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Page 1: Aamisha Gupta MD, Zahid Amin MD, Damien Kenny MD, Massimo Caputo … · 2015-10-02 · Background 1.AminZ,BerryJM,Foker JE,1 Rocchini1AP,BassJL.IntraoperativeClosureofMuscularVentricularSeptalDefectinaCanineModeland

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

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

Page 2: Aamisha Gupta MD, Zahid Amin MD, Damien Kenny MD, Massimo Caputo … · 2015-10-02 · Background 1.AminZ,BerryJM,Foker JE,1 Rocchini1AP,BassJL.IntraoperativeClosureofMuscularVentricularSeptalDefectinaCanineModeland

Disclosures

Page 3: Aamisha Gupta MD, Zahid Amin MD, Damien Kenny MD, Massimo Caputo … · 2015-10-02 · Background 1.AminZ,BerryJM,Foker JE,1 Rocchini1AP,BassJL.IntraoperativeClosureofMuscularVentricularSeptalDefectinaCanineModeland

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

Page 4: Aamisha Gupta MD, Zahid Amin MD, Damien Kenny MD, Massimo Caputo … · 2015-10-02 · Background 1.AminZ,BerryJM,Foker JE,1 Rocchini1AP,BassJL.IntraoperativeClosureofMuscularVentricularSeptalDefectinaCanineModeland

Why Perventricular Access?

Page 5: Aamisha Gupta MD, Zahid Amin MD, Damien Kenny MD, Massimo Caputo … · 2015-10-02 · Background 1.AminZ,BerryJM,Foker JE,1 Rocchini1AP,BassJL.IntraoperativeClosureofMuscularVentricularSeptalDefectinaCanineModeland

Objectives

Page 6: Aamisha Gupta MD, Zahid Amin MD, Damien Kenny MD, Massimo Caputo … · 2015-10-02 · Background 1.AminZ,BerryJM,Foker JE,1 Rocchini1AP,BassJL.IntraoperativeClosureofMuscularVentricularSeptalDefectinaCanineModeland

Methods electively

*

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

Page 7: Aamisha Gupta MD, Zahid Amin MD, Damien Kenny MD, Massimo Caputo … · 2015-10-02 · Background 1.AminZ,BerryJM,Foker JE,1 Rocchini1AP,BassJL.IntraoperativeClosureofMuscularVentricularSeptalDefectinaCanineModeland

Methods

Page 8: Aamisha Gupta MD, Zahid Amin MD, Damien Kenny MD, Massimo Caputo … · 2015-10-02 · Background 1.AminZ,BerryJM,Foker JE,1 Rocchini1AP,BassJL.IntraoperativeClosureofMuscularVentricularSeptalDefectinaCanineModeland

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

Page 9: Aamisha Gupta MD, Zahid Amin MD, Damien Kenny MD, Massimo Caputo … · 2015-10-02 · Background 1.AminZ,BerryJM,Foker JE,1 Rocchini1AP,BassJL.IntraoperativeClosureofMuscularVentricularSeptalDefectinaCanineModeland

Procedural Steps: Glidewire Placement

Page 10: Aamisha Gupta MD, Zahid Amin MD, Damien Kenny MD, Massimo Caputo … · 2015-10-02 · Background 1.AminZ,BerryJM,Foker JE,1 Rocchini1AP,BassJL.IntraoperativeClosureofMuscularVentricularSeptalDefectinaCanineModeland

Procedural Steps: Coronary Injection

Page 11: Aamisha Gupta MD, Zahid Amin MD, Damien Kenny MD, Massimo Caputo … · 2015-10-02 · Background 1.AminZ,BerryJM,Foker JE,1 Rocchini1AP,BassJL.IntraoperativeClosureofMuscularVentricularSeptalDefectinaCanineModeland

Cook Medical Extra Large Check-Flow Introducer

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

Page 12: Aamisha Gupta MD, Zahid Amin MD, Damien Kenny MD, Massimo Caputo … · 2015-10-02 · Background 1.AminZ,BerryJM,Foker JE,1 Rocchini1AP,BassJL.IntraoperativeClosureofMuscularVentricularSeptalDefectinaCanineModeland

Cook Medical Extra Large Check-Flow Introducer

Page 13: Aamisha Gupta MD, Zahid Amin MD, Damien Kenny MD, Massimo Caputo … · 2015-10-02 · Background 1.AminZ,BerryJM,Foker JE,1 Rocchini1AP,BassJL.IntraoperativeClosureofMuscularVentricularSeptalDefectinaCanineModeland

Procedural Steps: Pre Stent of RVOT

Page 14: Aamisha Gupta MD, Zahid Amin MD, Damien Kenny MD, Massimo Caputo … · 2015-10-02 · Background 1.AminZ,BerryJM,Foker JE,1 Rocchini1AP,BassJL.IntraoperativeClosureofMuscularVentricularSeptalDefectinaCanineModeland

Procedural Steps: Pre Stent of RVOT

Page 15: Aamisha Gupta MD, Zahid Amin MD, Damien Kenny MD, Massimo Caputo … · 2015-10-02 · Background 1.AminZ,BerryJM,Foker JE,1 Rocchini1AP,BassJL.IntraoperativeClosureofMuscularVentricularSeptalDefectinaCanineModeland

Procedural Steps: Melody Valve Placement

Page 16: Aamisha Gupta MD, Zahid Amin MD, Damien Kenny MD, Massimo Caputo … · 2015-10-02 · Background 1.AminZ,BerryJM,Foker JE,1 Rocchini1AP,BassJL.IntraoperativeClosureofMuscularVentricularSeptalDefectinaCanineModeland

Procedural Steps: Melody Valve Balloon Dilation

Page 17: Aamisha Gupta MD, Zahid Amin MD, Damien Kenny MD, Massimo Caputo … · 2015-10-02 · Background 1.AminZ,BerryJM,Foker JE,1 Rocchini1AP,BassJL.IntraoperativeClosureofMuscularVentricularSeptalDefectinaCanineModeland

Procedural Steps: Post Melody Valve Placement

Page 18: Aamisha Gupta MD, Zahid Amin MD, Damien Kenny MD, Massimo Caputo … · 2015-10-02 · Background 1.AminZ,BerryJM,Foker JE,1 Rocchini1AP,BassJL.IntraoperativeClosureofMuscularVentricularSeptalDefectinaCanineModeland

Procedural Steps: Sheath Removal

Page 19: Aamisha Gupta MD, Zahid Amin MD, Damien Kenny MD, Massimo Caputo … · 2015-10-02 · Background 1.AminZ,BerryJM,Foker JE,1 Rocchini1AP,BassJL.IntraoperativeClosureofMuscularVentricularSeptalDefectinaCanineModeland

Results

Page 20: Aamisha Gupta MD, Zahid Amin MD, Damien Kenny MD, Massimo Caputo … · 2015-10-02 · Background 1.AminZ,BerryJM,Foker JE,1 Rocchini1AP,BassJL.IntraoperativeClosureofMuscularVentricularSeptalDefectinaCanineModeland

Complications

Page 21: Aamisha Gupta MD, Zahid Amin MD, Damien Kenny MD, Massimo Caputo … · 2015-10-02 · Background 1.AminZ,BerryJM,Foker JE,1 Rocchini1AP,BassJL.IntraoperativeClosureofMuscularVentricularSeptalDefectinaCanineModeland

Complications

Page 22: Aamisha Gupta MD, Zahid Amin MD, Damien Kenny MD, Massimo Caputo … · 2015-10-02 · Background 1.AminZ,BerryJM,Foker JE,1 Rocchini1AP,BassJL.IntraoperativeClosureofMuscularVentricularSeptalDefectinaCanineModeland

Complications

Page 23: Aamisha Gupta MD, Zahid Amin MD, Damien Kenny MD, Massimo Caputo … · 2015-10-02 · Background 1.AminZ,BerryJM,Foker JE,1 Rocchini1AP,BassJL.IntraoperativeClosureofMuscularVentricularSeptalDefectinaCanineModeland

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

Page 24: Aamisha Gupta MD, Zahid Amin MD, Damien Kenny MD, Massimo Caputo … · 2015-10-02 · Background 1.AminZ,BerryJM,Foker JE,1 Rocchini1AP,BassJL.IntraoperativeClosureofMuscularVentricularSeptalDefectinaCanineModeland

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