Pediatric and Adult Interventional Cardiac Symposium (PICS/AICS 2010)

Abstract

Introduction: Pulmonary artery (PA) rehabilitation is one of the most common procedures performed in the cardiac catheterization laboratory, but solid data on procedure-related adverse events (AE) is scarce with most studies reporting small retrospective, single center experiences. Methods: Data was prospectively collected using a multi-center registry (C3PO). Between 02/07 and 12/09, 8 institutions submitted details on 1315 procedures (proc) that included either balloon angioplasty or stent implantation within a proximal or lobar branch PA. Results: The majority of patients (pts) had either complex 2-ventricle circulation (71%), or single-ventricle physiology (22%). The median age was 3.5 years (1d -70yr). Out of 2894 PA intervention, balloon angioplasty was performed in 51% (>8Atm in 34%), cutting balloon angioplasty in 14%, stent-angioplasty in 14%, and stent implantation in 21%. Procedures included interventions on proximal PAs in 60%, lobar branches in 17%, or both in 23%. Four or more PA lesions were treated in 9% proc. 81% of cutting balloons were used in lobar branches, whereas 82% of all stents were used in proximal branch PAs. Additional interventions were performed in 38% proc. Out of 324 total AE 53% were observed in 815 proc without additional cath interventions: No more than minor AE were documented in 9% proc; moderate/major/ catastrophic (level 3-5) AE were documented in 9% proc. 0.1% patients died as a direct result of the procedure. Type of AE included arrhythmias (16%), hypoxia or hypotension (10%), bleed via ET tube/reperfusion injury (16%), vascular trauma/tear/ aneurysm (19%), balloon rupture/stent migration/ malposition and stentrelated problems (14%), AE at vascular entry site (9%), and other AE (16%). AE were classified as not preventable in 49%, as possibly preventable in 43%, and as preventable in 8%. Factors associated with an increased incidence of level 3-5 AE included age <1 month (31% vs. 10%), date since last surgery <30 days (22% vs. 9%), number of treated lesions >4 (20% vs. 9%). There was a trend for increased risk of AE in pts with complex 2-ventricle and suprasystemic RV (21% vs. 14%). The incidence of level 3-5 AE was not related to weight, use of inotropes at start, location (proximal/lobar) and single vs. complex 2v. Conclusion: PA rehab is associated with not insignificant morbidity. Neonates, early postop period, and multi-level rehab are risk factors for level 3-5 AE.Background: Transcatheter treatment of many congenital and structural heart defects became the method of treatment. Recently new device -Cardio-O-Fix (COF) was introduced into clinical practice. Methods: Five patients aged 0,5 -69 years were included to the study -2 with ASD, 1 with PFO and cryptogenic stroke, and 2 with PDA (one 6 months old infant with additional hypertrophied cardiomyopathy, and 53 y old women after previous ligation of PDA with its recanalization). All were treated percuatneously with Cardio-O-Fix Occluders. There were no preliminary patient selection -the only limitation was the size o...