Ward Y Vanagt1, Björn Cools2, Derize E Boshoff2, Stefan Frerich3, Ruth Heying2, Els Troost2, Jacoba Louw2, Benedicte Eyskens2, Werner Budts2, Marc Gewillig4. 1. Department of Congenital and Pediatric Cardiology, University Hospital Gasthuisberg, Leuven, Belgium; Department of Pediatrics, Cardiovascular Research Institute Maastricht CARIM, Maastricht University Medical Center MUMC, Maastricht, The Netherlands; Department of Physiology, Cardiovascular Research Institute Maastricht CARIM, Maastricht University Medical Center MUMC, Maastricht, The Netherlands. 2. Department of Congenital and Pediatric Cardiology, University Hospital Gasthuisberg, Leuven, Belgium. 3. Department of Pediatrics, Cardiovascular Research Institute Maastricht CARIM, Maastricht University Medical Center MUMC, Maastricht, The Netherlands; Department of Physiology, Cardiovascular Research Institute Maastricht CARIM, Maastricht University Medical Center MUMC, Maastricht, The Netherlands. 4. Department of Congenital and Pediatric Cardiology, University Hospital Gasthuisberg, Leuven, Belgium. Electronic address: Marc.Gewillig@uzleuven.be.
Abstract
BACKGROUND: Controversy remains regarding the use of covered stents in congenital heart disease (CHD). We evaluate the possibilities and safety of covered Cheatham-Platinum (CCP) stents in CHD. METHODS: Single-center retrospective CHD-database study of all CCP stents, 2003-2012. Three study groups: aortic coarctation (CoA), right ventricular outflow tract pre-stenting for percutaneous revalvulation (RVOT), and miscellaneous. Continuous data expressed as median (range). RESULTS: 114 CCP stents in 105 patients, age 16.8 years (4.2-71.2). CoA group: 54 CCP stents in 51 patients: 3/54 for aneurysm exclusion, in 51/54 covering used "prophylactically" because of increased risk for vessel tear. Overall, CCP stenting increased the coarctation diameter from 6mm (0-15) to 15 mm (10-20) (p<0.001). RVOT group: 39 CCP stents in 37 patients (34 with RVOT graft, 3 with transannular patch): the graft lumen had shrunken from nominal 21 mm (10-26) to 13 mm (5-22); with the CCP stent the RVOT was redilated to 22 mm (16-26, p<0.001 vs stenosis). Miscellaneous group: 21 CCP stents in 17 patients: closure of Fontan-circuit fenestration (n=5), restoration of superior caval vein (n=2) or pulmonary artery (n=3) patency, relief of supra-pulmonary stenosis (n=2), exclusion of aberrant pulmonary arteries (n=1), cavopulmonary conduit expansion (n=2), Blalock-Taussig shunt flow reduction (n=1), and defibrillator lead protection from sharp stents (n=1). Hybrid procedures performed in 3/17 patients. CCP stent was used as rescue treatment in 2/patients to seal iatrogenic bleeding. CONCLUSION: CCP stents can safely be applied in CHD patients. The covering allows adequate sealing of existing or expected tears, thereby increasing the safety margin with more complete dilation.
BACKGROUND: Controversy remains regarding the use of covered stents in congenital heart disease (CHD). We evaluate the possibilities and safety of covered Cheatham-Platinum (CCP) stents in CHD. METHODS: Single-center retrospective CHD-database study of all CCP stents, 2003-2012. Three study groups: aortic coarctation (CoA), right ventricular outflow tract pre-stenting for percutaneous revalvulation (RVOT), and miscellaneous. Continuous data expressed as median (range). RESULTS: 114 CCP stents in 105 patients, age 16.8 years (4.2-71.2). CoA group: 54 CCP stents in 51 patients: 3/54 for aneurysm exclusion, in 51/54 covering used "prophylactically" because of increased risk for vessel tear. Overall, CCP stenting increased the coarctation diameter from 6mm (0-15) to 15 mm (10-20) (p<0.001). RVOT group: 39 CCP stents in 37 patients (34 with RVOT graft, 3 with transannular patch): the graft lumen had shrunken from nominal 21 mm (10-26) to 13 mm (5-22); with the CCP stent the RVOT was redilated to 22 mm (16-26, p<0.001 vs stenosis). Miscellaneous group: 21 CCP stents in 17 patients: closure of Fontan-circuit fenestration (n=5), restoration of superior caval vein (n=2) or pulmonary artery (n=3) patency, relief of supra-pulmonary stenosis (n=2), exclusion of aberrant pulmonary arteries (n=1), cavopulmonary conduit expansion (n=2), Blalock-Taussig shunt flow reduction (n=1), and defibrillator lead protection from sharp stents (n=1). Hybrid procedures performed in 3/17 patients. CCP stent was used as rescue treatment in 2/patients to seal iatrogenic bleeding. CONCLUSION:CCP stents can safely be applied in CHD patients. The covering allows adequate sealing of existing or expected tears, thereby increasing the safety margin with more complete dilation.
Authors: Maximilian Salcher; Alistair Mcguire; Vivek Muthurangu; Marcus Kelm; Titus Kuehne; Huseyin Naci Journal: BMC Health Serv Res Date: 2017-04-10 Impact factor: 2.655
Authors: Emine Hekim Yılmaz; Mustafa Orhan Bulut; Mehmet Küçük; İlker Kemal Yücel; Abdullah Erdem; Ahmet Çelebi Journal: Anatol J Cardiol Date: 2018-03-21 Impact factor: 1.596