Use of covered Cheatham-Platinum stents in congenital heart disease.
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.


CONCLUSIONS
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.
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.
Ward Y
WY
Vanagt
Department of Congenital and Pediatric Cardiology, University Hospital Gasthuisberg, Leuven, Belgium.
Björn
B
Cools
Department of Congenital and Pediatric Cardiology, University Hospital Gasthuisberg, Leuven, Belgium.
Derize E
DE
Boshoff
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.
Stefan
S
Frerich
Department of Congenital and Pediatric Cardiology, University Hospital Gasthuisberg, Leuven, Belgium.
Ruth
R
Heying
Department of Congenital and Pediatric Cardiology, University Hospital Gasthuisberg, Leuven, Belgium.
Els
E
Troost
Department of Congenital and Pediatric Cardiology, University Hospital Gasthuisberg, Leuven, Belgium.
Jacoba
J
Louw
Department of Congenital and Pediatric Cardiology, University Hospital Gasthuisberg, Leuven, Belgium.
Benedicte
B
Eyskens
Department of Congenital and Pediatric Cardiology, University Hospital Gasthuisberg, Leuven, Belgium.
Werner
W
Budts
Department of Congenital and Pediatric Cardiology, University Hospital Gasthuisberg, Leuven, Belgium. Electronic address: Marc.Gewillig@uzleuven.be.
Marc
M
Gewillig
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D020099:Coated Materials, Biocompatible / Q000008:administration & dosage*; D016208:Databases, Factual; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010984:Platinum / Q000008:administration & dosage*; D011859:Radiography; D012189:Retrospective Studies; D015607:Stents / Q000706:statistics & numerical data*; D055815:Young Adult
D020099:Coated Materials, Biocompatible; D010984:Platinum
Cheatham-Platinum; Complication of angioplasty; Congenital heart disease; Covered stent