Correction of sinus venosus atrial septal defects with the 10 zig covered Cheatham‐platinum stent – An international registry

Abstract

Background Covered stent correction of sinus venosus ASDs (SVASD) is a relatively new technique. Challenges include anchoring a sufficiently long stent in a nonstenotic superior vena cava (SVC) and expanding the stent at the wider SVC‐RA junction without obstructing the anomalous right upper pulmonary vein (RUPV). The 10‐zig covered Cheatham‐platinum (CCP) stent has the advantage of being available in lengths of 5–11 cm and dilatable to 34 mm in diameter. Methods An international registry reviewed the outcomes of 10‐zig CCP stents in 75 patients aged 11.4–75.9 years (median 45.4) from March 2016. Additional stents were used to anchor the stent in the SVC or close residual shunts in 33/75. An additional stent was placed in 4/5 (80%) with 5/5.5 cm CCPs, 18/29 (62%) with 6 cm CCPs, 5/18 (28%) with 7 cm CCPs, 5/22 (23%) with 7.5/8 cm CCPs and 0/1 with an 11 cm CCP. A “protective” balloon catheter was inflated in the RUPV in 17. Results Early stent embolization in two patients required surgical removal and defect repair and tamponade was drained in one patient. The CT at 3 months showed occlusion of the RUPV in one patient. Follow up is from 2 months to 5.1 years (median 1.8 years). QP:QS has reduced from 2.5 ± 0.5 to 1.2 ± 0.36 (p < .001) and RVEDVi from 149.1 ± 35.4 to 95.6 ± 21.43 ml/m2 (p < .001). Conclusions Ten‐zig CCPs of 7–8 cm appear to provide reliable SVASD closure with a low requirement for additional stents. Careful selection of patients and meticulous attention to detail is required to avoid complications.

Modified safety techniques for transcatheter repair of superior sinus venosus defects with partial anomalous pulmonary venous drainage using a 100‐mm Optimus‐CVS® covered XXL stent

“…3,5 Assessing the patency of the foramen ovale can ease some procedural steps. 5 Our case confirms that RULPV continuous access is important as it allows continuous pressure monitoring and the possibility of bail-out balloon dilation or even stenting in the event of pulmonary vein obstruction. Pulmonary venous protection can be very helpful in preventing excessive bulging of the stent into the pulmonary venous pathway.…”

“…In larger volume centers, 3D models are now used infrequently. A perfect understanding of the anatomy through precise measurement protocol of both TEE and multiplanar reconstruction CTA images might allow us to consistently identify eligible patients 5,6 …”

“…Moreover, we present two modified techniques for securing the implantation: temporary stent suture trapping and flaring the unique bare‐metal hybrid‐cell cranial end of the Optimus‐CVS into the innominate vein. The original suture control technique of Y. Boudjemline was previously published 5 . However, we modified it for a simpler approach to the stent mounting, less manipulation of the stent‐balloon unit, and a down‐sized delivery sheath in the neck.…”

Selección de lo mejor del año 2021 en cardiopatías congénitas

“…El implante de un stent recubierto desde la vena cava superior a la aurícula derecha ha sido descrito como tratamiento de los defectos tipo seno venoso superior únicamente en forma de pequeñas series de casos. Este trabajo 19 es un registro multicéntrico extenso (75 pacientes) que confirma los buenos resultados de esta técnica: sin mortalidad y una tasa baja de complicaciones que permiten plantear la técnica como una alternativa competitiva a la cirugía. No obstante, existen complicaciones específicas (la embolización del stent y la oclusión del drenaje venoso anómalo) que pueden llegar a precisar cirugía urgente, por lo que es esencial la selección apropiada de los casos, así como una planificación rigurosa.…”

New Insights into Sinus Venosus Defects from Cross-Sectional Imaging

“…Since its introduction in 2013 by Abdullah et al and in 2014 by Garg et al, transcatheter approach using a covered stent has increasingly been adapted [53,[70][71][72]. A large clinical series showed a suitability of transcatheter correction in >75% of patients with superior sinus venosus defect [53].…”