Page 87 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
Abhishek Chakraborty1, Mohanageetha Ardhanari1, Satinder Sandhu2,1
1Jackson Memorial Hospital, Miami, USA. 2University of Miami, Miami, USA
Background: Hemodynamically significant secundum atrial septal defect (ASD) can be associated with atrial arrhythmias.
Objectives: The objectives of this study were to observe the prevalence of atrial arrhythmias in patients who under- went transcatheter/surgical closure of ASD and to identify factors predictive of the occurrence of atrial arrhythmias.
Methodology: Patients older than 4 years who underwent transcatheter or surgical closure of ASD from January 1998 to December 2018 were identified. Patients with concom- itant congenital heart disease and with no follow-up after ASD closure were excluded from our study. Basic demo- graphics, co-morbidities, age of closure, type of closure, presence of atrial arrhythmias before, immediately after and 1 year after closure were identified through retrospec- tive chart review. Factors predictive of the prevalence of atrial arrhythmias: hemodynamic and other cardiovascu- lar characteristics of the patients were identified before closure, immediately after and 1 year after ASD closure. Univariate analysis of risk factors predicting the prevalence of atrial arrhythmias were done using Chi-square test. Binary logistic equation was used to identify independent factors predictive of atrial arrhythmias.
Results: There were 82 patients with age range 4-77 years (25.5±18.4; mean +SD); ASD diameter range 5-44 mm (22.7+10.2). The age at ASD closure was 4-77 years (35+20.5). There were 45 (54.9%) patients with ASD closure before 40 years and 37 (45.1%) had closure after 40 years of age. Comparing the patient characteristics and arrhyth- mias in the surgically corrected group (n=41) vs device clo- sure group (n=41) the only significant difference was the size of the ASD: 20.3 ± 8.5 mm in the device closure group vs 27.2 ± 10.7 in the surgical closure group. There were no statistically significant differences in the prevalence of arrhythmias or other patient characteristics between the two groups. Atrial flutter /fibrillation (AFF) was present in 23.2% of patients before closure. Size of the ASD, presence of mitral regurgitation (MR) or tricuspid regurgitation (TR), right atrial (RA) dilatation, right ventricular (RV) dilation, left atrial (LA) dilatation and presence of right heart (RH) failure were associated with increased prevalence of AFF in this group of patients. RV dilatation was found to be an independent predictor of AFF. AFF was present in 14.6% of patients in immediate post-closure period, and in 14.6%
of patients at 1 year-follow up. Age > 40 years, presence of residual moderate to severe RA dilatation, RV dilatation, LA dilatation, RH failure, MR and TR immediately after the procedure and at 1 year follow up were associated with increased prevalence of arrhythmias at 1-year follow-up. TR in the immediate post-procedure period was predictive of AFF 1-year post closure. At 1 year follow up there were 7 patients (transcatheter closure in 2 and surgical closure in 5) with new onset arrhythmias.
Conclusions: There is significant prevalence of AFF in hemodynamically significant ASD both before and after ASD closure. RV dilatation before closure is a significant predictor of AFF before closure, whereas, presence of mod- erate to severe TR is a significant predictor of AFF post closure.
117. REACHING BEYOND MANUFACTURER RECOMMENDED EXPANSION DIAMETER: SERIAL STENTDILATIONFORSOMATICGROWTHINCHILDREN Peter Guyon1,2, Bryan Mosher1,2, Kanishka Ratnayaka1,2, John Moore1,2, Howaida El-Said1,2
1University of California San Dieog, San Diego, USA. 2Rady Children's Hospital, San Diego, USA
Background: Stenting to relieve vessel stenosis in small patients requires use of small, low-profile stents. Subsequent vessel growth presents a problem since the small stents are not designed or recommended to expand to the size of a mature vessel.
Our primary aim is to examine a cohort of small stents which underwent serial dilation for patient growth. In all cases the stents were expanded beyond the nominal expansion diameter (manufacturer recommendation); in some cases they were expanded near or beyond the exper- imentally reported maximal expansion diameter; and in some cases they were intentionally fractured with re-stent- ing inside the fractured stent. This is the first such study in humans.
Methods: Retrospective review of all cases between 2004 and 2019 in which small diameter Formula, Visi-Pro, and Genesis stents were placed in the aorta or pulmonary arteries and then subsequently dilated for patient growth. Demographic data and procedure data are reported for each stent in the cohort. Key metrics are reported, includ- ing the presence of spontaneous fractures and any serious complications, as well as planned fractures and re-stenting.
Results: A total of 25 stents were implanted in 23 patients. The average age at original stent implantation was 14
Hijazi, Z
22nd Annual PICS/AICS Meeting