Page 72 - Journal of Structural Heart Disease Volume 4, Issue 4

Meeting Abstracts
174
St Joseph's Children's Hospital, Tampa, USA
Background: Transcatheter pulmonary valve implantation (TPVI) has expanded the options for addressing recurrent pulmonary valve dysfunction. The most commonly avail- able valve is adequate only for those with a history of sur- gical conduit and rare others with a balloon-sized MPA landing zone <24mm. The Sapien 3 valve o ers the pos- sibility of TPVI for many additional patients with landing zones up to 30mm.
Methods: Retrospective single center study of all patients who underwent a catheterization with the intent to attempt TPVI with a Sapien 3 valve, 2015 – 2018.
Results: 39 patients were brought for evaluation for TPVI with the Sapien 3. 16/39 were female, mean age was 27.3yrs (Range 7-62), and mean weight was 74 kg (range 18.1-159). Diagnosis was TOF variant (n=27), PS (n=7), and other (n=5). 36/39 had undergone prior cardiac surgery (range 1-4) and 2/36 had a surgical RV to PA conduit. 26/39 patients were symptomatic. Indication for TPVI was PR (n=36), PS/PR (n=2), and PS (n=1). Pre-procedural MRI or CTA was performed in 35/39 and a potential landing zone was any location in the RVOT or MPA <30mm in diameter. 34/39 underwent balloon sizing and 22/34 underwent attempted valve delivery. 22/22 attempts were successful. Valve landing zone stent(s) were placed in 14/22 patients. 8/22 valve implants were di cult requiring an RA loop (n=3), buddy wire (n=2), balloon stabilization of delivery wire (n=2), or contralateral branch PA wire position (n=1). Mean uoroscopy was 53.1minutes (range 22.5 – 105.8). A small perivalvar leak was noted in 7/22 patients. Length of stay was 1 day in 20/22 patients. Four major procedural adverse events occurred (stent migration in 2, arrhythmia in
1, and pulmonary hemorrhage in 1). There were no deaths or emergent surgeries. 4/22 developed ventricular ectopy and were discharged on beta blocker. In early follow-up all patients had normalization or near normalization of RV size and none had more than mild tricuspid regurgitation.
Discussion/Conclusion: Sapien 3 TPVI is possible in some patients with pulmonary valve dysfunction and larger right ventricular out ow tracts. Di cult valve advancement should be expected. Patient selection should improve with better analysis of pre-procedure imaging.
114. TRANSCATHETER AORTIC VALVE REPLACEMENT TO TREAT AORTIC INSUFFICIENCY IN PEDIATRIC PATIENTS
Carol McFarland, Mary Hunt Martin, Arvind Hoskoppal, Aaron Eckhauser, Robert Gray
University of Utah, Salt Lake City, USA
Background: Transcatheter aortic valve replacement (TAVR) was designed to treat calci c aortic valve stenosis. Data regarding the use of TAVR to treat aortic insu ciency (AI) in adults is limited and no data exists regarding use within native valves in pediatric patients. These patients require multiple re-interventions over their lifespan. Less invasive options can improve symptoms and function- ality while potentially decreasing open-heart surgical procedures.
Methods: Retrospective case series of pediatric patients who underwent TAVR at the University of Utah from 2015- 2018 for treatment of predominant AI. Percent device oversizing = [1 – (native valve area/nominal device area)] x 100.
114. Table.
1 Shone’s, s/p CoA 14.0 repair, mitral and
aortic valvotomy,
MVR and aortic valvotomy
2 Supracristal VSD s/p 17.9 repair, sub-AS repair,
and sub-AS repair with Konno
3 Unicuspid aortic 8.7 valve s/p aortic
valvotomy
36.3 kg
53.3 kg
23.4 kg
23mm Sapien XT
26mm Sapien 3
26mm Sapien 3
96 minutes
85 minutes
90 minutes
Femoral dissection requiring surgical repair
None
None
Pt
Diagnoses and sur- gical procedures
Age at TAVR (years)
Weight at TAVR
Device size and type
Procedure time
Procedural compli- cations
Journal of Structural Heart Disease, August 2018
Volume 4, Issue 4:114-206