Page 23 - Journal of Structural Heart Disease Volume 4, Issue 4

125
Meeting Abstracts
PDA occlusion. In this large cohort, there was no hemo- lysis, mortality, need for surgery or other serious adverse events.
24. TRANSCATHETER STENTING OF SUPERIOR VENA CAVA OBSTRUCTION AFTER PEDIATRIC HEART TRANSPLANTATION: A SINGLE-CENTER EXPERIENCE OF RISK FACTORS AND OUTCOMES
Arash Salavitabar1, Jonathan Flyer2, Warren Zuckerman1, Marc Richmond1, Matthew Crystal1, Mariel Turner1, Paul Chai1, Alejandro Torres1
1New York-Presbyterian Morgan Stanley Children's Hospital/ Columbia University Medical Center, New York, USA. 2The Robert Larner, M.D. College of Medicine at The University of Vermont, Vermont, USA
Objective: Transcatheter stent implantation for superior vena cava (SVC) obstruction following orthotopic heart transplantation (OHT) has been well-described. Pediatric patients may be at greater risk due to smaller absolute ves- sel size, donor-recipient size discrepancies, and complex congenital cardiac disease (CHD). We report a large sin- gle-center pediatric OHT experience that investigates the risk factors for SVC stenosis and procedural outcomes of stent implantation.
Methods: Single-center retrospective study of all pediatric OHTs between 1/1/00 and 12/31/16. Primary outcome was stent implantation in the SVC after OHT. Secondary out- comes included procedural success, clinical improvement, complications, and re-interventions. Primary risk factors included bicaval versus biatrial surgical anastomosis and history of previous superior cavo-pulmonary anastomosis (SCPA).
Results: Nineteen stents were implanted in 12/349 (3.4%) patients at a median 1.8 months (IQR 0.9, 4.8) after OHT. Indications included chylous e usion in 7, SVC syndrome in 3, and echo/angiographic stenosis in 2. Femoral access used in 6 patients, and right and left jugular veins in 4 and 2, respectively. Two patients underwent mechanical thrombectomy pre-stent placement. In 9 patients, a single stent was implanted while the other 3 patients received 2, 3, and 5 stents. Eleven (58%) stents were premounted (1 covered). All procedures were successful with no residual obstruction and no acute procedural complications. Most patients received enoxaparin for 3-6 months. Stent recipi- ents were younger (2.5yrs vs 10.0yrs, p=0.0097), weighed less (8.6kg vs 26.0kg, p=0.0024), and more likely to have had CHD (83% vs 32%, p=0.001) or previous SCPA (58% vs 18%, p=0.002). Bicaval anastomosis was not associated
with subsequent SVC stent implantation. Post-procedure median follow-up 29.7mo. (IQR 9, 141). Chylous e usions resolved within 2 weeks in 6/7 patients and SVC syndrome patients improved. One patient died of multi-organ failure 4 months post-procedure. Four (33%) patients required re-intervention (3 angioplasties, 1 stent) at a mean of 5.7 ± 3.6 months post-stent implantation. There was no residual obstruction at last follow-up.
Conclusions: SVC stent implantation after OHT is a safe and e ective procedure that is associated with younger age, smaller weight, CHD, and history of SCPA, while show- ing no association with bicaval vs. biatrial anastomosis.
25. NEW FUSION IMAGING - VESSELNAVIGATOR IN CHD INTERVENTIONS
Ji Seok Bang, Ja Kyung Yun, Eun Young Choi, Su Jin Park, So Ick Jang, Chung il Noh, Seong-Ho Kim
Sejong General Hospital, Bucheon, Korea, Republic of
Background: VesselNavigator is a new fusion imaging modality which overlays 3D CT image onto a live uoros- copy image. It provides an intuitive and continuous 3D roadmap by rotating overlaid CT imaging at any directions and allows for both advanced diagnostic and interven- tional cardiac catheterization procedures in patients with congenital heart disease(CHD). Therefore, lesions previ- ously considered resistant to interventional therapies can now be managed with high success, such as peripheral pulmonary artery stenosis.
Objectives: Recently, in our institute VesselNavigator was available rst in Asia. We would like to share our initial experiences with the audiences.
Methods: Between May 2016 and March 2018, VesselNavigator has been used in 38 patients with post- operative CHD; tetralogy of Fallot or pulmonary atresia in 17, transposition of great artery in 5, coarctation of aorta in 4, functional single ventricle in 4 and others in 8. Mean age was 13.3(0.4 – 73) years, and mean body weight was 32.4(5.4 – 98) kg. It helped to access a target vessel eas- ily, and to nd out the best angiocamera angle for diag- nosis and interventional procedure without additional angiography.
Results: VesselNavigator was used for pulmonary arterial interventions in 24 (stent in 12, balloon angioplasty in 12), aortic arch interventions in 3, collateral occlusion in 3, other intervention in 3 and diagnosis in 6 patients. Mean
Hijazi, Z
21st Annual PICS/AICS Meeting