Happel Christoph M, Zunzunegui Martínez Jose L, Del Cerro María Jesús, Schranz Dietmar, Khalil Markus, Ballesteros Fernando, Pardeiro César Abelleira, Bertram Harald, Beerbaum Philipp, Haas Nikolaus A
Pediatric Cardiology & Intensive Care Medicine, Department for Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Lower Saxony, Germany.
Unidad de Cardiología Infantil, Department for Pediatric Cardiology, Hospital Universitario Gregorio Marañón, Madrid, Madrid, Spain.
Cardiol Young. 2019 Jul;29(7):972-976. doi: 10.1017/S1047951119001264. Epub 2019 Jun 20.
Transcatheter implantation of pulmonary balloon-expandable stent-valves requires pre-stenting of the right ventricular outflow tract with large calibre stents. To increase awareness of the associated risks of this part of transcatheter pulmonary valve replacement therapy, we report potential fatal complications during the implantation of AndraStents® in the right ventricular outflow tract in six cases from five different European institutions and their management.
We present a retrospective case series analysis looking at the time period from 2013 to 2018. Of 127 AndraStents® implanted in the right ventricular outflow tract, in six patients, age from 13 to 71 years, a misconfiguration of the AndraStent® occurred forming a "diabolo"-configuration. During inflation of the balloon, the stent showed extreme "dog-boning", an expansion of the stent at both ends with the middle part remaining unexpanded. This led to rupture of the balloon and loss of manoeuvrability in four patients. Out of the total six cases, in four patients the stent was eventually expanded with high-pressure balloons, and in one case the stent was surgically retrieved. In one patient, in whom a percutaneous retrieval of the embolised stent was attempted, a fatal bleeding occurred.
Pre-stenting of the right ventricular outflow tract by AndraStents® can lead to misconfiguration of the stent with potentially fatal complications. Rescue strategies of misconfigured stents include stent inflation and placement with high pressure non-compliant balloons or surgical backup. Interventional retrieval measures of AndraStents® cannot be advised.
经导管植入肺动脉球囊扩张式支架瓣膜需要先用大口径支架对右心室流出道进行预支架植入。为提高对经导管肺动脉瓣置换治疗这一部分相关风险的认识，我们报告了来自欧洲五个不同机构的6例患者在右心室流出道植入安德拉支架（AndraStents®）过程中发生的潜在致命并发症及其处理情况。
我们进行了一项回顾性病例系列分析，观察时间为2013年至2018年。在127枚植入右心室流出道的安德拉支架中，6例患者（年龄13至71岁）的安德拉支架出现构型错误，形成了“空竹”构型。在球囊充气过程中，支架出现严重的“狗骨样”改变，即两端扩张而中间部分未扩张。这导致4例患者球囊破裂且失去操控性。在全部6例病例中，4例患者最终通过高压球囊使支架扩张，1例患者通过手术取出支架。在1例试图经皮取出栓塞支架的患者中发生了致命性出血。
使用安德拉支架对右心室流出道进行预支架植入可能导致支架构型错误并引发潜在致命并发症。对构型错误支架的挽救策略包括使用高压非顺应性球囊对支架进行扩张和放置，或手术备用。不建议对安德拉支架采取介入取出措施。
