McLennan Daniel I, Maldonado Jennifer R, Foerster Susan R, Handler Stephanie S, LaDisa John F, Gudausky Todd M, Guillory Roger J
Department of Pediatrics-Division of Cardiology, Herma Heart Institute, Children's Wisconsin and the Medical College of Wisconsin, Milwaukee, WI, United States.
Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, United States.
Front Cardiovasc Med. 2024 Jul 26;11:1410305. doi: 10.3389/fcvm.2024.1410305. eCollection 2024.
The past five years have yielded impressive advancements in fully absorbable metal stent technology. The desired ultimate ability for such devices to treat a vascular stenosis without long-term device-related complications or impeding future treatment continues to evoke excitement in clinicians and engineers alike. Nowhere is the need for fully absorbable metal stents greater than in patients experiencing vascular anomalies associated with congenital heart disease (CHD). Perhaps not surprisingly, commercially available absorbable metal stents have been implanted in pediatric cardiology patients with conditions ranging from pulmonary artery and vein stenosis to coarctation of the aorta and conduit/shunt reconstructions. Despite frequent short term procedural success, device performance has missed the mark with the commercially available devices not achieving degradation benchmarks for given applications. In this review we first provide a general overview detailing the theory of absorbable metal stents, and then review recent clinical use in CHD patients since the release of current-generation absorbable metal stents around 2019. We also discuss the challenges and our center's experience associated with the use of absorbable metal stents in this pediatric population. Lastly, we present potential directions for future engineering endeavors to mitigate existing challenges.
在完全可吸收金属支架技术方面,过去五年取得了令人瞩目的进展。这类装置能够治疗血管狭窄,且不会引发长期的与装置相关的并发症,也不妨碍未来的治疗,这种理想的终极能力持续激发着临床医生和工程师的兴趣。对于患有与先天性心脏病(CHD)相关血管异常的患者而言,对完全可吸收金属支架的需求最为迫切。也许并不令人惊讶的是,市售的可吸收金属支架已被植入患有各种病症的儿科心脏病患者体内,这些病症包括肺动脉和静脉狭窄、主动脉缩窄以及导管/分流重建。尽管短期手术成功率颇高,但市售装置的性能却未达预期,未能实现特定应用的降解基准。在本综述中,我们首先详细概述可吸收金属支架的理论,然后回顾自2019年左右新一代可吸收金属支架问世以来,其在CHD患者中的近期临床应用情况。我们还将讨论在这一儿科人群中使用可吸收金属支架所面临的挑战以及我们中心的经验。最后,我们提出未来工程努力的潜在方向,以应对现有挑战。