Correction of sinus venosus atrial septal defects with the 10 zig covered Cheatham-platinum stent - An international registry.

Abstract

Covered stent correction of sinus venosus ASDs (SVASD) is a relatively new technique. Challenges include anchoring a sufficiently long stent in a nonstenotic superior vena cava (SVC) and expanding the stent at the wider SVC-RA junction without obstructing the anomalous right upper pulmonary vein (RUPV). The 10-zig covered Cheatham-platinum (CCP) stent has the advantage of being available in lengths of 5-11 cm and dilatable to 34 mm in diameter. An international registry reviewed the outcomes of 10-zig CCP stents in 75 patients aged 11.4-75.9 years (median 45.4) from March 2016. Additional stents were used to anchor the stent in the SVC or close residual shunts in 33/75. An additional stent was placed in 4/5 (80%) with 5/5.5cm CCPs, 18/29 (62%) with 6cm CCPs, 5/18 (28%) with 7cm CCPs, 5/22 (23%) with 7.5/8cm CCPs and 0/1 with an 11 cm CCP. A "protective" balloon catheter was inflated in the RUPV in 17. Early stent embolization in two patients required surgical removal and defect repair and tamponade was drained in one patient. The CT at 3months showed occlusion of the RUPV in one patient. Follow up is from 2months to 5.1 years (median 1.8 years). QP:QS has reduced from 2.5± 0.5 to 1.2± 0.36 (p < .001) and RVEDVi from 149.1± 35.4 to 95.6± 21.43 ml/m2 (p < .001). Ten-zig CCPs of 7-8cm appear to provide reliable SVASD closure with a low requirement for additional stents. Careful selection of patients and meticulous attention to detail is required to avoid complications.