Page 86 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
148
114. HYBRID SUBXIPHOID APPROACH AS AN ALTERNATIVE ACCESS IN CHILDREN UNDERGOING COMPLEX CONGENITAL HEART INTERVENTIONS
Li Yen Ng, Khalid Al-Alwi, Jonathon McGuinness, Lars Nölke, Mark Redmond, Brian McCrossan, Paul Oslizlok, Kevin Walsh, Damien Kenny
Our Lady Children Hospital Crumlin, Dublin , Ireland
Background: Hybrid perventricular approach provides direct access through the heart and may alleviate the tech- nical limitations of complex percutaneous interventions particularly in infants with low body weight. We present our single centre experience and outcomes using this approach.
Method: Retrospective review of patients less than 15kg who underwent a hybrid perventricular approach via a small subxiphoid incision. Medical records were reviewed to obtain clinical, demographic and outcome data.
Results: 12 patients underwent 13 hybrid perventricular procedures using a subxiphoid approach. Median age at time of procedure was 5.5 months (9 days to 39 months) and median weight was 6.9kg (2-10.7). Procedure success rate was 100% none of the cases reverted to open surgical repair. Five patients underwent hybrid pulmonary valve replacement with three of these undergoing supplemental pulmonary artery stenting. Three patients underwent pul- monary outflow stenting and 2 infants underwent hybrid VSD device closure. One patient with a single ventricle who did not tolerate a percutaneous approach underwent LPA stenting for severe LPA coarctation with subsequent RVOT stenting. One further patient underwent implantation of a larger diameter stent for pulmonary artery bifurcation stenosis. There were no intra-procedural complications however one patient died within 72 hours. Minor adverse events occurred in 2 patients including a wound infection in one patient with an immunodeficiency syndrome.
Conclusion: Hybrid subxiphoid approach provides excel- lent alternative access to the heart especially in low birth weight infants to prevent hemodynamic instability or in small children requiring large delivery sheaths.
115. TRANSCATHETER THERAPY OF CONGENITAL AND POSTOPERATIVE PULMONARY VEIN STENOSIS.
Tatiana Molina-Sánchez, José García-Montes , JuanPablo Sandoval-Jones, Carlos Zabal-Cerdeira , Juan Calderón- Colmenero
Ignacio Chavez National Institute of Cardiology, Mexico City, Mexico
Background: Pulmonary vein stenosis (PVS) either con- genital or acquired (i.e. postoperative, post-radiofrequency ablation procedures) is associated with significant morbid- ity and poor outcome. Grim prognosis remains in patients affected with pulmonary vein stenosis and are often sub- ject to repeated interventions.
Methods: Single center retrospective review including all children (0-18 years) who underwenttranscatheter pul- monary vein intervention (balloon angioplasty or stent implantation) for congenital or postoperative PVS between January 2009 and January 2019.
Results: Fifteen patients underwent pulmonary vein inter- vention (balloon angioplasty (n=4,27%); stent implanta- tion (n=11, 73%) at a median age of 16 months (1 month-16 years). Intervention was consequence of postoperative PVS for total pulmonary venous return repair in 86% of cases. Single vein intervention was performed in 5 children, two veins in nine and one patient required intervention in all 4 pulmonary veins. For patients undergoing stent placement only one had two placitaxel-coated stents deployed, the rest were performed using appropriately sized standard bare metal coronary stents. Acute relief of obstruction (from a technical standpoint) was considered successful according to luminal gain determined on repeat angiog- raphy in all cases. Pullback pulmonary vein gradient post stent delivery was only recorded in 9 (52%) patients. A gra- dient decrease of ≥75% was achieved in 6 (66%) of these 9 patients. Major complications included stent embolization in one patient and pulmonary vein perforation in another. Early 30-day mortality occurred in 20% despite interven- tion. In addition, early catheter reintervention was high in our series (up to 20%).
Conclusions: A percutaneous approach for secondary PVS may be considered an alternative in selected candidates. However, despite technical success (if considering luminal gain after balloon or stent angioplasty), frustration is fre- quently met when dealing with this complex intervention due to considerable mortality and high rate of restenosis leading to reintervention in this often extremely fragile population.
References:
1. Circ Cardiovasc Interv. 2012;5:109-117.
2. J Am Coll Cardiol Intv 2017: 10; 17: 1788 - 1798
116. PREVALENCE AND PREDICTORS OF ATRIAL ARRHYTHMIAS IN CLINICALLY SIGNIFICANT SECUN- DUM ATRIAL SEPTAL DEFECT
Journal of Structural Heart Disease, August 2019
Volume 5, Issue 4:75-205