O-8
International experience of 10 zig Covered CP stent correction of Sinus Venosus ASD
Presenter
Eric Rosenthal, MD FRCP, Evelina London Children's Hospital, London, United Kingdom
Eric Rosenthal, MD FRCP1, Shakeel Ahmed Qureshi, M.D.1, Matthew I Jones, M.B.B.S.1, Kothandam Sivakumar, MD DM2, Younes Boudjemline, M.D., Ph.D.3, Ziyad M. Hijazi, M.D., MSCAI4, Salim Almaskary, Almaskary5, Reid D Ponder, Ponder6, Morris M. Salem, M.D., FSCAI7, Kevin Walsh, M.D.8, Damien Kenny, M.D., FSCAI9, Sebastien Hascoet, MD10, Darren P. Berman, M.D., FSCAI11, Gianfranco Butera Sr., M.D., FSCAI12, John D. Thomson, M.D., FSCAI13, Joseph J Vettukattil, M.B.B.S.14 and Evan M. Zahn, MD, MSCAI15, (1)Evelina London Children's Hospital, London, United Kingdom, (2)Madras Medical mission Hospital, Chennai, India, (3)Sidra Heart Center, Doha, Qatar, (4)Weill Cornell Medicine, Doha, IL, Qatar, (5)National Heart Centre, Muscat, Oman, (6)University of California, Los Angeles, Los Angeles, CA, (7)Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, (8)Mater University Hospital, Dublin, Ireland, (9)Children's Health Ireland, Dublin, Leinster, Ireland, (10)-, Paris, France, (11)Children's Hospital Los Angeles, Los Angeles, CA, (12)Ospedale Pediatrico Bambino Gesù, Lamezia Terme, Calabria, Italy, (13)-, Leeds, Leeds, United Kingdom, (14)Helen DeVos Children's Hospital, Grand Rapids, MI, (15)Cedars-Sinai Medical Center, Los Angeles, CA
Keywords: Adult Congenital Heart Disease (ACHD), Atrial Septal Defect (ASD) and Congenital Heart Disease (CHD)
Covered stent correction of sinus venosus ASDs (SVASD) is now an alternative to surgical repair. Challenges include anchoring a stent of sufficient length in a distensible, non-stenotic SVC, expanding the stent to diameters of up to 1.5 – 3 x the SVC at the SVC-RA junction to eliminate the shunt whilst simultaneously avoiding obstruction of anomalous right upper pulmonary venous (RUPV) return to the LA. The 10 zig covered CP (CCP) stent (Numed) has the advantage of being available in lengths of 5 – 11 cm and dilatable to 34 mm in diameter with moderate shortening. The 5 - 6 cm stents have recently received CE marking & FDA approval but longer stents still require formal regulatory permission in most centres.
Methods
An international registry was established to review outcomes of all 10 zig CCP stents in 75 patients aged 11 – 75 years (median 45) from 12 centres (Mar 2016 - Feb 2021). Pre-procedure assessment included diagnostic catheterisation in 30, 3D printed models in 34 and virtual models in 13. Procedural balloon testing used compliant balloons in 56 and/or non-compliant balloons in 42. Pulmonary vein monitoring was retrograde arterial in 20, trans-septal in 42 and by TEE in all.
Results
Additional stents were used to anchor the stent in the SVC or close residual shunts in 32/75. All 8 with SVC landing zone stents needed a 3rd stent for stability. 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. A secundum ASD was also closed in 3 patients and in 2 with pre-existing conduction disorders, transvenous pacing leads were passed through the stent.
Complications: the stent embolised on the recovery ward in 2 patients requiring surgical removal and defect repair; tamponade in another patient was drained after a few days. In one patient with haemoptysis the CT at 3 months showed occlusion of the RUPV. Follow up is from 3 weeks to 5 years (median 1.7 y). QP:QS has reduced from 2.5 +/- 0.5 to 1.2 +/- 0.36 (p<0.001) and RVEDVi from 149.1 +/- 35.4 to 95.6 +/- 21.43 ml/m2 (p<0.001).
Conclusions
10 zig CCPs of 7 – 8 cm appear to provider reliable SVASD closure with a low requirement for additional stents.