Zartner Peter A, Neudorf Ulrich, Bierbach Benjamin, Hart Chris, Schneider Martin B
Department of Cardiology, German Paediatric Heart Centre, Sankt Augustin, Germany.
Department of Cardiology, University Essen, Essen, Germany.
Catheter Cardiovasc Interv. 2018 May 1;91(6):1119-1124. doi: 10.1002/ccd.27543. Epub 2018 Feb 22.
The use of conventional metal stents in infants is severely limited by subsequent somatic growth. The use of a breakable balloon expandable stent (BS) designed for initial implant at small diameters but with properties that allow unlimited dilation in line with growth has potential advantages in this patient group. This study reports our experience with this stent between 2010 and 2014. A total of 17 BS were implanted in 14 infants (mean age 4.8 months). All but one stent was placed into the aorta to treat coarctation.
All implantations were successful and initial gradients dropped from a mean of 25-6 mm Hg (range from 1-50 down to 0-24 mm Hg). Mean follow-up was 3.3 years (range 5 days to 7 years) with a total cumulative follow-up of 46.7 patient years. Stent redilation was performed a median of 2.5 times (range 0-5). Sixteen stents in 13 patients remain in place. Following redilation beyond 10 mm, circumferential integrity of the BS was lost in 10 patients. No further stent implantation or related surgery was necessary. A 3 mm dissection occurred in one patient after redilation.
The BS performed well in terms of relief of stenosis and could be successfully dilated during the phase of the infants' most rapid growth. Mild intimal proliferation occurred in some patients early after implantation. In the course of the stepwise redilations and growth adjustments, both, planned longitudinal and transverse fractures occurred without allowing a collapse of the stented area.
常规金属支架在婴儿中的应用受到后续身体生长的严重限制。一种可断裂的球囊扩张支架（BS），设计用于小直径初始植入，但具有能随生长无限扩张的特性，在该患者群体中具有潜在优势。本研究报告了我们在2010年至2014年间使用这种支架的经验。共对14名婴儿（平均年龄4.8个月）植入了17个BS。除一个支架外，所有支架均植入主动脉以治疗缩窄。
所有植入均成功，初始压力阶差从平均25 - 6 mmHg（范围从1 - 50降至0 - 24 mmHg）下降。平均随访3.3年（范围5天至7年），总累积随访时间为46.7患者年。支架再次扩张的中位数为2.5次（范围0 - 5次）。13名患者中的16个支架仍在位。在扩张至超过10 mm后，10名患者的BS圆周完整性丧失。无需进一步植入支架或进行相关手术。一名患者在再次扩张后发生了3 mm的夹层。
BS在缓解狭窄方面表现良好，并且在婴儿生长最快的阶段能够成功扩张。一些患者在植入后早期出现轻度内膜增生。在逐步再次扩张和生长调整过程中，计划中的纵向和横向骨折均发生，且未导致支架区域塌陷。
