Rosenthal E, Qureshi SA, Jones M, Butera G, Sivakumar K, Boudjemline Y, Hijazi ZM, Almaskary S, Ponder RD, Salem MM, Walsh K, Kenny D, Hascoet S, Berman DP, Thomson J, Vettukattil JJ, Zahn EM.Catheter Cardiovasc Interv. 2021 Apr 28. doi: 10.1002/ccd.29750. Online ahead of print.PMID: 33909945
Take Home Points:
- Percutaneous correction of sinus venosus atrial septal defects in carefully selected patients is a feasible alternative to surgical closure.
- 10 zig covered Cheatham-platinum stents may facilitate this procedure by decreasing risk of embolization and minimizing the number of stents needed for defect closure.
- Careful assessment of pulmonary venous return remains a critical aspect of this procedure.
Commentary from Dr. Konstantin Averin (Edmonton), catheterization section editor of Pediatric Cardiology Journal Watch:
Percutaneous correction of sinus venosus atrial septal defects (SVASD) is gaining acceptance as an alternative to surgical closure in anatomically appropriate defects. This novel procedure may be aided by the availability of the 10-zig covered Cheatham-platinum stent (CCPS) due to its longer lengths, larger expansion diameters and less foreshortening. The authors established an international registry and conducted a retrospective analysis of the outcomes of implantation of 10 zig CCPs in patients with SVASDs at 12 centers.
From March, 2016 to February, 2021; 75 patients – median age 45.4 years (range 11.4-75.9) – underwent SVASD closure using a 10 zig CCPS. The technical aspects of this procedure were not the focus of this paper and have previously been described. Three primary techniques were utilized after wire externalization in the right internal jugular (RIJ) vein: (1) primary implant of a 10-zig CCPS (n=60); (2) use of 2 bare metal stents to “sandwich” the CCPS with one serving as a landing zone (n = 8); and (3) externalizing the mounting balloon via the RIJ, crimping the CCPS, and threading a long silk through a superior zig of the stent to facilitate stent positioning (n = 7). Overall, more than one stent was used in 32 patients with a shorter CCPS clearly being a risk factor for requiring an additional stent (Table 1).
There were 4 patients (5.3%) who experienced major complications – 2 stent embolizations after leaving the catheterization laboratory requiring surgical removal and repair of the defect; 1 patient with pericardial tamponade requiring sternotomy 3 days after the procedure (felt to be related to the trans-septal puncture); and 1 patient that ultimately developed right upper pulmonary vein atresia, hemoptysis and required a right upper lobectomy. During a median follow up of 1.8 years all symptomatic patients improved and all patients who had echocardiograms available (66) had a small residual leak or less.
Percutaneous correction of SVASD is again demonstrated to result in technical success with a low rate of complications in a relatively small number of patients. The authors demonstrate that this procedure is facilitated by longer 10 zig stents. The 10-zig CCPS seems to be a valuable tool in the armamentarium of providers seeking to undertake this challenging procedure and may decrease the need for multiple stents while maintain a low risk for stent embolization.