Page 96 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
158
fibrous plaques and endocardial thickening primarily of the right-sided heart valves. In advanced CHD, surgical valve replacement may be required. There are limited data on transcatheter valve replacement (TVR) in patients with CHD.
Objective: This study describes the performance of TVR within native or surgically implanted valves in patients with CHD.
Methods: Multicenter, retrospective study CHD patients who underwent TVR in any position between Jan 2007- Feb 2018. Results are presented as median (interquartile range) or mean. Continuous variables were compared using paired t-test.
Results: Ten patients (6 female) were included from five centers. Median age at TVR was 63.5 years (IQR 59.8-68.5 years), and median weight was 76.5 kg (IQR 61.3-82 kg). All patients were treated with a somatostatin analogue prior to the procedure. Seven patients had undergone prior surgical pulmonary valve replacement (PVR). Median time from surgical PVR to transcatheter (TC) intervention was 2.5 years (1.8-4.5 years). Moderate to severe pulmo- nary regurgitation was present in 8 patients. Ten patients had undergone prior surgical tricuspid valve replacement. Median time from surgical tricuspid valve replacement to TC intervention was 3.3 years (2.1-4.3 years). Seven patients had significant tricuspid valve stenosis (mean inflow gradient 6 mmHg [IQR 5-7.4]) and 4 had moderate to severe regurgitation. All patients underwent success- ful TVR (7 Melody, 3 Sapien) in the pulmonary position (3 native, 1 homograft, 6 bioprosthetic). Peak-to-peak cathe- ter gradient decreased from 22.5 mmHg (IQR 8.5-36.50) to 4 mmHg (IQR 2-10.3) (P = 0.01). Four patients also under- went successful tricuspid TVR (2 Melody, 2 Sapien) within surgical bioprosthetic valves. All pulmonary and tricuspid TVR were performed during the same procedure. There were no procedural deaths. On follow-up, five patients were alive (time from implant to death 1.3 years [IQR 0.3- 4.1]) with median (n=10) follow-up of 2.5 years (IQR 0.5-5). All patients had trivial to mild pulmonary valve stenosis (peak gradient 16.5 mmHg [IQR 5.2-28] compared to 28 mmHg [21-63] (p=0.03) pre-procedure) with no more than mild pulmonary valve regurgitation. No patient had more than mild tricuspid valve insufficiency following tricuspid TVR. The median tricuspid inflow gradient at follow-up was 2.5 mmHg (IQR 1.8-3.3) compared to 6 mmHg (IQR 5.8-6.8) (P=0.01) pre-procedure. There were no valve re-interven- tions prior to death or at the time of most recent follow up.
Discussion: There is limited data on durability of surgical or TC bioprosthetic valves in patients with CHD. The results of this small, multicenter study demonstrate that patients required subsequent valve replacement within 2.5 (IQR 1.8-4.5) and 3.3 (IQR 2.1-4.3) years after surgical pulmonary and tricuspid valve replacement, respectively. Successful TVR was performed with maintenance of valvar function at up to 6 years post procedure (median 2.5 [IQR 0.5-5]). Although additional data and longer follow-up are needed, these results suggest that TVR can be performed safely in these high surgical risk patients.
127. EARLY PULMONARY HYPERTENSION AFFECTING CARDIAC INTERVENTION IN PATIENTS WITH TRISOMY 18
Robert Petersen1, Beth Price2, Renuka Peterson1
1Saint Louis University, St. Louis , USA. 2SSM Health Cardinal Glennon Children’s Hospital, St. Louis , USA
Introduction: Pulmonary hypertension (PH) associated with congenital heart disease (CHD) increases the risk of morbidity and mortality in pediatric patients. In the subset of patients with chromosomal disorders, including triso- mies, studies have shown early development of severe PH which plays a significant role in the management of these patients and which can lead to premature death. This study introduces a series of cases in which pediatric patients with trisomy 18 were diagnosed with severe PH earlier than is expected for their degree of CHD, which has thus guided their management and precluded some patients from fur- ther cardiac intervention.
Methods: A retrospective review was performed initially on eleven patients with Trisomy 18 who presented for car- diac intervention and were suspected of having PH based on bidirectional intracardiac shunting and desaturation. Hemodynamic data were obtained from cardiac catheter- ization or in the operating room. To measure the degree of PH, parameters such as pulmonary vascular resistance index (PVRI), the ratio of right ventricular pressure to left ventricular pressures (RV/LV), and the ratio of total pulmo- nary blood flow to total systemic blood flow (Qp/Qs) were compared.
Results: From 2001 to 2018, 22 patients with Trisomy 18 presented to our institution for cardiac intervention. Our eleven cases with significant PH represented 50% of these patients. Heart defects included ventricular septal defect, patent ductus arteriosus, aortic arch hypoplasia, aortic stenosis, double outlet right ventricle, and atrial septal defect. For patients undergoing cardiac catheterization, the median PVRI was 9.2 WU x m2 with a range of 2 to 28 WU x m2. Reactivity of PH to medical interventions was
Journal of Structural Heart Disease, August 2019
Volume 5, Issue 4:75-205