Page 82 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
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selection needs to be individualized depending on the location and size of the pseudoaneurysm.
Conclusion: LV pseudoaneurysm may be seen as a late complication of percutaneous VSD closure, which has not been previously reported. It is associated with a very high mortality rate if left untreated. Transcatheter occlusion might be an alternative option to conventional surgery in selected cases.
108. SAFETY AND FEASIBILITY OF SAPIEN VALVE TRANSCATHETER PULMONARY VALVE REPLACEMENT IN THE NATIVE OR PATCHED RIGHT VENTRICULAR OUTFLOW TRACT
Shabana Shahanavaz1, Evan Zahn2, Mary Hunt Martin3, Daniel Levi4, Jamil Aboulhosn 5, Holly Bauser Heaton 6, Athar Qureshi7, Britton Keeshon8, Jeremy Ringwald9, Brian Morray10, Darren Berman11, Jeffrey Zampi12, Sebastien Hascoet 13, Pleiss Julien 14, Patrice Guerin14, Diego Porras15, Bryan Goldstein16, Clement Karsenty17, Doff McElhinney18
1Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, USA.
2Guerin Family Congenital Heart Program, The Heart Institute and Department of Pediatrics Cedars-Sinai Medical Center,
Los Angeles, USA. 3Division of Pediatric Cardiology, Primary Children's Hospital, Salt Lake City, USA. 4Department of Pediatrics, Division of Cardiology, UCLA Mattel Children's Hospital, Los Angeles, USA. 5Ahmanson Adult Congenital Heart Disease Center, David Geffen School of Medicine at UCLA, Los Angeles, USA. 6Department of Pediatrics, Emory University School of Medicine, Atlanta, USA. 7The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, USA. 8Yale University, New Haven, USA. 9St Joseph's Children's Hospital, Tampa, USA. 10Division of Pediatric Cardiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, USA. 11The Heart Center, Nationwide Children's Hospital, Columbus, USA. 12University of Michigan
C.S. Mott Children's Hospital, Ann Arbor, USA. 13Hôpital Marie Lannelongue, Le Plessis-Robinson, France. 14Centre Hospitalier Universitaire de Nantes, Institut du Thorax, Fédération des Cardiopathies Congénitales, Service de Cardiologie, Nantes, France. 15Department of Cardiology, Boston Children's Hospital, Boston, USA. 16The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, USA. 17Hopital des enfants CHU , Toulouse, France. 18Lucile Packard Children's Hospital Stanford, Palo Alto, USA
Background: Transcatheter pulmonary valve replacement (TPVR) has gained acceptance as a non-surgical alternative in patients with a dysfunctional RV-PA conduit or biopros- thetic valve. However, current transcatheter valve technol- ogy is only approved to treat a minority of patients with right ventricular outflow tract (RVOT) dysfunction who merit intervention. A majority of patients referred for pulmonary
valve replacement have a history of surgical repair with an RVOT patch or transcatheter valvuloplasty without place- ment of a pulmonary conduit or prosthesis, and have regur- gitation through this patched or native RVOT. The primary aims of this large multicenter study were to evaluate the efficacy and safety of TPVR in the native or patched RVOT.
Methods: An international multicenter retrospective study was performed of all patients who underwent TPVR with a Sapien XT or S3 valve in a native or patched RVOT from 2014-2018. Demographic, diagnostic, procedural, and outcome data were collected after local IRB approval.
Results: A total of 240 patients underwent placement of a Sapien XT (n=43) or S3 (n=197) valve in the native RVOT, through either a femoral venous (87%), jugular venous (3%), or hybrid perventricular (10%) approach. The median age was 21 yrs (Q1-Q3 4-77 kg) and the median weight was 61 kg (Q1-Q3 15-159 kg). Baseline anatomy was predominantly tetralogy of Fallot (n=190) followed by valvar pulmonary stenosis (n=30). RVOT dysfunction consisted predominantly of severe pulmonary regurgi- tation (PR) in 202 patients (84%), pulmonary stenosis in 2, and mixed disease in 36. Sapien valve size was 29 mm in 167 patients (70%), 26 mm in 60 (25%), and 23 mm in 13 (5%). Pre-stent implantation was performed in 70% of patients. There was no procedural mortality. Procedural complications were identified in 13% of patients, includ- ing tricuspid valve injury (n=12, 5%), valve embolization (n=9, 4%), arrhythmia (n=8, 3%), pre-stent embolization (n=2, 1%), and coronary/aortic compression from the device (n=2, 1%). Valve embolization was more common in pre-stented pts (78%). On post-procedure echocardiog- raphy, 5 patients had moderate PR (all others had mild or less PR), 8 had mild paravalvular leak, and none had sig- nificant RVOT obstruction. During follow-up (median 1.7 years), endocarditis was diagnosed in 5 patients. Surgical interventions resulting from complications included tri- cuspid valve repair in 5 patients and pulmonary valve replacement in 6 (2 valve embolization, 2 aortic/coronary compression, 1 primary valve failure, 1 endocarditis). There were 3 deaths during follow-up, 1 from heart failure, 1 from progressive respiratory failure, and 1 of unknown cause.
Conclusions: In this international multicenter study, Sapien valve placement in the native or patched RVOT was found to be feasible with good hemodynamic outcomes and acceptable short-term results. Tricuspid valve injury and valve embolization during the procedure were nota- ble complications. Long-term valve function is yet to be determined
Journal of Structural Heart Disease, August 2019
Volume 5, Issue 4:75-205