Covered Stent Correction for Sinus Venosus Atrial Septal Defects, an Emerging Alternative to Surgical Repair: Results of an International Registry
Abstract
BACKGROUND: Covered stent correction for a sinus venosus atrial septal defect (SVASD) was first performed in 2009. This innovative approach was initially viewed as experimental and was reserved for highly selected patients with unusual anatomic variants. In 2016, increasing numbers of procedures began to be performed, and in several centers, it is now offered as a standard of care option alongside surgical repair. However, covered stent correction for SVASD is not recognized by regulatory authorities, and in the minds of many pediatric and adult congenital cardiologists and surgeons, the condition is viewed as treatable only by cardiac surgery with cardiopulmonary bypass. METHODS: In April 2023, all centers identified from international conferences, publications, and colleague networks to be undertaking covered stent correction for SVASD were invited to participate in a retrospective audit of their procedures. RESULTS: Data were received on 381 patients from 54 units over a 12-year period with 90% of procedures being performed over the past 5 years. Balloon-expandable stents (8 types) were used in the majority; self-expanding stents (4 types) were used in 4.5%. The commonest stent was the 10-zig covered Cheatham Platinum stent in 62% of cases. In 10 procedures, the stent embolized requiring surgical retrieval and repair of the defect, resulting in technically successful implantation in 371 of 381 (97.4%). Major complications (surgical drainage of tamponade, pacemaker implantation, surgery for pulmonary vein occlusion, and late stent removal) occurred in 5 patients (1.3%). Repeat catheterization to correct residual leaks was required in 7 patients (1.8%). Thus, 359 of 381 patients (94.2%) had successful correction without major complications or additional catheter interventions. CONCLUSIONS: This article details the exponential uptake of covered stent correction for SVASD during the past 5 years. Cardiopulmonary bypass was avoided in the majority of patients, and major complications were infrequent. Prospective registries with standardized definitions, inclusion criteria, and follow-up and comparative studies with surgery are now required to help support the extension of covered stent correction as an alternative standard-of-care option for patients with an SVASD.
Article Details
Authors (70)
Eric Rosenthal
Paediatric and Adult Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s & St Thomas’ Hospital Trust, UK (E.R., S.A.Q., M.J., S.-F.Y., S.K.).
Shakeel A. Qureshi
Paediatric and Adult Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s & St Thomas’ Hospital Trust, UK (E.R., S.A.Q., M.J., S.-F.Y., S.K.).
Kothandam Sivakumar
Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India (K.S., P.S., P. Thejaswi).
Matthew Jones
San-Fui Yong
Paediatric and Adult Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s & St Thomas’ Hospital Trust, UK (E.R., S.A.Q., M.J., S.-F.Y., S.K.).
Saleha Kabir
Paediatric and Adult Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s & St Thomas’ Hospital Trust, UK (E.R., S.A.Q., M.J., S.-F.Y., S.K.).
Pramod Sagar
Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India (K.S., P.S., P. Thejaswi).
Puthiyedath Thejaswi
Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India (K.S., P.S., P. Thejaswi).
Sébastien Hascoet
Clement Batteux
Department of Congenital Heart Diseases, Centre de Reference Cardiopathies Congenitales Complexes M3C, Hospital Marie Lannelongue, Groupe Hospitalier Paris, Saint Joseph, Universite Paris-Saclay, Paris, France (S.H., C.B.).
Younes Boudjemline
Sidra Heart Center, Sidra Medicine, Doha, Qatar (Y.B., Z.M.H.).
Ziyad M. Hijazi
Sidra Heart Center, Sidra Medicine, Doha, Qatar (Y.B., Z.M.H.).
Jamil A. Aboulhosn
Daniel S. Levi
Division of Pediatric Cardiology, Mattel Children’s Hospital at UCLA, Los Angeles, CA (D.S.L., M.M.S.).
Morris M. Salem
Division of Pediatric Cardiology, Mattel Children’s Hospital at UCLA, Los Angeles, CA (D.S.L., M.M.S.).
Edwin Francis
Aster Medcity Hospital, Kochi, India (E.F.).
Aleksander Kempny
Adult Congenital Heart Disease, Royal Brompton Hospital, London, UK (A.K., A.F., C.B.-R.).
Alain Fraisse
Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Institute, Iran University of Medical Sciences, Tehran (A.F., Z.K.).
Carles Bautista-Rodriguez
Adult Congenital Heart Disease, Royal Brompton Hospital, London, UK (A.K., A.F., C.B.-R.).
Kevin Walsh
Damien Kenny
Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (K.W., D.K., B.T.).
Brian Traynor
Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (K.W., D.K., B.T.).
Salim N. Al Maskari
Paediatric Cardiology, National Heart Centre, Muscat, Oman (S.N.A.M.).
James R. Bentham
Department of Congenital Cardiology, Leeds General Infirmary, UK (J.R.B.).
László Környei
Gottsegen National Cardiovascular Center, Budapest, Hungary (L.K.).
Muthukumaran C. Sivaprakasam
Department of Paediatric Cardiology, Apollo Children’s Hospital, Chennai, India (M.C.S.).
Ata Firouzi
Adult Congenital Heart Disease, Royal Brompton Hospital, London, UK (A.K., A.F., C.B.-R.).
Zahra Khajali
Lee Benson
Labatt Family Heart Center, Hospital for Sick Children, Toronto General Hospital, University of Toronto School of Medicine, ON, Canada (L.B., M.O.).
Mark Osten
Alban-Elouen Baruteau
Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PRECICARE, France (A.-E.B.).
Matthew A. Crystal
Congenital Interventional Catheterization, Columbia University Vagelos College of Physicians and Surgeons, Morgan Stanley Children’s Hospital of New York–Presbyterian, New York (M.A.C.).
Thomas J. Forbes
Joe DiMaggio Children’s Hospital, Hollywood, FL (T.J.F.).
Stanimir Georgiev
Department of Congenital Heart Diseases and Pediatric Cardiology, German Heart Center, Munich, Germany (S.G.).
Horst Sievert
CardioVascular Center Frankfurt, Germany (H.S.).
Do Nguyen Tin
Department of Pediatrics, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam (T.D.N.).
Daniel Springmuller
Departamento de Cardiología Pediátrica, División de Pediatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Unidad de Cardiopatías Congénitas del Adulto, Instituto Nacional del Tórax, Santiago, Chile (D.S.).
Anand Subramanian
Pediatric Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences, Bangalore, India (A.S.).
Hussein A.M. Abdullah
Ibn- Albitar Center for Cardiac Surgery, Baghdad, Iraq (H.A.M.A.).
Radwa Bedair
Adult Congenital Cardiology, Bristol Heart Institute, UK (R.B.).
Francisco Chamié
INTERCAT–Interventional Cardiology, Rio de Janeiro, Brazil (F.C.).
Ahmet Celebi
Department of Pediatric Cardiology, Dr Siyami Ersek Hospital for Cardiology and Cardiovascular Surgery, Istanbul, Turkey (A.C.).
Jesus Damsky Barbosa
Cardiology and Hemodynamics, Pedro de Elizalde Children’s Hospital, Buenos Aires, Argentina (J.D.B.).
Pieter De Meester
University Hospitals Leuven, Leuven, Belgium
Luca Giugno
IRCCS Policlinico San Donato, Milano, Italy (L.G.).
Zakaria Jalal
Department of Pediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, France (Z.J.).
Clement Karsenty
Pediatric and Congenital Cardiology, Children’s Hospital CHU Toulouse, Institut des Maladies Métaboliques et Cardiovasculaires, Université de Toulouse, Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Clinique Pasteur, France (C.K.).
Anastasia Schleiger
Gregory Fleming
Division of Pediatric Cardiology, Duke University Medical Center, Durham, NC (G.F.).
Andre Jakob
Department of Paediatric Cardiology and Paediatric Intensive Care, University Hospital, LMU Munich, Germany (A.J.).
Tevfik Karagoaz
Department of Pediatric Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey (T.K.).
Gur Mainzer
Pediatric Cardiology Department, Hadassah Medical Center, Jerusalem, Israel (G.M.).
Gareth J. Morgan
Nazmi Narin
Shabana Shahanavaz
Department of Pediatrics Heart Institute, Cincinnati Children’s Hospital, University of Cincinnati College of Medicine, OH (S.S.).
Zachary L. Steinberg
Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle (Z.L.S.).
Osamah Aldoss
Division of Pediatric Cardiology, Stead Family Children’s Hospital, University of Iowa, Iowa City (O. Aldoss).
Elnur Alizade
Kosuyolu Heart, Research and Education Hospital, Department of Cardiology, Istanbul, Turkey (E.A.).
Oliver Aregullin
Congenital Cardiology, Congenital Heart Center, Spectrum Health Helen DeVos Children’s Hospital, Grand Rapids, MI (O. Aregullin).
Hélène Bouvaist
Service de Cardiologie–CHU Grenoble Alpes, France (H.B.).
Thilo Fleck
Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg–Bad Krozingen, Medical Center, University of Freiburg, Germany (T.F.).
François Godart
Sophie Malekzadeh-Milani
Paulo Motta
Interventional Cardiology, Home Hospital, Brasilia, Brazil (P.M.).
Ángel Sánchez-Recalde
Cardiology Department, University Hospital Ramón y Cajal, Madrid
Juan Pablo Sandoval
Imaging and Intervention in Congenital and Structural Heart Disease, Ignacio Chavez National Institute of Cardiology, Mexico City, Mexico (J.P.S.).
Weiyi Tan
Department of Chemistry
John Thomson
UES, a BlueHalo Company
Pablo Tomé Teixeirense
Hospital Fornecedores de Cana de Piracicaba, São Paulo, Brazil (P. Tome).
Evan M. Zahn
Department of Pediatrics, The Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (E.M.Z.).