The Heart Center, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio.
Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Catheter Cardiovasc Interv. 2020 Feb;95(2):270-279. doi: 10.1002/ccd.28528. Epub 2019 Oct 14.
We describe the technical considerations of transcatheter implantation of the CardioMEMS™ HF System (Abbott, Abbott Park, IL) in adult patients with complex palliated congenital heart disease (CHD) and advanced heart failure (HF).
Ambulatory pulmonary artery (PA) pressure monitoring with implantable hemodynamic monitors (IHMs) has been shown to reduce HF-related hospital admissions in non-CHD populations. HF is a common late cardiovascular complication in adult CHD necessitating better understanding of IHM application in this population.
We analyzed adults with complex CHD and advanced HF who were referred for CardioMEMS™ device implantation (2015-2018). Feasibility of device implantation, defined by successful device implantation and calibration, and procedural outcomes were evaluated.
CardioMEMS™ was successfully implanted in all 14 adults (35.5 ± 9.2 years old, 72 ± 12 kg) with complex CHD (single ventricle/Fontan, n = 8 [57%]; d-transposition of the great arteries/atrial switch, n = 6 [43%]). The device was delivered via femoral venous access in 13 (93%) patients and implanted in the left PA in 12 (86%). A long sheath was used in 8 (57%) patients, including 5/6 with an atrial switch operation. There was one device migration that did not require retrieval.
Transcatheter implantation of an IHM is feasible in select complex adult CHD patients with advanced HF. Further studies evaluating integration of ambulatory hemodynamics and the impact on clinical care are needed. This technology has the potential to improve medical management of advanced HF in patients with Fontan and atrial switch physiologies and provide new insights into their ambulatory hemodynamics.
我们描述了在患有复杂姑息性先天性心脏病（CHD）和晚期心力衰竭（HF）的成年患者中经导管植入 CardioMEMS™ HF 系统（雅培，雅培公园，IL）的技术考虑因素。
在非 CHD 人群中，使用植入式血流动力学监测器（IHM）进行可移动肺动脉（PA）压力监测已被证明可减少 HF 相关的住院治疗。HF 是成人 CHD 的常见晚期心血管并发症，需要更好地了解在该人群中应用 IHM。
我们分析了 2015 年至 2018 年期间因 CardioMEMS™ 装置植入而转诊的患有复杂 CHD 和晚期 HF 的成年人。评估了装置植入的可行性（定义为成功的装置植入和校准）和程序结果。
CardioMEMS™ 在所有 14 名患有复杂 CHD（单心室/Fontan，n = 8 [57%]；d-大动脉转位/心房开关，n = 6 [43%]）的成年人中均成功植入。该装置通过股静脉通路在 13 名（93%）患者中输送，并在 12 名（86%）患者中植入左 PA。在 8 名（57%）患者中使用了长鞘，其中包括 5/6 名心房开关手术患者。有 1 例装置迁移，但无需取出。
在患有晚期 HF 的选择复杂的成年 CHD 患者中，经导管植入 IHM 是可行的。需要进一步研究评估可移动血流动力学的整合及其对临床护理的影响。这项技术有可能改善 Fontan 和心房开关生理患者的晚期 HF 医疗管理，并为其可移动血流动力学提供新的见解。
