Page 28 - Journal of Structural Heart Disease Volume 4, Issue 4

Meeting Abstracts
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and interventional procedures (p = 0.04). We identi ed three factors that, if present at the time of RPH diagnosis were associated with major RPH: (1) chronic anticoagula- tion, (2) angiographic diagnosis of uncontained tear, and (3) hemodynamic compromise (Figure 2). Among patients that had at least one of these three factors at the time of RPH diagnosis, death was correlated with receiving conser- vative management or balloon tamponade with no other invasive management (stenting, coil embolization, and/or surgery) (p = 0.02).
Conclusions: RPH is a rare but potentially serious compli- cation of cardiac catheterization in patients with pediatric and congenital heart disease. Patients with pre-procedure anticoagulation, angiographic diagnosis of uncontained tear, and hemodynamic compromise at time of diagnosis of RPH have a high risk of major RPH and death, so early and aggressive invasive management should be consid- ered for this sub-group. Conservative management can be successful for patients that don’t meet these criteria at time of diagnosis.
31. UTILIZATION OF HEMODYNAMIC ASSESSMENT OF PEDIATRIC HEART FAILURE PATIENTS ON CONTINUOUS FLOW VENTRICULAR ASSIST DEVICES Subhrajit Lahiri1, Swati Choudhury2, Robert Loar2, Athar Qureshi2, Iki Adachi2, HariPriya Tunuguntla2
1Baylor College of Medicine, Houston, United Kingdom. 2Baylor College of Medicine, Houston, USA
Introduction: Optimizing the continuous- ow ventricular assist device (CFVAD) setting is critical for successful long- term support. This is particularly true in pediatric patients supported with adult CFVAD given the inherent issues related to the patient-device size mismatch. We sought to evaluate our single-institutional experience in CFVAD opti- mization using thehemodynamic assessment.
Method: A retrospective analysis of all patients on CFVAD support who underwent right heart catheteriza- tion (including central venous pressure [CVP], Pulmonary artery pressure [PAP], pulmonary capillary wedge pres- sure [PCWP], and blood pressure [BP]), at Texas Children’s Hospital (2013 to 2017) was performed.
Results: Twelve patients on CFVAD support had right heart catheterization performed for CFVAD optimization (8/12, 66%) to achieve balance between cardiac index and right heart function or assessment of explant (4/12, 33%). Dilated cardiomyopathy (7/12, 60%) was the most com- mon diagnosis. The median age at catheterization was 11
years (IQR 8, 17). Median time since CFVAD placement was 318 days (IQR 200, 900). Median baseline speed of device was 2333±253 rotations-per-minute (RPM). Eight patients (61%) had normal CVP (10±4mmHg) and PCWP (11±3.7 mmHg) at their original RPM settings. Hemodynamic data was found to be recorded anywhere between 2 to 4 speed settings. Six patients (50%) had their CFVAD speed increased to achieve optimal balance of cardiac index and right heart function. In 4 (33%) patients CFVAD speed was decreased for case-based hemodynamic optimization or explant. For the remaining two patients speed was not changed as they were found to be already at their optimal hemodynamics.(Table 1) On follow up, 5 patients under- went heart transplant; CFVAD was successfully explanted in 2 patients; and 5 patients remains on CFVAD support (median 3.3 years). Although all patients were on anticoag- ulation there was no post-procedural bleeding.
Conclusion: Use of hemodynamic assessment in pediatric patients with CFVAD support provides objective means of optimizing RPM, and has the potential to guide medical management.
32. OUTCOME OF NORWOOD PATIENTS HAVING CARDIAC CATHETERIZATION WHILE ON ECMO SUPPORT
Haysam Baho, Mohamed Mashaly, jameel Al-Ata, Amjad Kouatly, omar galal
King Faisal Specialist Hospital, Jeddah, Saudi Arabia
Introduction: Norwood repair of hypoplastic left heart syn- drome is a complex procedure which occasionally requires extracorporeal membrane oxygenation support (ECMO). our aim was to evaluate the outcome of those patients who require cardiac catheterization while on ECMO
Methods: Retrospective review of all Norwood repair patients placed on ECMO and had catheterizations per- formed at a single tertiary care center between 2005-2017. Demographic data, diagnosis,catheterization type ,surgi- cal Shunt used and days to decannulation were collected. Primary outcome was in-hospital mortality. Outcome was calculated according to Catheterization results. these were categorized into 4 types: New unsuspected ndings ( group 1 ), Con rmed suspected ndings ( group 2), Ruled out sus- pected ndings ( group 3)and needed Interventional pro- cedures ( group 4 ) . outcome was also calculated according to shunt type.
Journal of Structural Heart Disease, August 2018
Volume 4, Issue 4:114-206