OR01-4
Percutaneous perforation of the atretic pulmonary valve in pulmonary atresia with intact ventricular septum: A procedural outcomes analysis of radiofrequency versus chronic total occlusion wire perforation
Presenter
Arash Salavitabar, M.D., FSCAI, Nationwide Children's Hospital, Columbus, OH
Arash Salavitabar, M.D., FSCAI1, Sara Conroy, PhD1, Isaac Kistler1, Asaad Beshish, MD2, Ryan M. Callahan, M.D., FSCAI3, Matthew A. Crystal, M.D., FSCAI4, Howaida El-Said, M.D., Ph.D., FSCAI5, Bryan H. Goldstein, M.D., FSCAI6, Michael Hainstock, M.D.7, Ray Lowery, BA8, Amr Matoq, M.D.9, Daniel Mclennan, M.B.B.S.10, George T. Nicholson, M.D.11, Brian Quinn, M.D.12, Shyam K. Sathanandam, M.D., FSCAI13, Jessica Tang, M.D.14, Sara M. Trucco, M.D., FSCAI6, Wendy Whiteside, M.D., FSCAI8 and Darren P. Berman, M.D., FSCAI15, (1)Nationwide Children's Hospital, Columbus, OH, (2)Children's Healthcare of Atlanta / Emory University, Atlanta, GA, (3)Children's Hospital of Philadelphia, Wayne, PA, (4)NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, (5)The University of California, San Diego, San Diego, CA, (6)UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, (7)The University of Virginia, Charlottesville, VA, (8)C.S. Mott Children's Hospital, Ann Arbor, MI, (9)Cincinnati Children's Hospital Medical Center, Cincinnati, OH, (10)Alder Hey Children's Hospital, Liverpool, UK, United Kingdom, (11)Vanderbilt University, Nashville, TN, (12)Boston Children's Hospital, Dedham, MA, (13)The University of Tennessee Health Science Center, Memphis, TN, (14)Children's Hospital of Philadelphia, Philadelphia, PA, (15)Children's Hospital Los Angeles, Los Angeles, CA
Keywords: Congenital Heart Disease (CHD) and TPVR/Pulmonary Valve
Background
Percutaneous pulmonary valve perforation (PVP) is an accepted palliation for pulmonary atresia with intact ventricular septum (PA/IVS), with known major risks. This study aims to compare procedural success and safety between radiofrequency (RF) vs. chronic total occlusion (CTO) wire PVP in PA/IVS.
Methods
Multicenter, retrospective study of attempted percutaneous PVP in PA/IVS from 2007-2019. Descriptive summaries were used to compare procedural outcomes and univariable logistic regression models to estimate odds ratios.
Results
PVP was attempted in 206 patients. Figure 1 is a flowchart of PVP attempts. Median weight 3.1 kg (2.7, 3.5), age 3 days (1, 6). Median procedure duration was 106 min (76, 142). PVP was successful on first attempt in 104 (63%) in RF group and 20 (74%) in CTO group, with overall success of 95% in RF and 96% in CTO when excluding wire type crossover. Use of stiff end of coronary wires was included to capture cross-over to RF and CTO, which was minimal. Comparing patients who received only RF vs. only CTO attempts, overall and major complication rates were 27.2% and 16.7% with RF, and 12.5% and 4.2% with CTO. Pulmonary artery/RVOT perforation occurred in 11% with RF and 3.7% with CTO. There was a 3.6 times increased odds of any complication (95% CI 1.9, 7.0, p<0.01) and 5 times increased odds of major complication (95% CI 2.3, 11.3, p<0.01) in cases with multiple vs. 1 attempt, but with similar success rates (91% vs. 95%, OR 0.5 [0.2, 1.7], p=0.25).
Conclusions
RF and CTO PVP have high success rates, but with higher complication rates with RF. There is an increased odds of complications with multiple perforation attempts, as compared with one attempt.
