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 6 mm (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.