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Rebonato M, Pilati M, Milani SM, Bonnet D, Pascall E, Jones M, Betrian P, Bianco L, Lucron H, Hascoet S, Baruteau AE, Giugno L, Butera G. BeGraft Aortic Stents: A European Multi-Centre Experience Reporting Acute Safety and Efficacy Outcomes for the Treatment of Vessel Stenosis in Congenital Heart Diseases. J Cardiovasc Dev Dis 2024; 11:192. [PMID: 39057614 PMCID: PMC11276682 DOI: 10.3390/jcdd11070192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/18/2024] [Accepted: 06/18/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Stent implantation has become the preferred method of treatment for treating vessel stenosis in congenital heart diseases. The availability of covered stents may decrease complications and have an important role in the management of patients with complex anatomy. AIM This study aims to evaluate the feasibility and safety of the pre-mounted cobalt-chromium stent-graft-covered ePTFE Aortic BeGraft in a broad spectrum of vascular lesions. METHODS This is a multicenter retrospective results analysis of 107 implanted BeGraft stents between 2016 and 2022 in six different European centers. RESULTS One hundred and four patients with a mean age of thirteen years (range 1-70 years) and with the body weight of 56.5 kg (range 11-115 kg) underwent the BeGraft stent implantation. Stents were implanted in the following conditions: aortic coarctation (74 patients), RVOT dysfunction (12 patients), Fontan circulation (7 patients), and miscellaneous (11 subjects with complex CHD). All the stents were implanted successfully. The median stent diameter was 16 mm (range 7-24 mm), and the median length was 39 mm (range 19-49 mm). Major complications occurred in five subjects (4.7%). During a median follow-up of fourteen (1-70) months, stents' re-dilatation was performed in five patients. CONCLUSIONS The BeGraft stent can be used safely and effectively in a wide spectrum of congenital heart diseases. Whether these good results will be stable in the longer term still needs to be investigated in a follow-up given its recent introduction into clinical practice, in particular regarding stent fracture or neointimal proliferation.
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Affiliation(s)
- Micol Rebonato
- Department of Pediatric Cardiology, Cardiac Surgery and Heart Lung Transplantation, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.P.); (G.B.)
| | - Mara Pilati
- Department of Pediatric Cardiology, Cardiac Surgery and Heart Lung Transplantation, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.P.); (G.B.)
| | - Sophie Malekzadeh Milani
- Centre de Référence Malformations Cardiaques Congénitales Complexes—M3C, Hôpital Universitaire Necker Enfants Malades, F-75015 Paris, France; (S.M.M.); (D.B.)
| | - Damien Bonnet
- Centre de Référence Malformations Cardiaques Congénitales Complexes—M3C, Hôpital Universitaire Necker Enfants Malades, F-75015 Paris, France; (S.M.M.); (D.B.)
| | - Emma Pascall
- Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK; (E.P.); (M.J.)
| | - Matthew Jones
- Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK; (E.P.); (M.J.)
| | - Pedro Betrian
- Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (P.B.); (L.B.)
| | - Lisa Bianco
- Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (P.B.); (L.B.)
| | - Hugues Lucron
- Hôpital Marie-Lannelongue, F-92350 Le Plessis-Robinson, France; (H.L.)
| | - Sebastien Hascoet
- Hôpital Marie-Lannelongue, F-92350 Le Plessis-Robinson, France; (H.L.)
- Groupe Hospitalier Paris Saint Joseph, F-75014 Paris, France
| | - Alban-Elouen Baruteau
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, CHU Nantes, Nantes Université, FHU PRECICARE, F-44000 Nantes, France;
- CIC FEA 1413, INSERM, CHU Nantes, Nantes Université, F-44000 Nantes, France
- L’Institut du Thorax, INSERM, CNRS, CHU Nantes, Nantes Université, F-44000 Nantes, France
- UMR 1280, PhAN, INRAE, Nantes Université, F-44000 Nantes, France
| | | | - Gianfranco Butera
- Department of Pediatric Cardiology, Cardiac Surgery and Heart Lung Transplantation, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.P.); (G.B.)
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Anderson B, Justo R, Ward C. Early Experience With the Bentley BeGraft Aortic Stent for the Management of Aortic Arch Pathology in the Paediatric Population. Heart Lung Circ 2023:S1443-9506(23)00145-2. [PMID: 37072280 DOI: 10.1016/j.hlc.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 01/08/2023] [Accepted: 03/14/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Aortic arch pathology in older children is often treated preferentially with stenting. Both bare metal and covered stents have been utilised, with potential advantages of covered stents. The search for the ideal covered stent continues. METHODS Retrospective review of all paediatric patients undergoing treatment of aortic arch pathology utilising the Bentley BeGraft Aortic stent (BeGraft Aortic, Bentley InnoMed, Hechingen, Germany) from June 2017 to May 2021. Outcome measures were procedural success, complications, medium-term patency and need for re-intervention. RESULTS Fourteen (14) stents were placed in 12 children (seven males). Indications were coarctation of the aorta in 10 and aneurysm in two. Median age was 11.8 years (8.7-16.6 years) and median weight 42.5 kg (24.8-84 kg). Median coarctation narrowing of 4 mm (range 1-9 mm), improved to 11 mm (range 9-15 mm). The median coarctation gradient improved from 32 mmHg (range 11-42 mmHg) to 7 mmHg (range 0-14 mmHg). Both aneurysms were successfully occluded. There was no mortality or major morbidity. In one patient balloon rupture occurred requiring a second balloon for full inflation and one patient had a minor access site bleed. Follow-up median was 28 months (range 13-65 months). One patient underwent repeat balloon dilation for increased blood pressure gradient at 47 months post implant and a second patient additional stent insertion for a mid-stent aneurysm at 65 months. CONCLUSION The Bentley BeGraft Aortic stent can be safely deployed in children for the treatment of aortic arch pathology. Medium-term patency is acceptable. Longer term follow-up in larger series will be required to assess stent performance.
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Affiliation(s)
- Benjamin Anderson
- Queensland Paediatric Cardiac Service, Children's Health Queensland, Brisbane, Qld, Australia; Queensland Paediatric Cardiac Research group, Brisbane, Qld, Australia; University of Queensland, School of Medicine, Brisbane, Qld, Australia.
| | - Robert Justo
- Queensland Paediatric Cardiac Service, Children's Health Queensland, Brisbane, Qld, Australia; Queensland Paediatric Cardiac Research group, Brisbane, Qld, Australia; University of Queensland, School of Medicine, Brisbane, Qld, Australia
| | - Cameron Ward
- Queensland Paediatric Cardiac Service, Children's Health Queensland, Brisbane, Qld, Australia; Queensland Paediatric Cardiac Research group, Brisbane, Qld, Australia; University of Queensland, School of Medicine, Brisbane, Qld, Australia
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Early outcomes of the treatment of aortic coarctation with BeGraft aortic stent in children and young adults. Cardiol Young 2023; 33:354-361. [PMID: 36259152 DOI: 10.1017/s1047951122003237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We report our experience and early outcomes of using the BeGraft aortic stent in children, adolescents, and young adults. BeGraft aortic stent (Bentley InnoMed, Hechingen, Germany) requires a smaller long sheath compared to other covered stents, and it has a low profile and adequate radial power. With these features, it can overcome some limitations in the treatment of coarctation, especially in children. This is a single centre retrospective analysis of 11 implanted BeGraft aortic stents in coarctation of the aorta between July 2020 and November 2021. The eleven stents were successfully implanted in 11 patients (10 males). The median age of the patients was 13.7 years (interquartile range 12-16 years), and the median weight was 43 kg (interquartile range 35-62 kg). In five patients, after the stents were opened completely by the first balloon, they were exchanged with a Z-MED II™ balloon, 1-3 mm larger in diameter, and the stents were redilated. The median catheter-derived systolic peak-to-peak pressure gradient was 23 mm Hg (interquartile range 16-37 mmHg) before the procedure and 3 mm Hg (interquartile range 1-5 mm Hg) after the procedure. Except for the partial femoral artery thrombosis in two patients, no other procedural complications were observed in our study. The median follow-up duration was 5 months (interquartile range 2-12 months). During follow-up, only one patient (9%) had stent narrowing that required dilation. Our initial results and short-term follow-up showed that the BeGraft aortic stent implantation and redilation can be performed effectively, safely, and successfully in the treatment of coarctation of the aorta.
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Sagar P, Puthiyedath T, Sivakumar K. First-in-man use of an Indian-made balloon-expandable covered Zephyr stent and intermediate-term follow-up. Ann Pediatr Cardiol 2023; 16:48-51. [PMID: 37287848 PMCID: PMC10243650 DOI: 10.4103/apc.apc_122_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/15/2022] [Accepted: 01/10/2023] [Indexed: 06/09/2023] Open
Abstract
Covered stent is used in large-vessel angioplasty in anticipation of vessel wall injury. Apart from aortic coarctation, they are also used in dysfunctional right ventricular outflow conduits and find a recent role in transcatheter sinus venosus defect closure. Different methods of covering stents include glue fixation, sutureless lamination, sandwich, and sintering lamination. Covered Zephyr (Sahajanand laser technology limited, Gandhinagar, India) is a new Indian-made expanded polytetrafluoroethylene-covered balloon expandable cobalt-chromium stent. Its unique C and S links prevent foreshortening. We report the first-in-man use of this new stent in severe discrete postsubclavian coarctation of aorta and its short-term follow-up imaging.
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Affiliation(s)
- Pramod Sagar
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Thejaswi Puthiyedath
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Kothandam Sivakumar
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
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Hanazuka T, Sakata T, Ueda H, Watanabe M, Matsumiya G. Late open conversion after endovascular treatment for the coarctation of aorta in adult due to restenosis with thrombus. J Vasc Surg Cases Innov Tech 2022; 8:338-344. [PMID: 35812122 PMCID: PMC9263744 DOI: 10.1016/j.jvscit.2022.04.008] [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: 01/26/2022] [Accepted: 04/04/2022] [Indexed: 11/25/2022] Open
Abstract
A 22-year-old man was referred to our hospital for rib notching found on a radiograph and hypertension. Computed tomography revealed coarctation of the descending aortic isthmus. Because he refused open surgery, endovascular treatment was performed. The 2-year follow-up computed tomography scan showed infolding of the stent graft and thrombus formation. He had presented with intermittent claudication; therefore, graft interposition was performed. Endovascular surgery plays an important role in the treatment of coarctation of the aorta. However, insufficient dilatation can lead to restenosis accompanied by thrombus formation, and excess ballooning can cause aortic wall injury. Careful performance of the procedure and close postoperative follow-up are essential.
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Abstract
PURPOSE OF REVIEW Coarctation of the aorta remains a controversial topic with uncertainties in long-term outcomes. RECENT FINDINGS Recent advances in fetal imaging including echocardiography and MRI offer novel opportunities for better detection and prediction of the need for neonatal intervention.New imaging techniques are providing novel insights about the impact of arch geometry and size on flow dynamics and pressure gradients. The importance of arch size rather than shape for optimal hemodynamics has been identified. Long-term outcome data suggest a significant increase in mortality risk in coarctation patients beyond the third decade when compared with the general population. Hypertension is highly prevalent not only in adult patients following repair of coarctation but also in normotensive patients presenting with LV diastolic dysfunction and adverse remodelling, indicating that abnormal vascular properties are important. Patients with coarctation undergoing neonatal repair are at risk for adverse neurodevelopmental outcomes and patients could benefit from timely neurocognitive evaluation and intervention. SUMMARY Optimizing aortic arch size, prevention and aggressive treatment of hypertension and vascular stiffening are important to improve long-term outcomes.
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