Page 20 - Journal of Structural Heart Disease Volume 4, Issue 4

Meeting Abstracts
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Results: Since 2012, a pressure wire was used in all FAV procedures (n=13) with a procedural success rate of 92% (versus 77%-81% in the two largest published reports). Fetal intracardiac hemodynamics were available for ret- rospective review in 7 procedures. Of these fetuses, a BiV circulation was achieved in 4 (with 1 fetus currently still in utero). Comparing intracardiac pressure data to fetal echo data, the measured aortic valve gradients and LV systolic pressures correlated well with the echocardiographic esti- mates. LV end diastolic pressure was not recorded in all patients to allow association with BiV circulation. However, in those with serial measurements, LVEDP generally improved after aortic valvuloplasty, from a median of 22 mmHg pre-valvuloplasty to 16 mmHg postnatally (all BiV patients).
Discussion: Intra-cardiac hemodynamics can be success- fully and easily measured during FAV procedures. The use of a pressure wire may improve procedural success, facili- tating quicker recognition of wire position across the aortic valve. Invasive and non-invasive assessment of LV pressure and aortic gradient correlate closely, and although our data are limited in this case series, assessing LV diastolic function may aid in the ability to predict a successful BiV circulation. If additional centers adopt our technique to measure fetal intra-cardiac hemodynamics, we may build a more robust understanding of how these measurements may predict and improve patient outcomes.
19. TRANSCATHETER AORTIC LEAFLET LACERATION TO PREVENT CORONARY ARTERY OBSTRUCTION DURING TRANSCATHETER AORTIC VALVE REPLACEMENT: CONCEPT TO FIRST-IN-HUMAN Ja ar Khan1, Danny Dvir2, Adam Greenbaum3, Vasilis Babaliaros4, Toby Rogers1, Robert Lederman1
1 National Heart Lung and Blood Institute, Bethesda, USA 2 University of Washington, Seattle, USA
3 Henry Ford Hospital, Detroit, USA
4 Emory University, Atlanta, USA
Transcatheter aortic lea et laceration to prevent coro- nary artery obstruction during transcatheter aortic valve replacement: concept to rst-in-human
Background: Coronary artery obstruction is a rare but devastating complication of transcatheter aortic valve replacement (TAVR), with a 50% mortality. “Chimney” stents deployed in the coronary ostium and snorkeled into the aortic root are an inelegant solution, with risk of stent thrombosis, delayed coronary obstruction, and dif- culty re-engaging the coronary artery. We developed
a technique called Bioprosthetic or native Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction (BASILICA) to cut the aortic lea et in front of the threatened coronary artery immediately prior to TAVR.
Methods: We lacerated bioprosthetic pericardial lea ets in vitro using catheter electrosurgery, and tested lea et splaying after benchtop TAVR. The procedure was tested in anesthetized naïve swine. BASILICA was then o ered to patients at high risk of coronary obstruction from TAVR and ineligible for surgical aortic valve replacement. BASILICA used marketed devices. Catheters directed an electri ed guidewire to traverse and lacerate the aortic lea et down the centerline. TAVR was performed as usual. Carotid pro- tection using marketed devices was used at operator discretion.
Results: TAVR splayed lacerated bovine pericardial lea ets on the benchtop. BASILICA was successful in pigs, both to left and right cusps. Necropsy revealed full length lac- erations with no collateral thermal injury. Seven patients underwent BASILICA on a compassionate basis. Six had failed bioprosthetic valves, both stented and stent-less. Two had severe aortic stenosis, including 1 patient with native disease, 3 had severe aortic regurgitation, and 2 had mixed aortic valve disease. One patient required laceration of both left and right coronary cusps. There was no hemo- dynamic compromise in any patient following BASILICA. All patients had successful TAVR, with no coronary obstruc- tion, stroke, or any major complications. All patients sur- vived to 30 days.
Conclusions: BASILICA addresses the pathophysiology of TAVR-related coronary obstruction with transcatheter lea et laceration. It may be more durable than “chimney” stenting as a coronary protection strategy. The procedure was successful across a range of presentations, and is under evaluation in a prospective trial (NCT03381989). Its role in treatment of degenerated TAVR devices remains untested.
20. HOW CAN WE RESCUE A CRITICAL EXTREMELY SMALL INFANT? BALLOON AORTIC VALVULOPLASTY (BAVP) FOR AN INFANT WEIGHING ONLY 890G.
Naomi Nakagawa1, Masahiro Kamanda1, Yukiko Ishiguchi1, Yuji Moritoh1, Takayuki Suzuki1, Kengo Okamoto1, Kuhikazu Hisamochi2, Takuya Kawabata2
1 Department of Pediatric Cardiology, Hiroshima City Hospital, Hiroshima, Japan
Journal of Structural Heart Disease, August 2018
Volume 4, Issue 4:114-206