Implantable pulmonary artery pressure monitoring device in patients with palliated congenital heart disease: Technical considerations and procedural outcomes
Salavitabar A, Bradley EA, Chisolm JL, Hickey J, Boe BA, Armstrong AK, Daniels CJ, Berman DP.
Catheter Cardiovasc Interv. 2020 Feb;95(2):270-279. doi: 10.1002/ccd.28528. Epub 2019 Oct 14.
Take Home Points:
- Patient with complex congenital heart disease increasingly survive into adulthood and experience significant morbidity related to heart failure.
- Use of implantable hemodynamic monitor (CardioMEMS™) in this patient population is feasible and safe and allows for continuous tracking of pulmonary artery pressures.
- More work needs to be done to assess the long-term safety and clinical utility of such devices.
Commentary from Dr. Konstantin Averin (Edmonton), catheterization section editor of Pediatric Cardiology Journal Watch: Heart failure (HF) causes significant morbidity in adults with congenital heart disease (CHD). In non-CHD populations the use of implantable hemodynamic monitors (IHM) has been shown to decrease HF-related hospitalizations. To date, the use of these devices in CHD patients has been very limited. The authors sought to describe a single center experience utilizing IHM’s in adult patients with complex CHD – focusing on technical aspects and procedural outcomes.
The authors utilized the CardioMEMS™ device (Abbott Medical, Chicago, IL; picture below), a radiopaque sensor which is delivered via a 12 French sheath over a 0.018”wire and is anchored in a branch pulmonary artery (target diameter 7-15 mm) by a nitinol loop at each end.
Fourteen patients (35.5 ± 9.2 years; 72 ± 12 kg) met inclusion criteria (adult with complex CHD; NYHA FC III HF; and at least one decompensated HF admission referred for hemodynamic catheterization) and underwent successful implant of the CardioMEMS™ device. All patients had either Fontan (n = 8) or d-TGA s/p atrial switch (6) anatomy. The devices were implanted via a femoral vein in most (13/14) and a long sheath was utilized in slightly more than half (8/14). A long sheath was particularly useful when advancing the device in patients who had undergone a Mustard operation (5/8). The device was implanted in the LPA in most patients (12/14) due to easier calibration and subsequent data transmission in this location.
Calibration and subsequent data transmissions were accomplished in all patients. One patient required recalibration (with hemodynamic catheterization) due to significant changes in IHM transmissions. There was one major complication – device migration from the LPA to the RPA – with no clinical sequelae.
The use of IHM’s in patients with CHD is almost non-existent, even though invasive hemodynamics in this patient population are often felt to not be truly representative of patients in their daily lives. The authors have nicely demonstrated that despite the complex anatomies of adults with CHD, IHM implantation is feasible and safe in this patient population. Further studies are clearly needed to demonstrate long-term safety of these devices as they will likely remain in place forever and whether they will improve clinical outcomes.