Page 47 - Journal of Structural Heart Disease Volume 4, Issue 4

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Meeting Abstracts
this multicenter study was to demonstrate the feasibility and safety of utilizing upper extremity venous access for cardiac catheterization in pediatric cardiac catheterization laboratory.
Methods: We performed a retrospective review of all patients who underwent cardiac catheterization via upper extremity vascular access at all 3 institutions.
Results: There were 82 cardiac catheterizations attempted via upper extremity access (basilic or brachial vein) on 72 patients presenting to pediatric cardiac catheterization laboratory. Successful access was obtained in 75 (91%) catheterization attempts in 67 patients. Median age of catheterization was 18.79 years (n=76, interquartile range (IQR) 13.02-32.75) with a median weight of 59.4kg (n=75, IQR 43.3-76.5). The youngest patient was 4.1 months old, weighing 4.3 kg. Local anesthesia or light sedation was utilized in 58% (n=48) of procedures. Ultrasound was used for access in all patients. Diagnostic right heart catheter- ization was the most common procedure (87%, n=65), with 11 cases of acute vasoreactivity testing (15%), and intervention performed via the upper extremity in 8 cases (11%). Interventions included angioplasty, recanalization of occluded veins, thrombectomy, central line fragment retrieval, and veno-venous collateral vessel occlusion. Angiography was performed in 40 catheterizations (53%); with median uoroscopy time of 10.02min (n=75, IQR 2.87- 36.26) and dose area product (DAP)/kg of 3.765cGy cm2/kg (n=64, IQR 0.74-34.12). Patients had a median sheath dura- tion time of 48 minutes (n=57, IQR 19.5-147) and median total procedure time of 116 minutes (n= 65, IQR 80.5-299). Excluding interventions, 36% (n=27) of patients were dis- charged directly from the catheterization laboratory or from post-anesthesia care, with mean length of stay for outpatient procedures of 5.37 hours (n=27, IQR 4.25-6.92). At a median follow-up of 10 months (n=32, IQR 5-17.75), there are no reported complications related to access site.
Conclusions: Upper extremity venous access is a useful, feasible, and safe modality for cardiac catheterization in the pediatric cardiac catheterization laboratory.
68. MEDIUM- TO LONG-TERM OUTCOMES OF PERCUTANEOUS INTRAVASCULAR STENT THERAPY FOR TRANSVERSE AORTIC ARCH HYPOPLASIA
Darren P. Berman, MD1, Joanne L. Chisolm, RN1, Sharon
L. Cheatham, PhD, ACNP1, Brian A. Boe, MD1, Aimee K. Armstrong, MD1, Zach Steinberg, MD2, Thomas K. Jones, MD2, Michiel Voskuil, MD3, Gregor J. Krings, MD4, Jyothsna Akam Venkata, MD5, Tom J. Forbes, MD5, John P. Cheatham, MD1
1Nationwide Children's Hospital, Columbus, USA. 2Seattle Children's Hospital, Seattle, USA. 3University Medical Center Utrecht, Utrecht, Netherlands. 4Wilhelmina Children's Hospital of the University Medical Center Utrecht, Utrecht, Netherlands. 5Children's Hospital of Michigan, Detroit, USA
Background: Transverse aortic arch hypoplasia (TAAH) and abnormal arch geometry are associated with coarcta- tion of aorta (CoA). Both can contribute to systemic hyper- tension following repair of CoA. Intravascular stent therapy can relieve TAAH. Long-term outcomes from this interven- tion are unknown.
Methods: Multi-center retrospective review assessing the medium- to long-term outcomes from stent implantation for treatment of TAAH or obstruction.
Results: From 7/2002 – 12/2017, 146 patients underwent stent implantation with 187 stents to treat TAAH/obstruc- tion. Median (range) age and weight at time of interven- tion were 14.4 yrs (neonate – 63.6 yr) and 53 kg (3-149 kg). Initial procedure was performed for reCoA in 108 (74%). Prior interventions included: end-to-end anastomosis (50), subclavian ap (19), patch (15), other (24). Most stents were bare metal (95%) and open-celled (55%). Stent(s) overlapped 142 arch vessels: left subclavian (92), left com- mon carotid (37), innominate (3), other (10) in 118 (81%) patients. Number of overlapped vessels per patient varied (one - 95, two - 22, three - 1). Struts overlapping carotid branches were dilated in 27/40 (68%). Stent implantation signi cantly reduced the pressure gradient (25.9±16.5 to 4.0±6.1 mmHg, p<0.05). Procedure-related adverse events occured in 19 (13.0%) patients. Nine (6.2%) events required treatment: stent migration (4); aortic wall injury (2) requir- ing covered stent in 1 and surgery in 1; femoral artery access site injury (1) treated with a covered stent; brady- cardia requiring resuscitation (1); death (1) in a patient on ECMO with aortic wall injury. No neurologic events were seen in the 104 patients with follow-up data over a median time of 7 years, including 24 patients with a stent overlap- ping a carotid artery. Fifty-one patients underwent 72 elective re-interventions and 25 required additional stent implantation. Most patients remain on antiplatelet therapy (51%) and ≤1 anti-hypertensive medication (77%).
Conclusions: In this multi-center cohort, stenting the TAA is feasible and e ective. Most cases utilize open-celled bare metal stents with dilation of the struts extending across the carotid branches. In medium to long-term follow up, there were no reported neurologic events and the majority of patients were on ≤1 anti-hypertensive medication. More long-term robust follow-up is needed.
Hijazi, Z
21st Annual PICS/AICS Meeting