Page 49 - Journal of Structural Heart Disease Volume 4, Issue 4

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Meeting Abstracts
(13%). There was low mortality (n=2, 0.5%). Adverse events were reported in 7% of cases; most common were blood transfusion within 72 hours (2.8%) and anesthesia related events (1.8%). In the 5 selected interventions, technical procedural competence was “ideal” most frequently in PDA (95%) and ASD closure (90%). Procedural competence was technically “inadequate” most commonly in coarctation (100%), and aortic and pulmonary valvuloplasties (50%) due to high post-procedure residual gradients.
Conclusion: IQIC-CHDCR is a unique e ort to understand the spectrum of cardiac catheterization performed on CHD patients in LMIC. Safety event reporting and novel catego- rization of procedure e cacy may identify potential areas for quality improvement. Adverse events related to blood transfusions and anesthesia may bene t from such initia- tives. Procedural e cacy in valvuloplasties and coarcta- tion interventions may also be target areas.
71. THREE-DIMENSIONAL PRINTING AIDS IN PROCEDURAL PLANNING FOR TRANSCATHETER DUCTAL STENT PLACEMENT: A SINGLE-CENTER CASE SERIES
Reid Chamberlain1, Gregory Sturgeon1, Piers Barker1, Kevin Hill1,2, Gregory Fleming1
1Duke University, Durham, USA. 2Duke Clinical Research Institute, Durham, USA
Background: Three-dimensional (3D) printing is gaining traction as a means to better understand complex congen- ital cardiac anatomy prior to trans-catheter interventions. In 2017 our institution initiated a protocol including 3D printing for ductal stent placement in infants with ductal dependent pulmonary blood ow. Herein we report our experience.
Methods: 3D printing was performed from CT angiogram using Materialise Mimics and 3-matic (Materialise Leuven, Belgium) software with Stratasys Polyjet J750 (Stratasys Ltd. Eden Prairie, MN) printer on Vero and Tango photo- polymers. Determination of access was based on pre-pro- cedural review of the 3D model. Ductal dimensions were measured from the 3D model and compared with intra-procedural biplane angiography. Ductal tortuosity was quanti ed as an index comparing actual length of the vessel along its curvature to the linear length from aortic take-o to pulmonary insertion [(actual/straight length–1) x 100].
Results: Ductal anatomy 3D printing was performed in 6 infants. Most (4/6) demonstrated reverse angle ductal
morphology classi ed as Krichenko type C (n=2), D (n=1) and E (n=3). Median age and average weight (range) at stent placement were 15.5 days (7-122 days) and 3.2 kg (2.3-4.5kg). From 3D models we identi ed appropriate access approaches (4 carotid and 2 femoral) and suc- cessfully placed ductal stents in all 6 patients, including one with bilateral PDAs. A total of 13 bare metal coro- nary stents were deployed at a median diameter of 3.5 mm (3.0mm-4.0mm). Overall, 5 of 7 PDAs required more than one stent for complete coverage. All PDAs were tor- tuous, mean tortuosity index 90.0 (11.2-194.0), with the lowest tortuosity index in the 2 patients requiring a sin- gle stent. Ductal length by 3D model tended to measure longer than angiography (17.1 ± 4.8mm vs 14.6 ± 4.3mm, p=0.30) and more closely approximated total stent length (mean di erence in total stent to measured ductal length 1.9 ± 2.0mm by 3D vs 4.39 ± 2.3mm by angiography, p=0.07).
Conclusions: In our experience, 3D modelling and print- ing prior to ductal stent placement for ductal dependent pulmonary blood ow is useful in determining access approach for the procedure, and for optimally estimating ductal length and tortuosity.
72. LONG-TERM SUSTAINED INCREASE IN SYSTEMIC OXYGEN SATURATION WITH LOW MORBIDITY AND MORTALITY FOLLOWING TRANSCATHETER FONTAN FENESTRATION CLOSURE
Rajiv Devanagondi1, Glenn Leonard1,2
1University of Rochester, Rochester, USA. 2Pediatric Cardiology Associates of Western New York, Bu alo, USA
Background: Surgical Fontan fenestration decreases cen- tral venous pressure and preserves cardiac output while decreasing systemic arterial oxygen saturation immedi- ately following Fontan operation. Transcatheter fenes- tration closure increases oxygen saturation immediately, though the persistence of this increase and the long-term incidence of adverse outcomes such as death and heart transplant remain unknown. We describe immediate and long-term clinical and adverse outcomes following tran- scatheter fenestration closure.
Methods: Catheterization, echocardiogram, and clinic reports were retrospectively reviewed following transcath- eter extra-cardiac Fontan fenestration closure between 1/1/2003 and 12/31/2016. Data were reported as n(%) and median (IQR). Continuous variables were compared using Wilcoxon ranked sum test.
Hijazi, Z
21st Annual PICS/AICS Meeting