Page 78 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
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and time to AF onset were evaluated with descriptive anal- yses. A Freeman-Tukey arcsine transformation was per- formed for meta-analysis of AF incidence.
Results: From 765 records, 68 full text studies were included in data synthesis. Study sample sizes ranged between 20 and 1887 individuals, average study duration between 3.6 months and 18.5 years, and average age between 37 to 67 years across all studies. The meta-analysis found an average incidence of AF after PFO closure of approximately 3.0%. Of those who developed AF, the majority developed it within the short-term, about a few weeks to a year after closure. There was no consistency in reported predictors of AF development.
Conclusions: Incidence of AF post-closure was relatively low across studies, with a high level of between-study het- erogeneity. Until a concerted effort is made to improve accurate AF diagnosis, it will be difficult to gauge the true risks associated with transcatheter PFO closure.
102. PERCUTANEOUS IMPELLA RP USE FOR REFRAC- TORY RIGHT HEART FAILURE IN ADOLESCENTS- RESULTS FROM A MULTICENTER U.S. EXPERIENCE Athar M. Qureshi1, Mariel E. Turner 2, William O'Neill3, Susan W. Denfield1, Nima Aghili4, Amit Badiye5, Radhakrishan Gandhi6, Behnam Tehrani7, George Chang8, Jared K. Oyama9, Shashank Sinha7, Nicolas Brozzi5, Brian Morray10
1Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA. 2Morgan Stanley Children’s Hospital of New York- Presbyterian, Columbia University Medical Center, New York, New York, USA. 3Henry Ford Hospital, Detroit, MI, USA. 4St. Anthony Hospital, Lakewood, CO, USA. 5Jackson Memorial Hospital, Miami, FL, USA. 6Hoag Memorial Hospital, Newport Beach, CA, USA. 7Inova Fairfax Hospital, Annandale, VA, USA. 8Emory, St. Joseph’s Hospital, Atlanta, GA, USA. 9The Queen's Medical Center, Honolulu, HI, USA. 10Division of Pediatric Cardiology, Seattle Children’s Hospital, University of Washington School of Medicin, Seattle, WA, USA
Background: Percutaneous right ventricular assist device support with the Impella RP device (Abiomed, Danvers, MA) has been reported in adults, but a multicenter experi- ence in children has yet to be reported.
Methods: We included patients < 21 years of age who underwent implantation of an Impella RP device for refrac- tory right heart failure from 6/2016 - 4/2018 at 9 U.S. (7 adult and 2 pediatric) Centers.
Results: A total of 12 adolescents with a median age of 18 (14 - 21) years, median weight 74.4 (49-112.4) kg. under- went Impella RP implantation. The underlying diagnosis
was post-heart transplant rejection in 5, primary myocar- ditis in 3, cardiogenic shock in 2, cardiomyopathy in 1, and arrhythmogenic right ventricular dysplasia in 1 patient (INTERMACS profile -cardiogenic shock in 9 and slow pro- gressive decline in 3 patients). The central venous pres- sure decreased significantly from a median of 20 (16 - 35) mmHg to 12 (7 - 17) mmHg post Impella RP implantation, (p = 0.001). One patient was supported with an intra-aor- tic balloon pump (IABP) and the rest were concomitantly supported with a percutaneous or surgically placed left ventricular assist device. There were 2 procedural adverse events- 1 patient suffered a retroperitoneal hemorrhage from simultaneous Impella CP implantation and 1 patient underwent leg amputation due to arterial thrombosis from an IABP. There was 1 adverse event related to the Impella RP device (thrombosis resulting in explant). The average support duration was 6.5 days (4.8 hours - 18.4 days) and survival to hospital discharge was 83 %. At a median follow up of 11 months (5 days - 2.5 years), 8/12 (67%) patients are alive with complete recovery.
Conclusions: In this multicenter experience, use of the Impella RP device was found to be efficacious and safe when used in adolescents. The Impella RP device should be considered as a treatment modality in select adoles- cents with severe right heart failure refractory to medical therapy. Further studies are warranted to identify suitable candidates for Impella RP therapy for right heart failure.
103. PREVALENCE AND CLINICAL OUTCOMES IN PATIENTS WITH PULMONARY HYPERTENSION UNDER- GOING TRANSCUTANEOUS CLOSURE OF ATRIAL SEP- TAL DEFECTS
Selai Akseer1, Lusine Abrahamyan1, Eric Horlick2
1The University of Toronto, Toronto, Canada. 2The University Health Network (UHN), Toronto, Canada
Background: Atrial septal defect (ASD) is the second most common congenital heart disease (CHD) accounting for 8-10% of all heart defects, with an estimated prevalence of 1.64 per 1000 live births. The left to right shunt causes a volume overload in the right side of the heart resulting in structural abnormalities. The volume overload triggers right atrium hypertrophy which pulls apart the leaflets of the tricuspid valve causing leakage and overflow into the right ventricle and subsequently through the pulmonary arteries.
The lungs respond to hyperkinetic blood flow by narrowing its blood vessels to reduce the volume of blood that enters it. This constriction however increases the blood pressure
Journal of Structural Heart Disease, August 2019
Volume 5, Issue 4:75-205