title: The Use and Outcomes of Small, Medium and Large Premounted Stents in Pediatric and Congenital Heart Disease.
abstract: We sought to describe the use and outcomes of small, medium and large premounted stents in patients with congenital heart disease, including incidence of and risk factors for re-intervention and development of in-stent stenosis. Premounted stents offer several advantages over traditional manually crimped bare-metal stents, especially in small patients. There are no data describing the medium-term effectiveness and outcomes of premounted stents in congenital heart disease. We performed a single-center retrospective review of all small, medium and large premounted stents implanted over an 8-year period. Premounted stents were implanted in 71 vessels within 59 patients with a 97 % success rate. Regardless of implantation site, premounted stent implantation resulted in significant improvements in vessel size and pressure gradient (p < 0.0001). Over a median follow-up duration of 3.1 years [interquartile range (IQR) 1.3-5.2], 25 patients (43 %) required re-intervention (18 catheter based, 3 surgical and 4 hybrid) at a median time of 1.4 years (IQR 0.9-3.0) from implant. Factors associated with re-intervention included age ≤1.9 years [hazard ratio (HR) 2.4, p = 0.03], weight ≤11.5 kg (HR 2.5, p = 0.03) and bare-metal premounted stents compared to covered premounted stents (HR 4.2, p = 0.001). In-stent stenosis was diagnosed in 42 % of premounted stents which underwent follow-up angiography. No identified characteristics were associated with in-stent stenosis, including "oversizing" the premounted stent. Small, medium and large premounted stents are effective in treating vascular stenosis in congenital heart disease. Frequent follow-up is required, especially in smaller patients with expected somatic growth, and to evaluate for in-stent stenosis which occurs in nearly half of premounted stents.
authors: The Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205-2664, USA. brian.boe@nationwidechildrens.org.
authors: Brian A
authors: BA
authors: Boe
authors: Division of Pediatric Cardiology, University of Michigan, Ann Arbor, MI, USA.
authors: Jeffrey D
authors: JD
authors: Zampi
authors: Division of Pediatric Cardiology, University of Michigan, Ann Arbor, MI, USA.
authors: Kurt R
authors: KR
authors: Schumacher
authors: Division of Pediatric Cardiology, University of Michigan, Ann Arbor, MI, USA.
authors: Sunkyung
authors: S
authors: Yu
authors: The Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205-2664, USA.
authors: Aimee K
authors: AK
authors: Armstrong
mesh_terms: D002648:Child; D003251:Constriction, Pathologic; D006330:Heart Defects, Congenital; D006801:Humans; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
keywords: Congenital heart disease; Stent implantation; Stent restenosis