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Sun L, Li JJ, Xu YK, Xie YM, Wang SS, Zhang ZW. Initial status and 3-month results relating to the use of biodegradable nitride iron stents in children and the evaluation of right ventricular function. Front Cardiovasc Med 2022; 9:914370. [PMID: 35979021 PMCID: PMC9376250 DOI: 10.3389/fcvm.2022.914370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/05/2022] [Indexed: 11/15/2022] Open
Abstract
Background Pulmonary artery stenosis is often associated with congenital heart disease. The aim of the study was to evaluate the efficacy and safety of stenting for branch pulmonary artery stenosis using a biodegradable nitride iron stent (IBS® Angel™) and right ventricular systolic and diastolic function. Methods From July 2021 to February 2022, a total of 11 cases (ages ranged from 36 to 86 months old) were included in this pre and post-intervention, prospective, cohort and preclinical study. All cases underwent transthoracic echocardiographic (TTE), chest radiography, along with computed tomography (256-slice scanner, multiple-detector) and right heart catheterization. Different types of biodegradable nitride iron stents were implanted. TTE was performed serially 1 day, 1 month and 3 months after the procedure to evaluate the rate of restenosis and right ventricular function. Results Stenting was successful in 11 patients. There were no major adverse cardiovascular events related to the device or to the procedure. Blood perfusion in the branch pulmonary artery was improved immediately. At follow-up, there was no significant restenosis that required re-intervention. None of the patients suffered from in-stent thrombosis, vascular embolism, stent displacement or heart failure. Compared with normal values, there were statistical with regards to FAC, E/A and E′/A′. Furthermore, we found that TAPSE correlated significantly with pulsed Doppler S wave (p = 0.008) and left ventricular ejection fraction (p < 0.01). The early trans-tricuspid inflow velocities E/E′ (tissue doppler at the lateral tricuspid annulus) correlated significantly with E′/A′ (p = 0.009). FAC and E′/A′ were statistically different from those prior to stenting (p = 0.041 and p = 0.035) when tested one month postoperatively. At three months postoperatively, only E/A showed a statistical difference (p = 0.015). Conclusion Our analysis suggests that biodegradable nitride iron stents are feasible, safe, and effective in children. Some small improvements were observed in right ventricular systolic and diastolic function after successful transcatheter intervention, although change was not statistically significant due to the small sample number. (A clinical Trial to Evaluate the Safety and Efficacy of IBS Angel in Patients With Pulmonary Artery Stenosis (IRIS); NCT04973540).
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McGee OM, Geraghty S, Hughes C, Jamshidi P, Kenny DP, Attallah MM, Lally C. An investigation into patient-specific 3D printed titanium stents and the use of etching to overcome Selective Laser Melting design constraints. J Mech Behav Biomed Mater 2022; 134:105388. [DOI: 10.1016/j.jmbbm.2022.105388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 07/05/2022] [Accepted: 07/17/2022] [Indexed: 11/15/2022]
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Wright J, Nguyen A, D’Souza N, Forbess JM, Nugent A, Reddy SRV, Jaquiss R, Welch TR. Bioresorbable Stent to Manage Congenital Heart Defects in Children. MATERIALIA 2021; 16:101078. [PMID: 34109305 PMCID: PMC8184019 DOI: 10.1016/j.mtla.2021.101078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Intravascular stents for pediatric patients that degrade without inhibiting vessel growth remain a clinical challenge. Here, poly(L-lactide) fibers (DH-BDS) at two thicknesses, 250 μm and 300 μm, were assembled into large, pediatric-sized stents (Ø10 - Ø20 mm). Fibers were characterized mechanically and thermally, then stent mechanical properties were compared to metal controls, while mass loss and degradation kinetics modeling estimated total stent degradation time. Thicker fibers displayed lower stiffness (1969 ± 44 vs 2126 ± 37 MPa) and yield stress (117 ± 12 vs 137 ± 5 MPa) than thinner counterparts, but exhibited similar fail strength (478 ± 28 vs 476 ± 16 MPa) at higher strains (47 ± 2 vs 44 ± 2%). Stents all exhibited crystallinity between 51.3 - 54.4% and fiber glass transition temperatures of 88.6 ± 0.5 °C and 84.6 ± 0.5 °C were well above physiological ranges. Radial strength (0.31 ± 0.01 - 0.34 ± 0.02 N/mm) in thinner stents was similar to metal stents (0.24 - 0.41 N/mm) up to Ø14 mm with no foreshortening and thicker coils granted comparable radial strength (0.32 ± 0.02 - 0.34 ± 0.02 N/mm) in stents larger than Ø14 mm. Both 10 mm (1.17 ± 0.02 % and 0.86 ± 0.1 %) and 12 mm (1.1 ± 0.03% and 0.89 ± 0.1%) stents exhibited minimal weight loss over one year. Degradation kinetics models predicted full stent degradation within 2.8 - 4.5 years depending on thickness. DH-BDS exhibiting hoop strength similar to metal stents and demonstrating minimal degradation and strength loss over the first year before completely disappearing within 3 to 4.5 years show promise as a pediatric interventional alternative to current strategies.
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Affiliation(s)
- Jamie Wright
- Department of Cardiovascular Thoracic Surgery, University of Texas at Southwestern Medical Center of Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390-8879, USA
| | - Annie Nguyen
- Department of Cardiovascular Thoracic Surgery, University of Texas at Southwestern Medical Center of Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390-8879, USA
| | - Nandika D’Souza
- Department of Material Science, University of North Texas, 1155 Union Circle #310440, Denton, TX 76203-5017
| | - Joseph M. Forbess
- Department of Surgery, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore MD 21201
| | - Alan Nugent
- Department of Pediatrics, Northwestern University, Ann & Robert H. Lurie Children’s Hospital of Chicago Box 21, 225 E Chicago Avenue, Chicago IL 60611, USA
| | - Surendranath R. Veeram Reddy
- Department of Pediatrics, University of Texas at Southwestern Medical Center of DallasAc, 5323 Harry Hines Blvd, Dallas, TX 75390-9063, USA
| | - Robert Jaquiss
- Department of Cardiovascular Thoracic Surgery, University of Texas at Southwestern Medical Center of Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390-8879, USA
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Ma I, El Arid JM, Neville P, Soule N, Dion F, Poinsot J, Chantepie A, Lefort B. Long-term evolution of stents implanted in branch pulmonary arteries. Arch Cardiovasc Dis 2020; 114:33-40. [PMID: 32917562 DOI: 10.1016/j.acvd.2020.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 05/17/2020] [Accepted: 05/27/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Branch pulmonary artery stenosis complicates the management of congenital heart diseases. Surgical branch pulmonary artery angioplasty is associated with a high reintervention rate. As an alternative, percutaneous or intraoperative branch pulmonary artery stents have been implanted to improve efficiency, but long-term evaluations are limited. AIM To describe the long-term evolution of branch pulmonary artery stents. METHODS We conducted a retrospective cohort study at Tours University Hospital. All stents implanted by surgery or catheterization in branch pulmonary arteries with a minimum follow-up of 12 months and at least one catheterization control were included. The primary endpoint combined cardiovascular mortality, surgical or percutaneous reintervention for stent complication or new stent implantation. RESULTS Between 2007 and 2017, 76 stents in 51 patients were included (62 stents implanted by surgery, 14 by catheterization). At implantation, the patients' mean age and weight were 4.7years (interquartile range 4.2years) and 17.3kg (interquartile range 11.0kg), respectively. Mean branch pulmonary artery minimum diameter was 4.1±2.1mm (mean Z-score-4.9±2.9), and mean initial stent diameter was 9.1±3.1mm. During a follow-up of 5.3years (range 0-11.2 years), freedom from primary endpoint was 86.8% (95% confidence interval 79.6-94.8%) at 1 year, 71.5% (95% confidence interval 61.9-82.7%) at 5years and 69.6% (95% confidence interval 59.6-81.2%) at 10 years. We did not identify any factors associated with major adverse cardiovascular events. Among stents without major adverse cardiovascular events, the mean branch pulmonary artery diameter Z-score at last evaluation had increased by +4.8±3.2 compared with the initial diameter (P<0.001). After stent implantation, a median of 2 re-expansions were performed for each stent (range 0-7). CONCLUSIONS Stent implantation should offer a good long-term solution for branch pulmonary artery stenosis, although iterative re-expansions are required.
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Affiliation(s)
- Iris Ma
- Institut des Cardiopathies Congénitales de Tours, Centre Hospitalier Universitaire de Tours, 37044 Tours, France; Université François Rabelais, 37000 Tours, France
| | - Jean-Marc El Arid
- Institut des Cardiopathies Congénitales de Tours, Centre Hospitalier Universitaire de Tours, 37044 Tours, France
| | - Paul Neville
- Institut des Cardiopathies Congénitales de Tours, Centre Hospitalier Universitaire de Tours, 37044 Tours, France
| | - Nathalie Soule
- Institut des Cardiopathies Congénitales de Tours, Centre Hospitalier Universitaire de Tours, 37044 Tours, France
| | - Fanny Dion
- Institut des Cardiopathies Congénitales de Tours, Centre Hospitalier Universitaire de Tours, 37044 Tours, France
| | - Jacques Poinsot
- Institut des Cardiopathies Congénitales de Tours, Centre Hospitalier Universitaire de Tours, 37044 Tours, France
| | - Alain Chantepie
- Institut des Cardiopathies Congénitales de Tours, Centre Hospitalier Universitaire de Tours, 37044 Tours, France; Université François Rabelais, 37000 Tours, France
| | - Bruno Lefort
- Institut des Cardiopathies Congénitales de Tours, Centre Hospitalier Universitaire de Tours, 37044 Tours, France; Université François Rabelais, 37000 Tours, France; Inserm UMR 1069 (Nutrition, Croissance et Cancer), 37032 Tours, France.
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Shibbani K, De Lima E Silva Bagno L, Poulin MF, Matella T, Diab K, Kavinsky C, Ramesh N, Bhat V, Hijazi ZM, Kenny D. Preclinical comparative assessment of a dedicated pediatric poly-L-lactic-acid-based bioresorbable scaffold with a low-profile bare metal stent. Catheter Cardiovasc Interv 2020; 96:878-888. [PMID: 32294303 DOI: 10.1002/ccd.28893] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 03/19/2020] [Accepted: 03/25/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Polymer-based bioresorbable scaffolds (PBBS) have been assessed for coronary revascularization with mixed outcomes. Few studies have targeted pediatric-specific scaffolds. We sought to assess safety, efficacy, and short-term performance of a dedicated drug-free PBBS pediatric scaffold compared to a standard low-profile bare metal stent (BMS) in central and peripheral arteries of weaned piglets. METHODS Forty-two devices (22 Elixir poly-L-lactic-acid-based pediatric bioresorbable scaffolds [BRS] [6 × 18 mm] and 20 control BMS Cook Formula 418 [6 × 20 mm]) were implanted in the descending aorta and pulmonary arteries (PAs) of 14 female Yucatan piglets. Quantitative measurements were collected on the day of device deployment and 30 and 90 days postimplantation to compare device patency and integrity. RESULTS The BRS has a comparable safety profile to the BMS in the acute setting. Late lumen loss (LLL) and percent diameter stenosis (%DS) were not significantly different between BRS and BMS in the PA at 30 days. LLL and %DS were greater for BRS versus BMS in the aorta at 30 days postimplantation (LLL difference: 0.96 ± 0.26; %DS difference: 16.15 ± 4.51; p < .05). At 90 days, %DS in the aortic BRS was less, and PA BRS LLL was also less than BMS. Histomorphometric data showed greater intimal proliferation and area stenosis in the BRS at all time points and in all vessels. CONCLUSIONS A dedicated PBBS pediatric BRS has a favorable safety profile in the acute/subacute setting and demonstrates characteristics that are consistent with adult BRSs.
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Affiliation(s)
- Kamel Shibbani
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | | | | | | | - Karim Diab
- Rush University Medical Center, Chicago, Illinois, USA
| | | | | | - Vinayak Bhat
- Elixir Medical Corporation, Milpitas, California, USA
| | | | - Damien Kenny
- Children's Hospital Ireland at Crumlin, Dublin, Ireland
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Abstract
The quest for an ideal biodegradable stent for both adult coronary and pediatric congenital heart disease applications continues. Over the past few years, a lot of progress has been made toward development of a dedicated pediatric biodegradable stent that can be used for congenital heart disease applications. At present, there are no biodegradable stents available for use in congenital heart disease. In this article, the authors review the different biodegradable materials and their limitations and provide an overview of the current biodegradable stents being evaluated for congenital heart disease applications.
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Affiliation(s)
- Tre R Welch
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Alan W Nugent
- Division of Cardiology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 21, Chicago, IL 60611, USA
| | - Surendranath R Veeram Reddy
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Children's Health System of Texas, Childrens Medical Center, 1935 Medical District Drive, Dallas, TX 75235, USA.
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Kenny D. Interventional Cardiology for Congenital Heart Disease. Korean Circ J 2018; 48:350-364. [PMID: 29671282 PMCID: PMC5940641 DOI: 10.4070/kcj.2018.0064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 03/05/2018] [Indexed: 12/22/2022] Open
Abstract
Congenital heart interventions are now replacing surgical palliation and correction in an evolving number of congenital heart defects. Right ventricular outflow tract and ductus arteriosus stenting have demonstrated favorable outcomes compared to surgical systemic to pulmonary artery shunting, and it is likely surgical pulmonary valve replacement will become an uncommon procedure within the next decade, mirroring current practices in the treatment of atrial septal defects. Challenges remain, including the lack of device design focused on smaller infants and the inevitable consequences of somatic growth. Increasing parental and physician expectancy has inevitably lead to higher risk interventions on smaller infants and appreciation of the consequences of these interventions on departmental outcome data needs to be considered. Registry data evaluating congenital heart interventions remain less robust than surgical registries, leading to a lack of insight into the longer-term consequences of our interventions. Increasing collaboration with surgical colleagues has not been met with necessary development of dedicated equipment for hybrid interventions aimed at minimizing the longer-term consequences of scar to the heart. Therefore, great challenges remain to ensure children and adults with congenital heart disease continue to benefit from an exponential growth in minimally invasive interventions and technology. This can only be achieved through a concerted collaborative approach from physicians, industry, academia and regulatory bodies supporting great innovators to continue the philosophy of thinking beyond the limits that has been the foundation of our specialty for the past 50 years.
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Affiliation(s)
- Damien Kenny
- Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.
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Kenny DP, Hijazi ZM. Current Status and Future Potential of Transcatheter Interventions in Congenital Heart Disease. Circ Res 2017; 120:1015-1026. [DOI: 10.1161/circresaha.116.309185] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 12/10/2016] [Accepted: 12/12/2016] [Indexed: 02/03/2023]
Abstract
Percutaneous therapies for congenital heart disease have evolved rapidly in the past 3 decades. This has occurred despite limited investment from industry and support from regulatory bodies resulting in a lack of specific device development. Indeed, many devices remain off-label with a best-fit approach often required, spurning an innovative culture within the subspecialty, which had arguably laid the foundation for many of the current and evolving structural heart interventions. Challenges remain, not least encouraging device design focused on smaller infants and the inevitable consequences of somatic growth. Data collection tools are emerging but remain behind adult cardiology and cardiac surgery and leading to partial blindness as to the longer-term consequences of our interventions. Tail coating on the back of developments in other fields of adult intervention will soon fail to meet the expanding needs for more precise interventions and biological materials. Increasing collaboration with surgical colleagues will require development of dedicated equipment for hybrid interventions aimed at minimizing the longer-term consequences of scar to the heart. Therefore, great challenges remain to ensure that children and adults with congenital heart disease continue to benefit from an exponential growth in minimally invasive interventions and technology. This can only be achieved through a concerted collaborative approach from physicians, industry, academia, and regulatory bodies supporting great innovators to continue the philosophy of thinking beyond the limits that has been the foundation of our specialty for the past 50 years.
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Affiliation(s)
- Damien P. Kenny
- From the Our Lady’s Children’s Hospital, Crumlin, Dublin, Ireland; and Weill Cornell Medical College, Sidra Medical and Research Center, Doha, Qatar
| | - Ziyad M. Hijazi
- From the Our Lady’s Children’s Hospital, Crumlin, Dublin, Ireland; and Weill Cornell Medical College, Sidra Medical and Research Center, Doha, Qatar
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Abstract
Percutaneous closure of muscular ventricular septal defects has been well described and has not attracted the same controversy or scrutiny as perimembranous defect closure. Therefore, the development of specifically designed devices has been limited. We report the first use of the Occlutech® muscular ventricular septal defect device. Does its design add any significant benefit?
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Kenny DP, Hijazi ZM. COAST-ing Toward Covered Stents for Aortic Coarctation: Not All Plain Sailing! JACC Cardiovasc Interv 2016; 9:494-5. [PMID: 26896891 DOI: 10.1016/j.jcin.2015.12.266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/03/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Damien P Kenny
- Department of Cardiology, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland.
| | - Ziyad M Hijazi
- Sidra Cardiovascular Center of Excellence, Weill Cornell Medical College, Sidra Medical and Research Center, Doha, Qatar
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