281: Use of covered stents for closure of fenestration in extracardiac cavopulmonary connection: technical aspects and mid-term results

Abstract

Closure of fenestration in a cavopulmonary connection (TCPC) is performed with devices used to close intracardiac or aorto-pulmonary connections. This study presents our data regarding the use of covered stents in patients with fenestrated TCPC. We retrospectively reviewed the data of all the patients receiving a covered stent to close a fenestration of TCPC between 2005 and 2012. 38 patients were included. Mean age and weight were respectively 7.6 years and 20 kg. Femoral access was mainly used (32) but also jugular access (5) and trans-hepatic access (1). A Cheatham Platinum Stent was used (34) but we also used Atrium V12 Stents (4). The balloon size was chosen according to the diameter of the conduit. We used BIB balloon (14) or simple balloon (Tyshak or Balt) (16) (balloon not reported (4)). Mean procedural and fluoroscopy times were respectively 42,5 +/ − 21 and 7,5±6,6 minutes. Mean central venous pressure rose from 10 to 12mmHg. Mean oxygen saturation increased from 90% to 96%. There was one anaphylactic shock at the end of the procedure and one air embolisation without hemodynamic compromise. Full occlusion was confirmed on angiogram in 36 patients. 2 cases required 2 stents to achieve full occlusion. There was one minimal residual shunt and one failure of the procedure with significant residual shunt in a patient with a conduit made of a Gore-Tex patch between the atrium and the pulmonary arteries. There were no embolic event, acute venous thrombosis or arrhythmias. Patients were treated with anti vitamin K for 6 months then aspirin. Mean follow-up is 49 months without thrombo-embolic complication or desaturation. Covered stent is an option to close fenestration in extracardiac TCPC. It is safe, easily achievable with low fluoroscopy time, very low risk of thrombo-embolic events or failure. The good results are sustainable. The main advantage of the technique is to avoid prosthetic device in the atrium