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Butera G, Piccinelli E, Kolesnik A, Averin K, Seaman C, Castaldi B, Cuppini E, Fraisse A, Bautista-Rodriguez C, Hascoet S, D'Amore C, Baruteau AE, Blasco PB, Bianco L, Eicken A, Jones M, Kuo JA, Rajszys GB. Implantation of atrial flow regulator devices in patients with congenital heart disease and children with severe pulmonary hypertension or cardiomyopathy-an international multicenter case series. Front Cardiovasc Med 2024; 10:1332395. [PMID: 38288053 PMCID: PMC10822980 DOI: 10.3389/fcvm.2023.1332395] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/22/2023] [Indexed: 01/31/2024] Open
Abstract
Background The Occlutech Atrial Flow Regulator (AFR) is a self-expandable double-disc nitinol device with a central fenestration. Its use has been approved in the adult population with heart failure and described for pulmonary hypertension (PH). Only case reports and small series have been published about its use in the paediatric population and for congenital heart disease (CHD). Objectives The authors sought to investigate the feasibility, safety, and short-term follow-up of AFR implantation in patients with CHD or children with PH or cardiomyopathy. Methods This is a multicenter retrospective study involving 10 centers worldwide. Patients of any age with CHD or patients aged < 18 years with PH or cardiomyopathy needing AFR implantation were included. Results A total of 40 patients underwent AFR implantation. The median age of the population at the time of the procedure was 58.5 months (IQR: 31.5-142.5) and the median weight was 17 kg (IQR: 10-46). A total of 26 (65.0%) patients had CHD, nine (22.5%) children, a cardiomyopathy, and five (12.5%), a structurally normal heart. The implantation success rate was 100%. There were two early and one late device thrombosis. Two patients (5.0%) with dilated cardiomyopathy on extracorporeal membrane oxygenator (ECMO) died during the hospital stay. At a median follow-up of 330 days (IQR: 125-593), 37 (92.5%) patients were alive. At follow-up, 20 patients improved their New York Heart Association (NYHA) class, 12 patients did not change their NYHA class, and one patient with idiopathic PH worsened. Conclusions AFR implantation in patients with CHD and children with severe PH or cardiomyopathy is promising and seems to have beneficial effects at short-term follow-up.
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Affiliation(s)
- Gianfranco Butera
- Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART, Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy
| | - Enrico Piccinelli
- Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART, Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - Adam Kolesnik
- Cardiovascular Interventions Laboratory, The Children’s Memorial Health Institute, Varsavia, Poland
| | - Kostantin Averin
- Division of Cardiology, Department of Pediatrics, Stollery Children’s Hospital, Edmonton, AB, Canada
| | - Cameron Seaman
- Division of Cardiology, Department of Pediatrics, Stollery Children’s Hospital, Edmonton, AB, Canada
| | - Biagio Castaldi
- Pediatric Cardiology Department, Padova University, Padova, Italy
| | - Elena Cuppini
- Pediatric Cardiology Department, Padova University, Padova, Italy
| | - Alain Fraisse
- Pediatric Cardiology Department, Royal Brompton Hospital, London, United Kingdom
| | | | - Sebastien Hascoet
- Pediatric Cardiology Department, Royal Brompton Hospital, London, United Kingdom
| | - Carmen D'Amore
- Epidemiology, Clinical Pathways and Clinical Risk Unit, Medical Direction, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Alban-Elouen Baruteau
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PreciCare, Nantes, France
| | - Pedro Betrián Blasco
- Pediatric Interventional Cardiology Unit, Vall d'Hebron Hospital, Barcellona, Spain
| | - Lisa Bianco
- Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART, Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy
- Pediatric Interventional Cardiology Unit, Vall d'Hebron Hospital, Barcellona, Spain
| | - Andreas Eicken
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München, München, Germany
| | - Matthew Jones
- Department of Paediatric Cardiology and Adults with Congenital Heart Diseases, Evelina Children’s Hospital, London, United Kingdom
| | - James A. Kuo
- Division of Cardiology, Children’s Healthcare of Atlanta, Atlanta, GA, United States
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