Hascoët Sebastien, Jalal Zakaria, Baruteau Alban, Mauri Lucia, Chalard Aurélie, Bouzguenda Ivan, Piéchaud Jean-François, Thambo Jean-Benoit, Lefort Bruno, Guérin Patrice, Le Gloan Lauriane, Acar Philippe, Houeijeh Ali, Godart François, Fraisse Alain
Groupe de cathétérisme interventionnel pédiatrique et congénitale/filiale de cardiologie pédiatrique et congénitale de la société française de cardiologie, France; Paediatric and congenital cardiology, Children's Hospital, Paul-Sabatier University, M3C CHU de Toulouse, Toulouse, France; Inserm UMR 1048, équipe 8 - I2MC - institut des maladies métaboliques et cardiovasculaires, Paul-Sabatier University, Toulouse, France; Department of Cardiology, Rangueil Hospital, Paul-Sabatier University, CHU de Toulouse, Toulouse, France; M3C Marie-Lannelongue Hospital, paediatric and congenital cardiac surgery, Paris Sud University, Paris, France.
Groupe de cathétérisme interventionnel pédiatrique et congénitale/filiale de cardiologie pédiatrique et congénitale de la société française de cardiologie, France; Paediatric and congenital cardiology, Haut Lévêque Hospital, M3C CHU de Bordeaux, Bordeaux, France.
Arch Cardiovasc Dis. 2015 Dec;108(12):650-60. doi: 10.1016/j.acvd.2015.07.002. Epub 2015 Oct 1.
Many stents are used "off-label" during the management of congenital heart diseases (CHD).
To describe indications for, results of, and adverse events associated with stenting in CHD in current practice.
Participation in this study was proposed to all catheterization laboratories that specialize in CHD in France (M3C network). All paediatric and adult CHD cases with stent implantation in 2013 were included retrospectively.
Overall, 207 stents were implanted in 151 patients across 11 centres. Median age was 13.7 years (range, 5 days to 70.1 years). Main procedure indications were branch pulmonary artery angioplasty (n=46, 29.1%), aortic (re)coarctation stenting (n=43, 27.2%), percutaneous pulmonary valve implantation (n=32, 20.2%) and ductus arteriosus stenting (n=14, 8.9%). The main stents implanted were the CP Stent™ (n=61, 29.5%), the Max™ LD stent (n=43, 20.8%), the Valeo(®) stent (n=28, 13.5%) and valved stents (n=30, 14.5%). Procedures were considered successful in 96.8% of cases (95% confidence interval [CI] 92.8-99.0%). Adverse events were observed in 23 procedures (14.7%, 95% CI 9.5-21.0%). Ductus arteriosus stenting (odds ratio 12.4, 95% CI 2.0-77.5; P<0.01) and pulmonary revalvulation (odds ratio 5.9, 95% CI 1.1-32.3; P=0.04) were risk markers for stent-related adverse events.
Stents are used in various CHD catheterization procedures, from infancy to adult age. The adverse events rate is significant and is related to the type of procedure.
在先天性心脏病（CHD）的治疗过程中，许多支架的使用属于“非适应证”应用。
描述当前实践中CHD支架置入的适应证、结果及相关不良事件。
向法国所有专门从事CHD治疗的导管实验室（M3C网络）提议参与本研究。回顾性纳入2013年所有植入支架的儿科和成人CHD病例。
总体而言，11个中心的151例患者共植入207枚支架。中位年龄为13.7岁（范围5天至70.1岁）。主要手术适应证为分支肺动脉血管成形术（n = 46，29.1%）、主动脉（再）缩窄支架置入术（n = 43，27.2%）、经皮肺动脉瓣植入术（n = 32，20.2%）和动脉导管支架置入术（n = 14，8.9%）。植入的主要支架为CP Stent™（n = 61，29.5%）、Max™ LD支架（n = 43，20.8%）、Valeo(®)支架（n = 28，13.5%）和带瓣支架（n = 30，14.5%）。96.8%的病例手术被认为成功（95%置信区间[CI] 92.8 - 99.0%）。23例手术观察到不良事件（14.7%，95% CI 9.5 - 21.0%）。动脉导管支架置入术（优势比12.4，95% CI 2.0 - 77.5；P < 0.01）和肺动脉瓣置换术（优势比5.9，95% CI 1.1 - 32.3；P = 0.04）是支架相关不良事件的风险标志物。
从婴儿期到成年期，支架被用于各种CHD导管手术。不良事件发生率较高，且与手术类型有关。
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