The Use and Outcomes of Small, Medium and Large Premounted Stents in Pediatric and Congenital Heart Disease

Abstract

We sought to describe the use and outcomes of small, medium and large premounted stents in patients with congenital heart disease, including incidence of and risk factors for re-intervention and development of in-stent stenosis. Premounted stents offer several advantages over traditional manually crimped bare-metal stents, especially in small patients. There are no data describing the medium-term effectiveness and outcomes of premounted stents in congenital heart disease. We performed a single-center retrospective review of all small, medium and large premounted stents implanted over an 8-year period. Premounted stents were implanted in 71 vessels within 59 patients with a 97 % success rate. Regardless of implantation site, premounted stent implantation resulted in significant improvements in vessel size and pressure gradient (p < 0.0001). Over a median follow-up duration of 3.1 years [interquartile range (IQR) 1.3-5.2], 25 patients (43 %) required re-intervention (18 catheter based, 3 surgical and 4 hybrid) at a median time of 1.4 years (IQR 0.9-3.0) from implant. Factors associated with re-intervention included age ≤1.9 years [hazard ratio (HR) 2.4, p = 0.03], weight ≤11.5 kg (HR 2.5, p = 0.03) and bare-metal premounted stents compared to covered premounted stents (HR 4.2, p = 0.001). In-stent stenosis was diagnosed in 42 % of premounted stents which underwent follow-up angiography. No identified characteristics were associated with in-stent stenosis, including "oversizing" the premounted stent. Small, medium and large premounted stents are effective in treating vascular stenosis in congenital heart disease. Frequent follow-up is required, especially in smaller patients with expected somatic growth, and to evaluate for in-stent stenosis which occurs in nearly half of premounted stents.

Keywords: Congenital heart disease; Stent implantation; Stent restenosis.