish Mother's Memorial Hospital, Research Institute, Lodz, USA. 4University of Colorado, Aurora, Colorado, USA. 5Philips Healthcare, Andover, Massachusetts, USA. 6Medical University of Lodz, Lodz, Poland
Background: Modern angiographic imaging platforms allow three-dimensional (3D) guidance of cardiac cathe- terization utilizing techniques such as 3D rotational angi- ography (3DRA) or fusion of pre-operative computed
tomography (CT) or magnetic resonance imaging (MRI) datasets.
Objectives: We report our eight years’ experience with 3D guidance for cardiac catheterizations in patients with con- genital heart defects (CHD). The data was analyzed with emphasis on frequency of utilization of 3D guidance and regard to the type of patient’s anatomy, type of catheter- ization (diagnostic or interventional), specific intervention, imaging technique, operator and time frame.
Methods: A retrospective review of institutional data- base was performed to identify all procedures performed since the installation of an angiographic system enabling 3D guidance: 3DRA since 2010 and fusion of CT/MRI since 2015. Patients deemed not suitable for 3D guided cathe- terization were excluded from further analysis. The reasons for exclusion were: type of intervention (septal defect or arterial duct closure, atrial septostomy, isolated balloon valvoplasty, hybrid intervention or a procedure performed on extracorporeal membrane oxygenation), type of angi- ography (peripheral or cerebral angiography), hemody- namic study (evaluation of pulmonary hypertension or shunt defect) or non-CHD intervention (airway, esopha- geal, electrophysiology procedure).
Results: Between 03/2010 and 01/2018, a total of 2459 procedures were performed including 1660 (67.5%) that were deemed eligible for 3D guidance. We used 3D guid- ance in 562 cases (34%) with a yearly utilization ranging from 28% to 43%. Fusion of CT/MRI was utilized in 14.5% of all 3D guided procedures with increasing yearly share from 3.5% to 43%. Three-dimensional guidance was more commonly used for interventional than diagnostic cathe- terizations (45% vs. 21%; p<.0001) with similar frequency in patients with bi-ventricular and single-ventricular phys- iology (33% vs. 35%; p=.4). There was a significant differ- ence in utilization of any type of 3D guidance between three operators (13% vs. 42% vs. 53%; p<.00001). Three- dimensional image guidance was most commonly used for treatment of pulmonary artery stenosis (37% of all 3D guided interventions), collaterals (16%), coarctation of the aorta (14%), right ventricular outflow tract stenosis (12%) or Fontan fenestration (12%).
More than half of the right ventricular outflow tract pro- cedures involved 3D guidance (52/84; 61.9%) followed by collateral procedures (71/123; 58%), ductus arteriosus stenting (13/23; 56.5%) and Fontan fenestration closure (51/102; 50%). Three-dimensional guidance was utilized in almost every second case of pulmonary artery (165/352;
Journal of Structural Heart Disease, August 2019
Volume 5, Issue 4:75-205