Page 30 - Journal of Structural Heart Disease Volume 4, Issue 4

Meeting Abstracts
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structural integrity of the coronary stent in this environ- ment is uncertain.
Methods: An invitro model was constructed to represent the interaction between coronary and out ow tract stents. One AndraStent, four CP stents, one Edwards SAPIEN XT valve stent and combination of AndraStent with CP stent were incrementally compressed against a 4mm coro- nary stent. The test apparatus designed to compress the stents was constructed from a linear slide table with cus- tom Aluminum wall mounts. The stent diameters were measured with a code developed in MATLAB. The relative decrease in diameter was calculated for each stent over a range of compression.
Results: In all combinations of stents, the coronary stent lost signi cant more relative diameter when compared with the larger out ow tract stents. At the maximum compressive amplitude, the average percent decrease in diameters of the AndraStent versus the coronary stent were 8.1%±0.8% and 36.5%±11.1% respectively. For the CP stent versus coronary stent, was 5.7%±0.8% and 45.2%±9.2% respectively. Combination CP stent within the AndraStent, versus the coronary stent were 3.9%±0.5% and 54.5%±4.2% respectively. Edwards Sapien stent ver- sus the coronary stent were 1.7%±0.1% and 68.9%±1.1% respectively. Deformation of the coronary stents varied signi cantly depending on the out ow tract stents with greater than 1mm of compression. The coronary stent had the greatest relative decrease in diameter when interact- ing with the Edwards SAPIEN XT valve.
Conclusion: The Edwards Sapien XT valve stent has the greater relative radial force demonstrated by the greater relative decrease in diameter of the coronary stent at nal compressive amplitude. These results support the concern that coronary stenting in the presence of coronary com- pression by an out ow tract stent implantation is likely to result in a signi cantly compromised coronary lumen; however, it may still be the best lifesaving option in the face of potentially catastrophic acute ischaemia.
36. OUTCOMES OF TRANSCATHETER PULMONARY ARTERY REHABILITATION IN PATIENTS WITH SYNDROMIC PULMONARY ARTERIOPATHIES
Scott Leopold1, Patrick Sullivan1, Cheryl Takao1, Sarah Badran1, Frank Ing2
1Children's Hospital Los Angeles, Los Angeles, USA. 2University of California, Davis, Sacramento, USA
Background: There are few reports in the literature on the outcomes of transcatheter pulmonary artery rehabilitation in patients with syndromic pulmonary arteriopathies.
Methods: Single-center review of pts with syndromic pul- monary arteriopathies undergoing catheterization from 2005 to 2017.
Results: 27 pts with syndromic pulmonary arteriopathies [Williams (n=11), Non-Williams familial arteriopathy (n=8), Alagille (n=7), and infantile arterial calcinosis (n=1)] under- went initial cath procedures for evaluation of their PA anat- omy at a median age and wt of 19 mo and 10.7 kg. 17 pts underwent interventional cath procedures, 10 of whom had undergone prior surgical pulmonary arterioplasty.
At initial intervention, 37 vessels (17 central, 20 peripheral) underwent balloon angioplasty and 17 vessels (9 cen- tral, 8 peripheral) underwent stent implantation. Cutting balloons were used once. Mean minimal PA diameter increased from 2.34±1.05 to 3.75±1.51 mm (p <0.0001). RV:systemic pressure ratios were 0.93±0.42 initially and 0.74±0.27 post intervention (p=0.14). Stent implantation was acutely superior to balloon angioplasty in all genetic diagnoses.
40 vessels in 17 pts underwent 96 cath reinterventions [46 repeat angioplasties, 20 stent implantations after initial angioplasty, 26 repeat stent dilations, and 4 repeat stent implantations] over a median follow up time of 26 mo (range 0-113). Pts on average had a reintervention every 15.8 mo. In-stent restenosis occurred after 54% of stent implantations and restenosis occurred after 76% of bal- loon angioplasties. 3 pts were referred for post interven- tion surgical PAplasty.
At most recent catheterization, among pts with follow up, mean minimal PA diameter had increased from an initial 2.36±1.30 to 4.17±2.04 mm (p <0.0001) and RV:systemic pressure ratio decreased from an initial 0.94±0.43 to 0.68±0.25 (P =0.015). There was 1 stent embolization in a Williams pt, 3 cases of pulmonary hemorrhage in 2 Alagille pts, no emergent operations, and no procedural deaths.
Conclusions: Transcatheter PA rehab, often coupled with surgical PA plasty, can safely and e ectively reduce RV:DAO pressure ratios and result in branch PA growth in pts with syndromic pulmonary arteriopathies.
Journal of Structural Heart Disease, August 2018
Volume 4, Issue 4:114-206