aamisha gupta md, zahid amin md, damien kenny md, massimo caputo … · 2015-10-02 · background...

Aamisha Gupta MD, Zahid Amin MD, Damien Kenny MD, Massimo Caputo MD

medtronic.com/melody/melody-­‐system.html  

Disclosures

Background

1.  Amin  Z,  Berry  JM,  Foker  JE,  Rocchini  AP,  Bass  JL.  Intraoperative  Closure  of  Muscular  Ventricular  Septal  Defect  in  a  Canine  Model  and  Application  of  the  Technique  in  a  Baby.  J  Thorac  Cardiovas  Surg.  1998;115:1374-­‐6  

Why  Perventricular  Access?    

Objectives

Methods electively

*  

Absent  Pulmonary  Valve.  Note  :  These  two  patients  had  previously  stented  RVOT    *  Trans-­‐annular  Patch    

Methods

Sub-Costal Incision No Sternotomy

Access Sheath Conclusion

Holoshitz  N,  Ilbawi  M,  Amin  Z.  Perventricular  Melody  Valve  Implantation  in  a  12  kg  Child.  Catheterization  and  Cardiovascular  Interventions  2013;  82:824-­‐827  

Procedural Steps: Glidewire Placement

Procedural Steps: Coronary Injection

Cook Medical Extra Large Check-Flow Introducer

https://www.cookmedical.com/products/ndo_xvcfw_webds/  XVCFW-22.0-35-25  

Cook Medical Extra Large Check-Flow Introducer

Procedural Steps: Pre Stent of RVOT

Procedural Steps: Pre Stent of RVOT

Procedural Steps: Melody Valve Placement

Procedural Steps: Melody Valve Balloon Dilation

Procedural Steps: Post Melody Valve Placement

Procedural Steps: Sheath Removal

Results

Complications

Complications

Complications

Conclusions ü  Our initial experience demonstrates that perventricular Melody Valve placement is

feasible in small sized patients ü Intraoperative TEE guidance may be utilized to prevent tricuspid valve injury ü  RVOT pre-stenting is preferable at the time of valve placement, not preoperatively

Ø  Care needs to be utilized while advancing the sheath across the stented RVOT

ü Procedure requires collaborative approach between CT surgery, interventional cardiology, and anesthesia

ü Associated with an ongoing learning curve ü  Our preliminary data suggests that this approach is a relatively safe alternative to

alleviate multiple reentry surgical sternotomies

Thank You