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一种新的经美国食品药品监督管理局批准的用于先天性心脏病的支架:G-ARMOR 的首例人体试验经验。

A new FDA approved stent for congenital heart disease: First-in-man experiences with G-ARMOR.

机构信息

School of Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA.

出版信息

Catheter Cardiovasc Interv. 2022 Dec;100(7):1261-1266. doi: 10.1002/ccd.30447. Epub 2022 Nov 2.

Abstract

We present the first clinical experience with a new hybrid cell structure covered stent, designed for congenital heart disease applications. It represents a significant redesign of the Cheatham Platinum (CP) Stent (Numed Inc.), maintaining the traditional benefits of the covered CP whilst significantly decreasing shortening and allowing controlled flaring at the ends through its combination of larger and standard sized cells. We first implanted the stent in 2 patients with superior sinus venosus defects with anomalous drainage of the right upper and middle lobe pulmonary veins. The first was a 40 year male and the second a 36 year old female. The third case was a 60 year old patient with near atresia of the aorta, with pre and poststenotic aortic dilation. The clinical result in all cases was excellent with no obstruction to pulmonary venous return and no visible L-R shunt on the transthoracic echo on 24 h and 2 week follow-up for the patient with sinus venosus defects and uniform complete revascularization of the aorta without any vascular complications in the patient with coarctation. These are the first uses of this stent in human subjects. The design is specifically aimed toward procedures where stent shortening is undesirable. Hence, coarctation of the aorta as well as stent implantation in preparation for percutaneous pulmonary valve placement are obvious use areas, as well as the growing body of evidence supporting percutaneous treatment of sinus venosus defects.

摘要

我们介绍了一种新型杂交细胞结构覆盖支架的首次临床应用经验,该支架专为先天性心脏病应用而设计。它代表了 Cheatham Platinum(CP)支架的重大重新设计(Numed Inc.),在保持 CP 覆盖支架的传统优势的同时,显著减少了缩短,并通过其大尺寸和标准尺寸细胞的组合实现了可控的扩张。我们首次在 2 例上腔静脉窦缺损伴右上肺静脉和中肺静脉异常引流的患者中植入了该支架。第一个是 40 岁男性,第二个是 36 岁女性。第三个病例是 60 岁患者,主动脉近闭锁,伴有术前和术后主动脉扩张。所有病例的临床结果均非常出色,没有肺静脉回流受阻,上腔静脉窦缺损患者的经胸超声心动图在 24 小时和 2 周随访时未见明显左向右分流,主动脉完全均匀再血管化,没有狭窄患者出现任何血管并发症。这是这种支架首次在人体中应用。该设计特别针对支架缩短不理想的手术。因此,主动脉缩窄以及为经皮肺动脉瓣置入做准备的支架植入术是明显的适应证,此外,越来越多的证据支持经皮治疗上腔静脉窦缺损。

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