Page 48 - Journal of Structural Heart Disease Volume 4, Issue 4

Meeting Abstracts
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69. TRANSCUTANEOUS PULMONARY VALVE REPLACEMENT IN PULMONARY ATRESIA WITH INTACT VENTRICULAR SEPTUM
Nicole Herrick1, Jesse Lee2, Kanishka Raynayaka2, John Moore2, Howaida El-Said2
1University of California San Diego, San Diego, USA. 2Rady Children's Hospital San Diego, San Diego, USA
Abstract
Background: Pulmonary atresia with intact ventricu- lar septum (PA/IVS) is a congenital heart lesion tradi- tionally managed by multiple surgical interventions including eventual pulmonary valve replacement. In the current era, those without RV dependent coronary circulation are initially managed with radiofrequency perforation of the pulmonary valve with patent ductus arteriosus stenting (PDA) followed by surgical 1.5 ven- tricle repair (Glenn with antegrade pulmonary blood ow) or biventricular repair (RVOT patch augmentation). Signi cant pulmonary insu ciency is expected result- ing in eventual need for pulmonary valve replacement. Transcutaneous pulmonary valve replacement (TPV) in this population is not well described in the literature.
Methods: Our institution’s catheterization laboratory database was queried to identify patients with PA/ IVS with TPV from 2010 to 2017. Procedural reports, angiograms and clinical records of patients were reviewed. Procedural technique, procedural outcomes, adverse events, and post hospital courses are reported.
Results: Nine patients were found to have PA/IVS and eventually TPV. The median age at TPV 7 years (5-32) and weight 20.3 kg (17.1-80.1). RF perforation/balloon dilation was performed in ve (5/9) patients, balloon dilation alone in one (1/9) and surgical valvotomy in one (1/9). Additional pulmonary blood ow was needed via a PDA stent in ve patients (5/9) and a BT shunt in three (3/9). Eight patients underwent subsequent surgical repair (biventricular repair with patch out ow augmentation (n=4) or 1.5 ventricle repair with bidirectional Glenn (n=4)). One patient did not require surgical intervention. Most common indications for TPV were severe PR with RV dilation (5/9), severe PR (3/9). One patient with bi-directional Glenn had severe PR with hepatic brosis. TPV was successfully implanted in all patients without major complications. Transient ventricular ectopy was seen in two patients with native out ow tracts, one required 2 months of Nadolol without recurrence. At median 9 months follow up (6-35 months), all patients have functional pulmonary valves and are clinically doing well.
Conclusion: PA/IVS which was traditionally managed with multiple surgical interventions, can be conceivably man- aged mostly in the interventional catheterization lab with one surgical operation. TPV can be a safe and e ective alternative to surgical valve replacement in this population.
70. EXPERIENCE FROM THE PILOT PHASE OF INTERNATIONAL QUALITY IMPROVEMENT COLLABORATION CONGENITAL HEART DISEASE CATHETERIZATION REGISTRY (IQIC-CHDCR) IN LOW AND MIDDLE INCOME COUNTRIES (LMICS)
Oliver Barry1, Fatima Ali2, Carlos Corona3, R. Krishna Kumar4, Miguel Ronderos5, Kaitlin Doherty1, Lisa Bergersen1, Kimberlee Gauvreau1, Kathy Jenkins1, Babar Hasan2
1Boston Children's Hospital, Boston, USA. 2Aga Khan University Hospital, Karachi, Pakistan. 3Kardias AC, Mexico City, Mexico. 4Amrita Institute for Medical Sciences, Kochi, India. 5Fundacion Cardioinfantil de Bogota, Bogota, Colombia
Background: Creating a collaborative of health care teams worldwide, IQIC aims to encourage a culture of safety and quality care for CHD patients treated in LMICs. Participation in IQIC has been associated with reduction in major mor- bidity and mortality after CHD surgery. IQIC-CHDCR is established on the same principles and aims at decreasing risk-strati ed adverse events and improve procedure e - cacy for cardiac catheterization performed in CHD patients in LMICs.
Objectives: The objective is to present demographics, procedural details and outcomes related to cardiac cath- eterization in CHD patients whose data was entered in the IQIC-CHDCR during the pilot phase.
Methods: From the experience of IMPACT and C3PO-QI registries, IQIC-CHDCR was designed to collect patient demographics, procedural details and outcomes in all CHD patients undergoing cardiac catheterization. Additionally, a novel e cacy categorization, de ned as ideal, adequate and inadequate based on technical results and safety events, was collected for 5 selected interventions (ASD clo- sure, PDA closure, coarctation, pulmonary and aortic val- vuloplasties). The IQIC-CHDCR pilot phase was opened to 6 participating sites from 5 countries (Mexico (2), Pakistan, India, Malaysia and Vietnam) from October 2017 through December 2018.
Results: A total of 429 patients were entered in the data- base. Most patients (66%) were 1-17 years of age. Majority (71%) of catheterizations were interventions with PDA clo- sure (23%) being most common followed by ASD closure
Journal of Structural Heart Disease, August 2018
Volume 4, Issue 4:114-206